Care Home: Therapia Road, 26

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What the care home does well The home focuses strongly on people`s choice and independence and uses imaginative ways for ensuring that people`s views are taken into account and that their personal wishes or goals are being met. Individuals are central to the planning of their care and staff have good information on how to meet each person`s needs. When needs change, the home is good at making sure the appropriate action is taken and involves other relevant healthcare professionals where necessary. Any changes in individual needs are acted upon and adjustments to their care and support are put in place. People at Therapia Road live fulfilling and active lives and enjoy a range of activities both within their home and the local community. The staff work hard to ensure that they understand the needs of the people they support and encourage individuals to achieve their personal ambitions. The staff group are skilled in communicating with people, and for those individuals with limited speech, great efforts have been made to document and to interpret their moods, gestures and expressions. The home also provides useful information for people in ways that they can understand. People are encouraged to see the home as their own and bedrooms reflect their individual personality and lifestyle in a unique way. The acting manager and staff show commitment and enthusiasm to run the home in the best interests of the people who live there. Good training and supervision systems support staff to do their jobs well. The staff have worked at the home for some time and know each person`s needs well. The home shows consistency in meeting with the National Minimum Standards and Regulations. Information from the AQAA also told us that the home has a good awareness of where it could improve and how it plans to develop its services over the next 12 months. What has improved since the last inspection? All areas that needed attention from the last inspection in May 2006 have been addressed. The home has improved upon its safeguarding practices. Staff have received training on recognising abuse and the safeguards which exist for people`s protection. This has included policy guidance on what action to take and how to refer any safeguarding concerns to the local social services department. Care planning has improved and reviews were being held more regularly. Plans were more individualised and included photographs, pictures and symbols that enable the person to fully participate in their plan of care. Records are now kept to show that staff have been employed correctly. Quality assurance systems have improved. A business plan has been developed that outlines the expected aims and outcomes for improving the services for the people in the home. People have been given questionnaires to seek their views about the home. The responsible individual from Odyssey has been visiting the home each month to check how well the home is running. There have been some home improvements with new leather sofas bought for the lounge and the kitchen has been refurbished. Odyssey has started to adapt some of their policies and procedures with pictures and photographs so that they are more accessible for people living in the home. As previously required, fire alarm checks were being carried out each week. What the care home could do better: Some areas of the home are in need of redecoration or repair. A planned maintenance and redecoration programme is needed to demonstrate how the premises are kept in a good state of repair and where any necessary and planned improvements are made to the upkeep of the building. Some of the bathroom facilities are in need of attention to ensure people`s safety and minimise the risk of scalding. Pipe work below a hand sink needs covering and the taps in the second floor bathroom need repair or replacement so that people can identify between the hot and cold water supply. To further ensure people`s safety and welfare, some further detail is needed concerning the management of their epilepsy. This is so that staff have clear instruction and an agreed timescale on when to seek assistance from the emergency services following an episode of prolonged or repeated seizures.As well as the Regulations and National Minimum Standards for Care Homes for Younger Adults, various guidance and information documents are available to service providers on our website. (www.csci.org.uk). CARE HOME ADULTS 18-65 Therapia Road, 26 East Dulwich London SE22 0SE Lead Inspector Claire Taylor Key Unannounced Inspection 12th June 2008 10:15 Therapia Road, 26 DS0000060225.V364231.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 Therapia Road, 26 DS0000060225.V364231.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. Therapia Road, 26 DS0000060225.V364231.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Therapia Road, 26 Address East Dulwich London SE22 0SE 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) 0208 693 3822 lu@odyssey-csft.org www.odyssey-csft.org Odyssey Care Solutions for Today Manager post vacant Care Home 5 Category(ies) of Learning disability (0), Physical disability (0), registration, with number Sensory impairment (0) of places Therapia Road, 26 DS0000060225.V364231.