Care Home: Striving For Independence Group

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What the care home does well Care plans are of good standard and provide staff with detailed information about the residents and the way they like to be supported. Care plans are reviewed internally and externally ensuring positive outcomes for people using the service. Risk assessments are detailed allowing residents to be as independent as possible without putting themselves into danger. The home is supporting residents to live an active and fulfilling life, by organising day trips, discos, barbeques, seasonal celebrations, etc. Regular house meetings allow residents to comment and take part in developments about the home and the service provided. Quality assurance systems are of very good standard; stakeholders are encouraged to take part in the process. Annual development systems focus on outcomes for people using the service. The expert used by the Commission for Social Care Inspection made very positive comments about the care, support and the home. These comments have been used throughout this report and have been highlighted. What has improved since the last inspection? The home has met all requirements made during the previous inspection and has now met all outcome groups. The overall quality rating has improved from good to excellent. Previously liquid medication was not signed once opened, this is now done and the risk of people being administered medication, which has expired, has reduced. Some areas of the home have been repainted and the environment has improved. The manager has re-organised staffing files, staff folders are now of good standard and all relevant documentation was available for inspection. The annual development plan has been updated and is now based on outcomes for service users. What the care home could do better: We made one requirement and a number of good practice recommendations during this inspection. The home has introduced a maintenance monitoring system, which if used regularly, should reduce the number of outstanding repair works as stated in this report. CARE HOME ADULTS 18-65 Striving For Independence Group 3 Pettsgrove Avenue Wembley Middlesex HA0 3AF Lead Inspector Andreas Schwarz Key Unannounced Inspection 1st August 2008 09:00 Striving For Independence Group DS0000017477.V366918.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 Striving For Independence Group DS0000017477.V366918.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. Striving For Independence Group DS0000017477.V366918.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Striving For Independence Group Address 3 Pettsgrove Avenue Wembley Middlesex HA0 3AF 020 8795 1586 020 8900 9633 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) Striving For Independence Group Homes Mr Otis Pinnock Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Striving For Independence Group DS0000017477.V366918.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 6 2nd August 2007 Date of last inspection Brief Description of the Service: Pettsgrove is one of three homes run by Striving for Independence, a family run organisation that provides care and accommodation for adults with a range of learning disabilities and challenging behaviours. Pettsgrove provides care for 6 adults of both genders. There is a self-contained day centre in the grounds, which is used by the homes residents as well as service users from other homes in the area. The house is detached and situated in a quiet residential road in Sudbury, close to local shops and transport to Harrow and Wembley. Accommodation is provided on two floors with single bedrooms and bathing and toilet facilities on each floor. There is a spacious lounge in the ground floor as well as large kitchen/ dining room and utility room. A well-kept garden is to the rear of the home. There is parking for up to 5 vehicles on the driveway as well as parking on the road. Fees and Charges can be obtained on request from the registered provider. Striving For Independence Group DS0000017477.V366918.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The outcomes for people using the service are excellent; this is a three star service. This unannounced key inspection took place on the 1st August 2008 and lasted the whole day. The registered manager and deputy manager were available during the best part of this key inspection. An Expert by Experience and his support worker accompanied us from 11:30am – 15:30pm. We asked the expert to find out how the home is run, whether there are enough staff on duty, are there enough activities for residents and could anything be improved in the home. The expert spoke with one person using the service during this inspection. We observed staff interacting and supporting residents. We sent out six resident and six staff surveys prior to this key inspection. Three residents and one staff survey has been returned to us. We looked at two care plans a sample of staffing records and other documents during this key inspection. The home returned a completed Annual Quality Assurance Assessment within the given timescale. We would like to take this opportunity thanking all involved in this unannounced key inspection. What the service does well: Care plans are of good standard and provide staff with detailed information about the residents and the way they like to be supported. Care plans are reviewed internally and externally ensuring positive outcomes for people using the service. Risk assessments are detailed allowing residents to be as independent as possible without putting themselves into danger. The home is supporting residents to live an active and fulfilling life, by organising day trips, discos, barbeques, seasonal celebrations, etc. Regular house meetings allow residents to comment and take part in developments about the home and the service provided. Quality assurance systems are of very good standard; stakeholders are encouraged to take part in the process. Annual development systems focus on outcomes for people using the service. The expert used by the Commission for Social Care Inspection made very positive comments about Striving For Independence Group DS0000017477.V366918.R01.S.doc Version 5.2 Page 6 the care, support and the home. These comments have been used throughout this report and have been highlighted. