Care Home: Vancouver Road

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What the care home does well This is a new service and the manager and staff team have worked well to prepare for people coming to live in the home. The home aims to care for people who have specialist needs such as autism and other complex needs where their behaviour may challenge the service. Before anyone moved in, the staff team were given lots of training to enable them to meet people`s needs and understand the way the home should be run. Admissions to the home are well managed and arranged in a planned way so that people`s needs are fully assessed, whilst ensuring that the home is suitable for them. Individuals are central to the planning of their care and staff have good information on how to meet each person`s needs. When a person`s 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 Vancouver Road live fulfilling and active lives and their views and choices are respected. 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 home uses imaginative ways for ensuring that people`s views are taken into account and that their personal wishes or goals are being met. Written feedback included, "Promotes SU (service users) independence" and "Very good with providing care and support to the service users to its utmost standard." People take part in leisure activities which are meaningful to them and take account of their social interests, choices and personal capabilities. The manager is knowledgeable and experienced and provides the staff team with good support and leadership. Written feedback included "I must confess, we get 100% support from my manager." The 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 and reflect upon their performance and practice. The home is kept clean, safe and decorated to a good standard so that people live in comfortable and homely surroundings. The physical layout of the environment has been designed in a way that meets the specific needs of the people who live there. It is safe for people and staff because appropriate health and safety practices are carried out. There is lots of space both inside the home and outside, within the enclosed rear garden. People using the service have the benefit of a separate activity room and spa bath. Two of the bedrooms have additional living space for personal use. What has improved since the last inspection? This was the home`s first inspection so it was not possible to identify where improvements have been made. What the care home could do better: Although the staff team have undertaken a variety of useful training, some further training is needed that is specific to the needs of the people living in the home. Training on epilepsy must therefore be arranged so that staff have the knowledge and skills to fully support individuals with such specialist needs. People who use the service must be provided with the necessary information about the home and the services that they can expect to receive. The Statement of Purpose and Service Users Guide must be available to them as well as any prospective users. In addition, each person needs an up to date and completed contract so that they or their representative are given full information about the costs and what the home provides for the money. As required by law, a photograph needs to be kept on each person`s care plan. Management of risk for people could be improved by ensuring that each assessed risk is recorded separately. This is to ensure that staff have clear information on how each risk should be managed whilst promoting the person`s safety and independence. Finally, people need a lockable facility in their bedrooms so that they can safely store any valuables or chosen possessions. Good practice areas for the service to consider are outlined as follows. The owning organisation should consider improving its business systems by providing a computer and working printer for the home. This will give the manager and staff team better resources to work more efficiently and improve outcomes for the people using the service. Records could be suitably adapted to meet people`s different communication abilities and make them moremeaningful to individuals. For example, person centred plans, social activity timetables and the home`s complaints procedure could be formatted in a way that each person can understand more fully. In addition, we suggest that the home purchases a camera so that people have the opportunity to personalise their records with photographs. It would be better if information about each person`s specific needs and the home`s objectives were included in the induction pack. This will further ensure that new staff are fully informed about the support that people require and how the home runs. The names of staff and people involved in fire evacuation drills should be recorded to show that those taking part have refreshed their knowledge at regular intervals. 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. CARE HOME ADULTS 18-65 Vancouver Road 16 Vancouver Road Forest Hill London SE23 2AF Lead Inspector Claire Taylor Unannounced Inspection 13th February 2008 10:20 Vancouver Road DS0000070564.V358768.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 Vancouver Road DS0000070564.V358768.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. Vancouver Road DS0000070564.V358768.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Vancouver Road Address 16 Vancouver Road Forest Hill London SE23 2AF 020 8699 7983 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) Caretech Community Services Limited Chrysogonus Okechi Diala Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Vancouver Road DS0000070564.V358768.