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th May 2006 Brief Description of the Service: The home is in a residential area of East Dulwich, close to public transport routes and local shops, cafes, pubs and a Post Office. The property is a large semi-detached house with a large garden and patio area to the rear of the house. The home provides care for five people with learning disabilities who have shared the home for many years. There were no vacancies at the time of the inspection. Fees were £1995 per week and were correct at the time of this inspection. More detailed information about the services provided can be found in the home’s Statement of Purpose and Service User Guide – copies of these can be obtained directly from the home. Therapia Road, 26 DS0000060225.V364231.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 stars. This means the people who use this service experience good quality outcomes. This unannounced visit lasted seven hours and the acting manager, George Hunt assisted with our inspection. Various records were looked at in relation to people’s care, staffing and the way the home was being run. Prior to the visit, the home returned its Annual Quality Assurance Assessment (AQAA) when we asked for it. This is a self-assessment that the provider (owner) must complete every year. It is used to tell the Commission about the services provided, how the home makes sure of good outcomes for the people using it and any planned developments. The completed AQAA provided us with good information about what the service does well and where it needs to improve. Some details from the AQAA are included in this report. This report makes reference to “Odyssey Care Solutions” who are the registered owning organisation. Towards the end of our visit, we met with the five people who live in the home and some of the other staff to ask their views about Therapia Road. All those who took part are thanked for their time and contribution to this inspection. What the service does well: The home focuses strongly on people’s choice and independence and uses imaginative ways for ensuring that people’s views are taken into account and that their personal wishes or goals are being met. Individuals are central to the planning of their care and staff have good information on how to meet each person’s needs. When needs change, the home is good at making sure the appropriate action is taken and involves other relevant healthcare professionals where necessary. Any changes in individual needs are acted upon and adjustments to their care and support are put in place. People at Therapia Road live fulfilling and active lives and enjoy a range of activities both within their home and the local community. The staff work hard to ensure that they understand the needs of the people they support and encourage individuals to achieve their personal ambitions. The staff group are skilled in communicating with people, and for those individuals with limited speech, great efforts have been made to document and to interpret their moods, gestures and expressions. The home also provides useful information for people in ways that they can understand. People are encouraged to see the home as their own and bedrooms reflect their individual personality and lifestyle in a unique way. The acting manager and staff show commitment and enthusiasm to run the home in the best interests of the people who live there. Good training and supervision systems support staff to do their jobs well. The staff have worked at the home for some time and know each person’s needs well. Therapia Road, 26 DS0000060225.V364231.R01.S.doc Version 5.2 Page 6 The home shows consistency in meeting with the National Minimum Standards and Regulations. Information from the AQAA also told us that the home has a good awareness of where it could improve and how it plans to develop its services over the next 12 months. What has improved since the last inspection? What they could do better: Some areas of the home are in need of redecoration or repair. A planned maintenance and redecoration programme is needed to demonstrate how the premises are kept in a good state of repair and where any necessary and planned improvements are made to the upkeep of the building. Some of the bathroom facilities are in need of attention to ensure people’s safety and minimise the risk of scalding. Pipe work below a hand sink needs covering and the taps in the second floor bathroom need repair or replacement so that people can identify between the hot and cold water supply. To further ensure people’s safety and welfare, some further detail is needed concerning the management of their epilepsy. This is so that staff have clear instruction and an agreed timescale on when to seek assistance from the emergency services following an episode of prolonged or repeated seizures. Therapia Road, 26 DS0000060225.V364231.R01.S.doc Version 5.2 Page 7 As well as the Regulations and National Minimum Standards for Care Homes for Younger Adults, various guidance and information documents are available to service providers on our website. (www.csci.org.uk). 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. Therapia Road, 26 DS0000060225.V364231.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Therapia Road, 26 DS0000060225.V364231.