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Striving For Independence Group DS0000017477.V366918.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 Striving For Independence Group DS0000017477.V366918.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. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at National Minimum Standards 1 and 2 during this inspection. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home understands the importance of having sufficient information when choosing a care home. The home has developed a comprehensive statement of purpose and service user’s guide, which is very specific to the resident group. Admissions are not made to the home until a full needs assessment has been undertaken. EVIDENCE: This is what you told us in your Annual Quality Assurance Assessment: We undertake a comprehensive needs assessment before prospective residents decide if they want to visit the home. The home is providing detailed information to prospective people using the service. This information can be seen in the Statement of Purpose and Service Users Guide. We involve prospective people using the service in the assessment process. This is what we found during this key inspection: Striving For Independence Group DS0000017477.V366918.R01.S.doc Version 5.2 Page 9 We looked at the Statement of Purpose and Service Users Guide; both documents are available in a user-friendly format. People using the service receive the service users guide as part of their induction to the home. The document is compliant with National Minimum Standards. We informed the registered manager to review both documents and up date the Commission for Social Care Inspection new contacts details. The home admitted one person since the previous inspection. A detailed assessment was undertaken before the person moved in. The needs assessment is in different parts. Part one summary, which are personal details of the person. Part two introductions, which is looking at medical, family, personal history of the person. Part three backgrounds and part four proposed care service. The needs assessment sampled during this inspection provided good information about the persons behaviour, needs, likes and dislikes. The home involved staff of the person’s previous placement in the assessment process. Striving For Independence Group DS0000017477.V366918.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. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at National Minimum Standards 6, 7 and 9 during this inspection. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service involves individuals in the planning of care, which affects their lifestyle and quality of life. Care plans are person centred and are agreed with the individual. Plans are written in plain language, are easy to understand and look at all areas of the individual’s life. Each care plan includes a comprehensive risk assessment, which is reviewed regularly. The management of risk is positive in addressing safety issues while aiming for improved outcomes for people. EVIDENCE: This is what you told us in your Annual Quality Assurance Assessment: Striving For Independence Group DS0000017477.V366918.R01.S.doc Version 5.2 Page 11 We have a comprehensive Service User Plan, which consists of a Personal Planning Programme, Risk Assessments, Positive Behaviour Guidelines and a Personal Profile. These documents outline service users personal goals, wants, needs and expectations also the strategies and methods to address service users needs, agreements on any restrictions, strategies for managing risk and responses to changing needs and goals. This is what we found during this key inspection: We looked at two care plans during this key inspection one was from a person recently moving in and one from a person living in the home for a number of years. Both documents were of very good standard. Areas such as personal care needs, behavioural needs, cultural needs, and social needs are addressed in the care plan. Episodes of challenging behaviour are recorded in monitoring charts and information obtained is included in behaviour management plans. Care plans are reviewed annually and family members, social workers, key workers and registered manager take part in the review process. The manager told us that key workers and residents meet regularly to discuss progress and care plan objectives; this was confirmed by one of the key workers we have spoken to during this inspection. The key worker told us about a form, which she is using to record the key worker meetings and any progress is than recorded in the care plan. We checked petty cash and account balance sheets of two residents in Pettsgrove; both records were of good standard. People using the service have to contribute to the care cost; this is stipulated in the contract issued to residents. Residents finances are managed by the home and the registered person is acting as appointee for some of the people living at Pettsgrove. The expert told us that staff listen to people using the service the following statement was made: It was good to see staff listening to what residents wanted; I saw someone get up and tap the ice cream tub in the kitchen and a staff member asked if they wanted it and served them some; the resident seemed happy with this and it looked like something that usually happened this way. We have seen detailed risk assessments in both care plan folders assessed during this inspection. All risk assessments include a risk management plan for care staff. Staff told us that risk assessments are reviewed and updated during care plan review meetings or if risks have changed. Striving For Independence Group DS0000017477.V366918.