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories 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 N/A- New Service Date of last inspection Brief Description of the Service: The home is located in a residential area of Forest Hill, London and offers single room accommodation for six people with learning disabilities. The home is well placed for local shops, amenities and public transport links with a train and bus station a short walk away. This service was newly registered in August 2007 and is part of the South East region of CareTech who are the owning organisation and also run other residential care homes. Vancouver Road is a large spacious house with an enclosed rear garden where there is an activity room and spa bath within a separate building. The accommodation is available in either one of four single bedrooms, or one of two flats. As well as the bedroom, these flats provide additional living space for two people. All six bedrooms have en suite bathroom facilities. Shared living areas include a lounge, dining room, fully fitted kitchen with separate laundry facilities and sensory room on the first floor. The Statement of Purpose describes the home; “It provides accommodation and support for 6 men and women between the ages of 18 & 65 inclusive, who have learning disabilities, autism and complex needs including behaviours that may challenge.” Fees start at £1309 and were correct at the time of the visit. Vancouver Road DS0000070564.V358768.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 was the home’s first key inspection since it was registered in August 2007. There were four vacancies in the home. 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 “Caretech” who are the registered owning organisation. Feedback from the written comment cards returned by three staff and one relative also informed this inspection. We met the two people who live in the home and spoke with the manager and some of the staff. We also had a look around the house. All those who took part are thanked for their time and contribution to this inspection. What the service does well: This is a new service and the manager and staff team have worked well to prepare for people coming to live in the home. The home aims to care for people who have specialist needs such as autism and other complex needs where their behaviour may challenge the service. Before anyone moved in, the staff team were given lots of training to enable them to meet people’s needs and understand the way the home should be run. Admissions to the home are well managed and arranged in a planned way so that people’s needs are fully assessed, whilst ensuring that the home is suitable for them. Individuals are central to the planning of their care and staff have good information on how to meet each person’s needs. When a person’s 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 Vancouver Road live fulfilling and active lives and their views and choices are respected. 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 home uses imaginative ways for ensuring that people’s views are taken into account and that their personal wishes or goals are being met. Written feedback included, “Promotes SU (service users) independence” and “Very good with providing care and support to the service users to its utmost standard.” People take part in leisure activities which are meaningful to them Vancouver Road DS0000070564.V358768.R01.S.doc Version 5.2 Page 6 and take account of their social interests, choices and personal capabilities. The manager is knowledgeable and experienced and provides the staff team with good support and leadership. Written feedback included “I must confess, we get 100 support from my manager.” The 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 and reflect upon their performance and practice. The home is kept clean, safe and decorated to a good standard so that people live in comfortable and homely surroundings. The physical layout of the environment has been designed in a way that meets the specific needs of the people who live there. It is safe for people and staff because appropriate health and safety practices are carried out. There is lots of space both inside the home and outside, within the enclosed rear garden. People using the service have the benefit of a separate activity room and spa bath. Two of the bedrooms have additional living space for personal use. What has improved since the last inspection? What they could do better: Although the staff team have undertaken a variety of useful training, some further training is needed that is specific to the needs of the people living in the home. Training on epilepsy must therefore be arranged so that staff have the knowledge and skills to fully support individuals with such specialist needs. People who use the service must be provided with the necessary information about the home and the services that they can expect to receive. The Statement of Purpose and Service Users Guide must be available to them as well as any prospective users. In addition, each person needs an up to date and completed contract so that they or their representative are given full information about the costs and what the home provides for the money. As required by law, a photograph needs to be kept on each person’s care plan. Management of risk for people could be improved by ensuring that each assessed risk is recorded separately. This is to ensure that staff have clear information on how each risk should be managed whilst promoting the person’s safety and independence. Finally, people need a lockable facility in their bedrooms so that they can safely store any valuables or chosen possessions. Good practice areas for the service to consider are outlined as follows. The owning organisation should consider improving its business systems by providing a computer and working printer for the home. This will give the manager and staff team better resources to work more efficiently and improve outcomes for the people using the service. Records could be suitably adapted to meet people’s different communication abilities and make them more Vancouver Road DS0000070564.V358768.R01.S.doc Version 5.2 Page 7 meaningful to individuals. For example, person centred plans, social activity timetables and the home’s complaints procedure could be formatted in a way that each person can understand more fully. In addition, we suggest that the home purchases a camera so that people have the opportunity to personalise their records with photographs. It would be better if information about each person’s specific needs and the home’s objectives were included in the induction pack. This will further ensure that new staff are fully informed about the support that people require and how the home runs. The names of staff and people involved in fire evacuation drills should be recorded to show that those taking part have refreshed their knowledge at regular intervals. 