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 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. Good information is available about the home to help people make a choice about whether to live there. People are confident that the care home can support them. This is because good arrangements are in place for assessing people’s needs so that staff are aware of how to support them. EVIDENCE: The statement of purpose and service user guide had just been reviewed and updated in May of this year. They both contain lots of useful information and are written in a way that is meaningful and specific to the individual home and the group of people who live there. The home has used photographs, pictures and simple language to help people understand what rights they have at the home and what they can expect while living there. The same group of people have lived at Therapia Road for a number of years and there have been no new admissions. The organisation has procedures in place however on admissions and assessments. These ensure that any prospective person is central to the process and the service considers the needs assessment and the capacity of the home to meet a person’s needs. The manager advised that the home would also carry out its own needs assessment. We looked at the care records for three people and each file Therapia Road, 26 DS0000060225.V364231.R01.S.doc Version 5.2 Page 10 contained a needs assessment that was undertaken through care management arrangements in the local authority of Southwark. The assessment focuses on achieving positive outcomes for people and covers all aspects of a person’s life, including individual strengths, hobbies, social needs, dietary preferences, health and personal care needs. For equality and diversity, the AQAA said, “Our Communication Passports are individualised to suit the needs of each service user.” Records showed that the home considers the ethnic and diversity needs of each person such as their age, race and chosen religion. Therapia Road, 26 DS0000060225.V364231.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People 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. People’s needs and goals are met as the home has a plan of care that the person, or someone close to them, has been involved in making. Individuals are consulted and given opportunities to influence how the home is run. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. EVIDENCE: We looked at care records for three people who live in the home. Since our last inspection, the manager and staff team have created ‘Communication Passports’ for each person. These form part of an informative care plan that looks at all areas of the individual’s life in a person centred way. Each one included information about who and what is important to the person, how they keep safe, their goals and aspirations, their skills and abilities, and how they make choices in their life. The passport also guides staff on how to understand the person’s means of expression. I.e. communicating through body language, Therapia Road, 26 DS0000060225.V364231.R01.S.doc Version 5.2 Page 12 gestures or unique behaviours and temperaments. Plans were highly individualised and included photographs, pictures and symbols that enable the person to fully participate in their plan of care. Each individual’s preferred communication style was clearly recorded. Some people use Makaton signing and objects of reference and visual timetables are used for other individuals, one of who has a hearing impairment. These are used to improve the person’s recognition of daily routines and promote their independence in choice and decision-making. Staff have been trained to sign in Makaton so that they can support people’s communication needs more fully. We also saw detailed daily records that gave a sense of a person’s experience of their day. Discussion with the manager and staff showed that they clearly know each person’s unique needs, likes and dislikes. In response to our last inspection, reviews were being held at least six monthly and involve the person, their relative/ representative and Care Manager wherever possible. Reviews focus on asking what has worked for the individual, where there is progress, achievements, concerns and identifies action points. One member of staff was preparing for a review meeting during our visit. Records and discussion showed that staff support people to make decisions about their lives. Minutes of monthly meetings showed that people are consulted about what they want to do whatever their communication style. For example, picture cards and photographs are used to promote choice of activities, places to go and preferred meals. People are asked about the things that they like, what they want and how they want things to happen. At the most recent house meeting, one person requested to go to church and another to visit their family. All five people were asked about their holiday preferences. Each person has a key nominated staff and is provided with one to one time to go on activities of their choice. Plans included comprehensive risk assessments that matched the needs of each person and had been regularly reviewed. A risk assessment also tells the staff how to make sure that each person is kept safe from anything that might harm them. The process is managed positively to help people to lead the life they want. Plans show that action should be taken to lessen risk, whilst encouraging independence for people. Examples included use of the kitchen, travelling in the community, safety around the home and management of epilepsy for three individuals. Where there are limitations in a person’s best interests, the decisions had been made with the agreement of the individual or their representative. Examples included locking some bedroom doors. People were comfortable with the staff, and the team have clearly established positive and cooperative relationships with each individual. Therapia Road, 26 DS0000060225.V364231.