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): We assessed National Minimum Standards 12, 13, 15, 16 and 17 during this key inspection People using 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 a strong commitment to enabling residents to develop or maintain their skills, including social, emotional, communication, and independent living skills. People who use the service have the opportunity to develop and maintain important personal and family relationships. Residents are involved in meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. Residents are involved in the domestic routines of the home. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. EVIDENCE: Striving For Independence Group DS0000017477.V366918.R01.S.doc Version 5.2 Page 13 This is what you told us in your Annual Quality Assurance Assessment: The home is providing a lifestyle for the service users, which fulfil their social, cultural, religious and recreational interests and needs. The home is supporting service users putting choice and control over their lives into action. The home is providing a well balanced diet. Residents are given help to maintain contacts with their families and friends. This is what we found during this key inspection: Three residents access day services provided by the local authority and three residents access a day service provided by Striving for Independence. The expert visited the Striving for Independence day service and made the following statement. “I saw residents colouring, doing puzzles and painting and there were different activities available on different days depending on what people could do and were interested in. There were good plans on the wall showing these activities in pictures, but the plans were very high up and difficult for the residents to see; it would be good if they could have their own copies handy.” The expert suggested laminated copies to be given to residents accessing the day centre. One resident told the expert that he is involved in household activities, shopping and knitting. The manager told us that he is in the process of reviewing the key working system and is currently developing guidance and procedures for key workers. The home has purchased the Change package, which is used to communicate with residents more clearly and allowing service users to make clearer choices. The home discussed and is planning to access local colleges for some of the clients living at the home. Residents living at Pettsgrove access the community regularly. The home is organising day trips during the summer holidays. Residents recently went to Brighton, which they have enjoyed. People’s participation to these outings is recorded in their daily records. One person recently admitted was going swimming while in the previous place, Pettsgrove is continuing with this activity on a weekly basis. Daily records show that residents go to café’s, Pubs and restaurants. Families are invited to attend review meetings. The home is organising regular parties, where family members and significant others are invited. During the day of this inspection the home was organising a disco party for the evening of this inspection. Staff explained to us that they invite residents from other Striving for Independence homes and people using the service can invite friends and/or family to these parties. The home is arranging the disco night Striving For Independence Group DS0000017477.V366918.R01.S.doc Version 5.2 Page 14 fortnightly. Staff told us that sexuality issues are discussed during review meetings. The expert asked one of the residents the following question. “I asked one residents if the staff were friendly he said “yes” and “yes” when I asked if it was a good house. He mentioned cooking, knitting and shopping as activities that he liked and seemed proud of his room as he showed us it. He had chosen his bedding and had many things in it that he wanted to show me and tell me about. We observed staff treating residents with respect. Bathrooms can be locked from the inside to maintain peoples privacy. Staff were interacting professionally and respectful with all residents during this key inspection. The home has a summer and winter menu in place. Menus are discussed during residents meetings, which are arranged monthly and records were available for inspection. Meals provided are varied, healthy and culturally appropriate meals such as curries, plantain, roasts are provided. Residents accessing external day services take a packed lunch. The home is providing two cooked meals each day. Meals are nicely prepared and all meals are home cooked. Residents are involved in cooking the meals. The expert told us, “Residents get involved in cooking and eat the cakes they make at mealtimes. Staff said they are involved in cooking meals in the home as well depending on their abilities and are involved in doing household tasks like the laundry and cleaning.” Another issued raised by the expert was the cramped condition in the dinning area and staff standing above residents when supporting them to eat. As supposed to sitting with them during meal times, which would create a more relaxed atmosphere. “The dining area, space is very cramped, so this would be very difficult for staff to sit together with residents and would need some working out, but I think it would help residents and staff to get on even better.” Striving For Independence Group DS0000017477.V366918.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We assessed National Minimum Standards 18, 19 and 20 during this key inspection. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each person centred plan Personal support is responsive to the varied and individual needs and preferences. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. The home respects and understands the rights of residents in the area of health care and medication EVIDENCE: This is what you told us in your Annual Quality Assurance Assessment: Our staff communicates effectively with residents. We provide service users with up to date information about relevant health care issues that concerns them. Key workers work with service users to ensure that they receive the Striving For Independence Group DS0000017477.V366918.R01.S.doc Version 5.2 Page 16 health care services to which they are entitled to. All decisions on medication are recorded on Medication Administration Sheets and/or health appointment sheet. All staff have received accredited medication training. This is what we found during this key inspection: The two care plans assessed during this key inspection provide clear guidance for staff how people using the service like to be supported with their personal care. Bathrooms and toilets can be locked from the inside ensuring peoples privacy. All residents at Pettsgrove are mobile and do not require any technical aids. Residents were nicely dressed and clothes were appropriate for the time of the year. Staff told us that three residents require minimal personal care support. Records showed that depending on the need of the person, clinicians such as psychiatrist, speech and language therapist, and psychologist are involved in the care of the individual. All residents have a designated key worker. Key workers meet monthly with residents to review care plan goals and assess any further support required. This is recorded in the key worker form and then in the care plan of the person. The home has very detailed health records, documenting outcomes and any required actions from these appointments. The General Practitioner monitor people’s health regularly. Residents visit dentists and opticians, with staff support, outcomes of these visits are clearly recorded in the persons file and follow up appointments are recorded in the diary. All residents are registered with a General Practitioner. The home has a detailed medication policy in place, which has been reviewed in April 2007. A local pharmacist is dispensing the medication. The home is recording medication received and disposed of. The Medication Administration Sheet had no gaps and all staff have received accredited medication training. We noted that Medication Administration Sheets had labels instead of handwritten or typed, explaining the name, dosage, route and frequency of medication administered to residents. We asked the homes manager to discuss with the pharmacist, as the Royal Pharmaceutical Society does not recommend this practice. Medication is stored safely and the key is kept with the shift leader. Striving For Independence Group DS0000017477.V366918.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We assessed National Minimum Standards 22 and 23 during this key inspection. People using the service experience good outcomes in the area. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that is clearly written and easy to understand. The complaints procedure is supplied to everyone living at the home and is displayed in a number of areas within the service. The policies and procedures for Safeguarding Adults are available and give clear specific guidance to those using them. EVIDENCE: This is what you told us in your Annual Quality Assurance Assessment: All residents receive a complaints policy in a user-friendly format. We have not received a complaint since the last key inspection. Staff have had all the checks to determine their fitness to work with vulnerable adults. Staff have received training in how to respond to suspected abuse. Staff have received challenging behaviour training. This is what we found during this key inspection: The home has a complaints policy in place, which is available in people’s rooms. The procedure is available in user-friendly format. The home did not Striving For Independence Group DS0000017477.V366918.R01.S.doc Version 5.2 Page 18 receive a complaint since the last key inspection. Staff spoken to tell us that they would record complaints and inform the manager about the complaint they have received. A family member made a safeguarding adult alert to the local authority. This has been dealt with and investigated according to the Safeguarding adult’s procedure the home has in place. The outcome of this investigation concluded that the home was not at fault. The home has put actions into place as stipulated in strategy meeting minutes received in March 2008. An additional 4 members of staff have attended Safeguarding adults training provided by Brent social services. In October 2008 staff most recently started will attend the Safeguarding adults training session. All of the three staff spoken to during this inspection were clear about whom and how to report Safeguarding adults allegation. The home is providing challenging behaviour training to staff enabling them to deal appropriate with residents if they challenge the service. We observed staff working with residents, while they presented challenging behaviour, which was seen as appropriate. Striving For Independence Group DS0000017477.V366918.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We assessed National Minimum Standards 24 and 30 during this inspection. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The home is a very pleasant, safe place to live the bedrooms and communal rooms meet the National Minimum Standards. The home is well lit, clean and tidy and smells fresh. The management has a good infection control policy in place, which is reviewed regularly. EVIDENCE: This is what you told us in your Annual Quality Assurance Assessment: The physical environment of the home and the day centre is constructed for the convenience and comfort of the service users. The buildings and grounds Striving For Independence Group DS0000017477.V366918.R01.S.doc Version 5.2 Page 20 are maintained to ensure that they are in safe condition. Toilets, washing and bathing facilities are suitable for the service users. Service users are encouraged to personalise their rooms. The laundry facilities are located away from the kitchen. Hand washing facilities are present where infected materials and clinical waste is handled. This is what we found during this inspection. Pettsgrove is a spacious building and accommodation is provided on both floors. All rooms are single occupancy and toilet facilities are available on both floors. People using the service have access to a large living room, which is nicely decorated and a well-maintained garden can be used during the summer. A small vegetable patch to grow tomatoes, potatoes, etc is used by people using the service. The expert assessed the building during this inspection and made the following recommendations to improve the property and the quality of life for the people living in it. “I saw several broken fittings around the home. Kitchen and day centre drawers that were broken. A screw sticking out of a broken fitting in the downstairs toilet. Broken slabs on the front drive that makes it uneven for people walking. Loose and broken pieces of walling in the back garden. The bin in the day centre toilet was rusty and had no bag in it; I think if someone fell against it they could really hurt themselves.” The manager told us that he is aware of some of the problems and is in the process of introducing a monthly monitoring form, which is looking at residents, issues around the building and Health and Safety. This would enable the home to respond quicker to any maintenance issues. The expert was invited in one of the resident’s rooms during this inspection and made the following comments. “When I asked one resident if it was a good house. He said that he liked and seemed proud of his room as he showed us it. He had chosen his bedding and had many things in it that he wanted to show me and tell me about.” The utility room is on the ground floor and can be accessed without taking soiled clothing through the kitchen. The home was clean and free of any Striving For Independence Group DS0000017477.V366918.R01.S.doc Version 5.2 Page 21 offensive odours. Policies regarding Food Safety, Infection control are in place and have bee reviewed in April 2007. Staff takes part in Health and Safety training during their induction. The home has a contract with a company to remove clinical waste. The washing machine was in good working order and can launder clothes above 65º Celsius. Striving For Independence Group DS0000017477.V366918.R01.S.doc Version 5.2 Page 22 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): We assessed National Minimum Standards 31, 34, 35 and 36 during this inspection. People using the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The recruitment of good quality carers is seen as integral to the delivery of an excellent service. The service is proactive rather than reactive in its staffing, recruitment and training. Management prioritise training and facilitate staff members to undertake external qualifications beyond basic requirements. The roles and responsibilities of staff are clearly defined and understood, based on accurate job descriptions and specifications. Induction training exceeds Skills for Care requirements and includes person centred planning and thinking. Staff meetings are used for consultation and training and staff. EVIDENCE: This is what you told us in your Annual Quality Assurance Assessment: Striving For Independence Group DS0000017477.V366918.R01.S.doc Version 5.2 Page 23 All staff have a clearly defined job description, which are linked to achieving service users goals. Staff have received role specific training and are aware of the General Social Care Councils Code of Conduct. We encourage all our staff to do National Vocational Qualification in Care and offer sponsorship. Staffing levels are consistent with service users assessed needs. Staff meeting take place monthly in-house and six monthly with all the employees of the company. We provide induction training for all new staff. This is what we found during this inspection: We looked at the homes rota; staffing levels are appropriate. Three members of staff work during the day. Two members of staff support residents during the morning and during the evening. Staff spoken to told us that they are happy with the staffing levels. We observed staff during this inspection, and staff did not seem rushed and spent enough time with the residents. The home has employed three new staff, which are currently in the process of achieving their National Vocational Qualification in Care. New staff is not working on their own and are supported by more experienced senior staff. The home has a shift leader programme in place, which teaches new staff shift leading responsibilities. Staff come from different backgrounds, which reflect the cultural and ethnic background of residents. The home employed one member of staff despite a slight disability and supported her in overcoming this. We spoke to four members of staff and assessed three staffing files. The home has a recruitment procedure in place, which has been followed. All staffing records were of good standard and required documentation such as references, Criminal Records Bureau checks, application forms, proof of identity were in place. Staff confirmed of having received a job descriptions and providing documentation for a Criminal Records Bureau clearance. We spoke to four members of staff, all staff informed us that they have done an induction. Some of the staff are still in the process of completing their induction. The induction lasts over twelve weeks and inductees meet weekly with their supervisor. Inductions are recorded. The home has seven staff employed all staff have or are currently in the process of achieving the National Vocational Qualification in Care. Staff have attended Manual Handling training, First Aid training, Health and Safety training, Safeguarding adults training, etc. Certificates and records are on file. All staff have a current and very detailed staff development plan in place. One member of staff told us that the home is arranging challenging behaviour training and specialist training can be requested. Striving For Independence Group DS0000017477.V366918.R01.S.doc Version 5.2 Page 24 New staff told us that they have had regular supervisions and records have been viewed during this inspection. We looked at supervision records of a member of staff working with the organisation for 1-½ years and records showed that she has received six supervisions and one annual appraisal. During the day of this inspection the home had a staff meeting, staff informed us that home organises these meetings monthly and every six month they organise a staff meeting with all employees of the organisation. Striving For Independence Group DS0000017477.V366918.