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 People 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. People lead fulfilling lives as they are supported in the lifestyle they choose and have good links with the local community. Relationships with family and friends are well supported and daily routines ensure that people’s dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. EVIDENCE: Records related to lifestyle were seen for three people. Records showed that people have a varied and fulfilling programme and take part in leisure activities which are important to them. Most of the daily activities offered are through local day centres and community facilities. During the inspection, all five people were out at their respective day care services. The person centred plans had good information about what activities each person likes to take part in and how staff should support them. Individuals sign their plans in agreement Therapia Road, 26 DS0000060225.V364231.R01.S.doc Version 5.2 Page 14 and each have a planned activity timetable that is complemented with pictures and photographs. Examples seen included one person’s preferred hair salon and their favourite restaurant. One person enjoys creative art activities and uses an area in their bedroom to follow their hobby. Another person likes playing musical instruments and watching TV. People have an individual planned activity programme, which takes account of their preferences, interests, experiences, age and capabilities. These activities are regularly reviewed to ensure that they meet any changing needs. Activity plans are also flexible so that daily programmes can alter if individuals wish to do something different. People can access and enjoy their local community resources, such as using public transport, shops, pubs, and local leisure facilities. Activities include bowling, bingo, sailing, cinema, social clubs and visits to art galleries for one person. For one individual, the staff team have introduced a timetable of prepared and planned activities. Records showed that this has helped to ease the person’s anxiety, as they require routine and structure in their daily life. People’s preferences with regard to daily routine and how individuals spend their leisure time is respected. When people returned from their respective day care services, staff supported them with their preferred routines and interests. Individuals chose to watch television, listen to music and prepare themselves a drink or snack. Care records include details about each person’s social needs and who is important in their lives. Families are involved and the staff support people to visit and to keep contact with those that are close to them. Written feedback from one relative told us that the home always keeps them up to date with important issues. Individuals are able to spend time alone or in the company of others. Odyssey had begun some further work on assessing people’s social needs and preferences so that individuals have opportunities to meet new friends within the organisation and broaden their social networks. Staff had completed a ‘friendship profile’ with each person to look at their personal interests and hobbies in more detail. The aim is to support people to match up with others who have similar lifestyles. People are able to eat at flexible times according to their routines and social lives and are actively involved in cooking and meal preparation. We saw records to show that people are asked what they want to eat and that their food choices were included on the weekly menus. The menus reflected a healthy and varied diet. Again, picture cards and photographs are used to help people to make choices. Therapia Road, 26 DS0000060225.V364231.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): 18, 19 and 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. People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. The home’s medication systems are well organised to ensure safe, consistent treatment and support for each person. EVIDENCE: The personal care needs of each person were well documented and understood by all staff. Where support is required with personal physical care, this is identified and guidance is available on how specific tasks should be undertaken. Several people have specific goal plans to help them develop their personal care skills. Known as Training in Systematic Programmes (TSIs), these are designed to help people develop skills and become more independent. People are involved in all areas of daily living in the home and encouraged to be responsible for housekeeping tasks such as cooking, cleaning and laundry. We saw good information about people’s healthcare needs in their care plans. The manager plans to develop health action plan books for all five people living Therapia Road, 26 DS0000060225.V364231.R01.S.doc Version 5.2 Page 16 in the home. These will provide a more person centred profile of an individual’s healthcare needs and detail how they will be delivered. A copy of one such plan had been completed for one person. The AQAA too stated, “ To compile individual Health Action Plans.” People are supported to access routine health appointments and any other checks that they may need. This includes regular contact with GPs, Consultants and other health care professionals as necessary. For example, dentist, optician and physiotherapy services. Three individuals have epilepsy and the staff work in partnership with other healthcare professionals to enable each person to lead an active life as far