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): Striving For Independence Group DS0000017477.V366918.R01.S.doc Version 5.2 Page 26 We looked at National Minimum Standards 37, 39 and 42. People using the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The registered manager has the required qualification and experience, is competent to run the home and meets its stated aims and objectives. The manager has sound knowledge of both strategic and financial planning. The manager is able to describe a clear vision of the home based on the organisation’s values and corporate priorities. The manager ensures that staff follow the policies and procedures. The Annual Quality Assurance Assessment contains excellent information that is fully supported by appropriate evidence. The data section of the Annual Quality Assurance Assessment is accurately and fully completed and supports evidence in the self-assessment section. The home works to a clear health and safety policy. All staff are aware of the policy and are trained to put theory into practice. Regular random checks take place to ensure they are working to it. EVIDENCE: This is what you told us in your Annual Quality Assurance Assessment: The Home has a formal quality system and there is evidence of continuous self-monitoring and assessment. The views of residents and stakeholders are obtained. Staff is consulted on the development and revising of policies and procedures. There are written policies and procedures on all safe working practices issues: - Moving and Handling, Fire Safety, Food Hygiene, First Aid and Infection Control. Risk assessments are carried out every year. Managers and staff carry out regular checks on all aspects of health and safety. The Annual Development Plan has been completed. This is what we found during this inspection: The registered manager informed us that the home is planning to change the current management structure. The registered manager will promote the deputy manager to be the Homes Manager, who will than be registered with the Commission for Social Care Inspection. The registered manager will continue working for the organisation, but in a different capacity. Staff spoken to was very positive about the support they receive from the registered and Striving For Independence Group DS0000017477.V366918.R01.S.doc Version 5.2 Page 27 deputy manager. Staff made the following comments about the management, “she (Deputy Manager) is excellent”, “the manager is very helpful”, “ the management was very supportive when I started here”. We interviewed the deputy manager during this inspection, who told us that she enjoys the good team working and likes to develop and motivate staff. The deputy manager has qualifications in Care and is currently awaiting her certificate for the Registered Managers Award. The registered manager has a Masters in management. The home has undertaken stakeholder surveys and produced an annual development plan, which is of excellent quality. The annual development plan is based on the National Minimum Standards outcome groups and areas such as diversity, sexuality, activities, and management are addressed. The annual development plan is currently in draft format. The home is holding regular residents meetings, staff meetings and general staff meetings, to discuss individual as well as collective issues regarding the home, support, training, etc. The home has forwarded an Annual Quality Assurance Assessment, which was very informative. Information and evidence from the Annual Quality Assurance Assessment has been used throughout this report. The manager told us that he is introducing a monthly monitoring system, which is assessing care planning, Health and Safety and the environment. Families and relatives are invited regularly to parties and celebrations allowing them to comment about the service. We have received three service users surveys and one staff survey prior to this key inspection. The staff survey pointed out that the home has effective channels of communication in place, this was confirmed by all the staff spoken to and observations made by us during this key inspection. The home has a wide range of Health and Safety policies in place, the polices have been reviewed in April 2007. We sampled the Landlords Gas Safety Certificate, which has been renewed in December 2007. Other information was obtained from the Annual Quality Assurance Assessment, which evidenced that all certificates are up to date. The home has a fire risk assessment, which has been reviewed. Fire equipment has been serviced in February 2008 and fire evacuations are done monthly. Staff receives Health and Safety training during their induction and all staff was able to tell us where the policy folder is kept and that the manager discussed relevant policies during induction. Striving For Independence Group DS0000017477.V366918.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 4 32 X 33 X 34 3 35 4 36 3 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 3 14 X 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 X 4 X X 3 X Striving For Independence Group DS0000017477.V366918.R01.S.doc Version 5.2 Page 29 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 23(2) Requirement The responsible person must ensure that maintenance issues raised by the expert are dealt with, ensuring the home is providing safe and comfortable accommodation for people using the service. Timescale for action 15/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA12 Good Practice Recommendations The home should provide a laminated copy of day service activities to each person accessing the Striving for Independence day service. The registered person should review the dinning area allowing staff sitting with residents while assisting them to eat. The registered person should inform with the dispensing pharmacist not to use labels on Medication Administration DS0000017477.V366918.R01.S.doc Version 5.2 Page 30 2. YA17 3. YA20 Striving For Independence Group Sheet, as the Royal Pharmaceutical Society does not recommend this. Striving For Independence Group DS0000017477.V366918.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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