as possible whilst managing their health condition. Literature about epilepsy is available in the home and staff have received training to enable them to fully support people with such specialist needs. Staff spoken to knew what action to take when a person experienced a seizure. Although there were guidelines for staff to follow concerning the management of each person’s epilepsy, some further detail is needed on how to deal with repeated episodes or prolonged seizures. This is so that staff have clear instruction and an agreed timescale on when to seek assistance from the emergency services. This will further ensure the person’s safety and welfare. People who live in the home do not have the capacity to manage their own medication. The home has a detailed policy however and would support a person should they wish to manage their own medication. Medication is reviewed at regular intervals and according to any changed needs. An appropriate healthcare professional reviews each person’s condition regularly to ensure that they receive the correct medication regime or treatment where necessary. Medication is supplied from a local chemist and records were accurate for the receipt, disposal and return of medication. The administration charts were signed and accounted for and records showed that all staff have been trained to administer medication. Some people are prescribed as required medication and the home has a policy to ensure that such medication is given appropriately. In addition, the reason for its use must be authorised by a manager. Domestic medication such as Paracetamol was not available in the home and it is suggested that the home considers the use of homely remedies for people who use the service. Homely remedies can be used to provide immediate relief for mild to moderate symptoms, for example to treat a headache. We suggest that the manager consults with the G.P. and develops a policy to cover the use of homely remedies. Therapia Road, 26 DS0000060225.V364231.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): 22 and 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. Arrangements for complaints and safeguarding people from abuse are well managed and ensure that each person feels listened to and safe. EVIDENCE: The complaints procedure is supplied to everyone living at the home and is displayed in a number of areas around the house. Individuals are provided with regular opportunities to voice their views or concerns. This is achieved through monthly house meetings and organised contact with their keyworkers each week. There is a complaints book and two complaints have been made since our last inspection. Records showed that both were investigated in line with the organisation’s policy and that the home and registered provider takes people’s views seriously. A suggested previously, records should show whether the complainant was satisfied with the outcome and actions taken. Plans for improvement on the AQAA said, “Odyssey to produce an ‘Easy Read’ policy to facilitate service user complaints in a form suited to their preferred communication method.” Records confirmed that staff are properly inducted on abuse awareness and there are policies and procedures for safeguarding adults that give clear specific guidance to those using them. In response to our last inspection, the manager and staff received training on safeguarding issues last year. Most people living in the home need support with their finances. We saw that accurate records are kept of all financial transactions and daily checks are made at each shift handover to ensure that these are correct. Personal Therapia Road, 26 DS0000060225.V364231.R01.S.doc Version 5.2 Page 18 expenditure sheets were sampled and balanced correctly with amounts held in the home. This means that the home safeguards people’s financial interests. Therapia Road, 26 DS0000060225.V364231.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): 24, 25, 26, 27 and 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. Overall the home is comfortably decorated and furnished although some redecoration work is needed so that people live in more welcoming and homely surroundings. People have their own bedrooms that have been designed and furnished to reflect the person’s individuality and meet their needs. Facilities are clean and generally safe for people to use although some improvements are needed in two of the bathrooms. EVIDENCE: People have been consulted and involved with arranging the décor in the home. There are many homely touches around the house such as individual artwork creations, photographs of family and friends, holidays and parties. Some new leather sofas have been purchased for the lounge and the kitchen has been refurbished. Some parts of the home would still benefit from further redecoration and the manager had acknowledged this on the AQAA. Plans for Therapia Road, 26 DS0000060225.V364231.R01.S.doc Version 5.2 Page 20 improvement said, “To improve the fabric of the house internally and repair/ replace various items i.e. carpets, furniture and internal decorations etc.” There is a varied choice of indoor entertainment for people to use including widescreen TV, DVD player, musical instruments, board games, puzzles and art and craft activities. Bedrooms clearly reflected each person’s individuality, interests, leisure needs and preferences. People have personalised their rooms how they like and been involved with choosing their room colour and furnishings. Individuals have their own TV, music systems and chosen possessions such as art creations, pottery and personal photographs that were meaningful to them. People said that they were happy with their bedrooms. The bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of the people who use the service. For example, there is a walk in shower facility for one person who has mobility needs. Some of the bathroom facilities are in need of attention however to ensure people’s safety and minimise the risk of scalding. In the first floor bathroom, the pipe work below the hand sink was exposed and on the second floor, the hot and cold indicators on the bath taps were missing. People must be able to identify between the hot and cold water supply. A repairs book is used to identify any areas within the premises that need attention. Despite this, both the manager and staff expressed some frustration in waiting for work to be completed. Records indicated that the owners deal with some maintenance issues in a reactive rather than a proactive manner. The manager advised that the home does not have a planned maintenance and redecoration programme. This must now be put in place so that people can be further assured how the organisation keeps the home in a good state of repair and makes any necessary improvements to the upkeep of the building. Aside from these issues, the premises appeared very clean and tidy. Good hygiene practices are observed and systems in place to control the risk of infection. A part time cleaner is employed and people living in the home are supported to join in with housekeeping tasks. Therapia Road, 26 DS0000060225.V364231.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 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. People are supported by a competent and skilled staff team who have worked in the home for some time. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their manager. EVIDENCE: We looked at staff rotas, which showed that the home is staffed efficiently, and the staffing structure is planned around people’s routines, lifestyles and assessed needs. There are always between two and three staff each day and staffing arrangements are flexible so that people are appropriately supported. For example, three staff are allocated on shift for a weekly activity such as bowling. There is a low turn over of staff, and people benefit from the consistency of a well-established staff team. Staff appeared motivated and keen to improve outcomes for the people who use the service. Regular staff team meetings are held; minutes were clear and focused on people’s needs as well as the day-to-day running of the home. Odyssey has good recruitment procedures which ensure that staff are vetted correctly before they begin work. Therapia Road, 26 DS0000060225.V364231.R01.S.doc Version 5.2 Page 22 This means that people using the service are protected from unsuitable workers. The main staff records are held centrally at the organisations head office in line with an agreement made with the Commission. In the home, a record is kept to evidence that appropriate recruitment checks have been carried out by Odyssey. We looked at the employment files for three staff and each contained all the necessary recruitment checks and required records. AQAA- “Locum staff have been fully integrated into staff training schedules to improve their knowledge and skills.” Records confirmed that the home easily meets the required standard for numbers of trained NVQ staff; six members have completed the level 2 qualification and two staff have also trained to level 3. Staff are provided with good support and the necessary training to meet people’s collective and individual needs. We saw an organisational training programme that provides a variety of courses for staff to update their skills and knowledge along with recognition of mandatory training that they must attend. Specialist training has been provided on epilepsy, person centred planning, communication, equality and diversity, autism, challenging behaviour and Makaton signing. Discussions with staff confirmed that they found training valuable and relevant to their work. Records showed that staff receive regular supervision with the manager or deputy as well as an annual appraisal of their work. These systems therefore support staff to do their jobs well and reflect upon their performance and practice. Therapia Road, 26 DS0000060225.V364231.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People 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. The acting manager has relevant qualifications and a good leadership approach to run the home in the best interests of the people who live there. People’s opinions are central to how the home develops and reviews its practice and there and good arrangements in place for monitoring the quality of care provided. The environment is safe for people and staff because health and safety practices are carried out. EVIDENCE: Since our last inspection, there has been a change of manager. George Hunt took over the running of the home in May 2007. He has many years experience in working with people who have learning disabilities and was previously employed as the manager in another one of Odyssey’s registered homes. The Therapia Road, 26 DS0000060225.V364231.R01.S.doc Version 5.2 Page 24 home manager confirmed that he has made an application to register with the Commission. Certificates confirmed that he successfully completed the required NVQ level 4 qualification in April of this year and has attended a variety of training courses relevant to his role. Discussion showed that he is knowledgeable about each person’s unique needs and understands the importance of person centred care and effective outcomes for people who use the service. The manager offers clear leadership, guidance and direction to staff. Staff spoken to had confidence in their manager and felt that the home was run well. We saw that there have been some improvements with the home’s quality assurance systems since our last visit in May 2006. We saw a corporate business plan that details the business arrangements for monitoring the performance and practice of the home. The manager also completes a regular achievement report to monitor how the home improves upon outcomes for people using the service. The responsible individual from Odyssey visits the home once a month and completes an audit of the service. Reports were detailed and showed that the owners make sure the conduct of the home is closely monitored. We saw some satisfaction questionnaires that were completed by people living in the home and their relatives. They included very positive comments about the staff and the lifestyle that people lead. Examples were “A well run home with the interest of the clients foremost.” And, “Always find the staff very helpful.” Odyssey had begun to adapt some of their policies and procedures with pictures and photographs so that they are more accessible for people living in the home. Mandatory training is provided by Odyssey and records showed that staff training is planned ahead so that they can update their skills and knowledge when needed. This includes training in health and safety, first aid; fire; moving and handling and infection control. The home has good systems in place that aim to promote the health, safety and welfare of the people using the service, staff and visitors. In addition, there is policy guidance for staff to follow regarding a range of health and safety activities. Records are maintained of all accidents and incidents at the home. As required by law, the service keeps us informed of any reportable events. We saw a detailed risk assessment that aims to safeguard the welfare of all people living and working in the home. It included information about maintaining a safe environment and working practices such as moving and handling, house security, use of hot water and storage of knives and sharps. There is a health and safety coordinator within the staff team. A regular check of the environment is carried out monthly to ensure that it remains safe. The completed AQAA stated that all relevant safety checks were up-to-date. We looked at some of the servicing and maintenance records for the home. Fire drills were being held regularly and alarms and equipment had been serviced. Fire procedures were available in pictorial form so that people using the service could understand them better. Key health and safety training for staff is held and planned so that staff update their skills and knowledge at appropriate intervals. Therapia Road, 26 DS0000060225.V364231.R01.S.doc Version 5.2 Page 25 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 4 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 3 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 3 34 3 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 4 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 3 X X 3 X Therapia Road, 26 DS0000060225.V364231.R01.S.doc Version 5.2 Page 26 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 YA19 Regulation 12(1) 13(4 c) Requirement To further ensure people’s safety and welfare, some further detail is needed concerning the management of their epilepsy. This is so that staff have clear instruction and an agreed timescale on when to seek assistance from the emergency services following an episode of prolonged or repeated seizures. A planned maintenance and redecoration programme is needed to demonstrate how the premises are kept in a good state of repair and where any necessary and planned improvements are made to the upkeep of the building. To ensure people’s safety and minimise the risk of scalding, the exposed pipe work below the sink in the first floor bathroom needs to be covered. To ensure safety, the taps in the second floor bathroom need repair or replacement so that people can identify between the DS0000060225.V364231.R01.S.doc Timescale for action 31/07/08 2. YA24 23(2)(b) (d) 31/08/08 3. YA27 13(4) 31/08/08 4. YA27 13(4) 31/08/08 Therapia Road, 26 Version 5.2 Page 27 hot and cold water supply. 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 YA20 Good Practice Recommendations The home, in consultation with the G.P., arranges for people to be prescribed any necessary homely remedies and develops a policy to cover its use. The Registered Manager should ensure that the complaints records show whether the complainant was satisfied with the outcome of the complaints investigation. Repeated from last inspection. The Responsible Individuals should consider investigating and employing a professionally recognised quality assurance tool within the home. Repeated from last inspection. Questionnaires should be offered to other professionals who have an interest in the service. Results from these surveys should form part of the quality assurance plan. This will further show how their views influence the running of the home. 2. YA22 3. YA39 4. YA39 Therapia Road, 26 DS0000060225.V364231.R01.S.doc Version 5.2 Page 28 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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