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. 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. Vancouver Road DS0000070564.V358768.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 Vancouver Road DS0000070564.V358768.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): 1,2,4 and 5 Quality in this outcome area is good. We have made this judgement using a range of evidence, including a visit to this service. There is good information about the service but this must be readily available so that people and those close to them can decide whether the care home can meet their support and accommodation needs. Contracts are also needed so that people know how much they will pay and what the home provides for the money. Admissions are arranged in a planned way and the needs of people who use the service are fully assessed prior to moving in. This ensures that the needs of the person are understood and can be met. EVIDENCE: The AQAA identified where the home could improve and stated “To provide a picture brochure about the home for the service users to initally look at and read about home. Vancouver Road will provide the service users with a service user’s guide and statement of purpose in an appropriate format.” We saw that the owners, Caretech, have produced a brief leaflet about the home but there was no Statement of Purpose or Service Users Guide available for people to see. Copies of these must be given to the people living in the home and made available for any prospective users of the service. After the visit, the manager did send us a copy of the home’s Statement of Purpose and Service Users Guide. Both documents give clear information to help people understand what services the home can provide. In addition the Service Users Guide is supplemented with pictures to make it easier to understand. The Vancouver Road DS0000070564.V358768.R01.S.doc Version 5.2 Page 10 contract or terms and conditions are included in the guide. The contract details what the person is expected to pay and includes accurate information about the facilities and services that people can expect to receive. Again, people must be provided with a copy however. We looked at records concerning admission for the two people currently living in the home. These showed that individuals were given the opportunity to spend time in the home before moving in. The manager advised that people are offered a transition or introductory period of two weeks. People are invited to view the home, stay for a meal and join in with activities if they so choose. The home ensures that families or representatives are also involved where appropriate. In addition, staff visited one person in their previous home so that they could get to know them and start the assessment process. As part of the admission process, the home carries out its own needs assessment, which covers all areas as well as people’s known strengths, skills, interests, and ability to take positive risks. People’s ethnic and diversity needs are identified through assessment. Examples seen included details about people’s preferred religion or beliefs and cultural preferences. Copies of needs assessments were seen on file for both people as well as detailed needs assessments completed by their care managers from social services. Caretech have good procedures in place which ensure that any prospective person is central to the process prior to coming to live at the home. The manager advised that emergency admissions would be avoided where possible. Following a new admission, a review meeting is held after six weeks to check that the person is happy in the home and that it is suitable to meet their individual needs. We saw records that reflected this practice for both individuals. Vancouver Road DS0000070564.V358768.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 Quality in this outcome area is good 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 that promote their independence although some plans need more detail to fully safeguard individuals from potential harm. EVIDENCE: We looked at care records for both people who live in the home. Each person had an informative care plan that looks at all areas of the individual’s life in a person centred way. One person had only been in the home for six weeks and their plan contained a range of information to tell staff about their support needs. Known as “Individual support requirements” there is a summary of their assessed needs with details about what staff must do to meet each area of need. Examples included “likes to chat with staff” for communication and “I like warm milk on my cereals” for nutrition. Person centred planning had Vancouver Road DS0000070564.V358768.R01.S.doc Version 5.2 Page 12 recently begun and staff had commenced the groundwork for creating plans with involvement of both the person and their family. It included information about the person’s preferred routines, activities, likes and dislikes and social links. The plans describe each person in a positive way (for example what people like and admire about them, and their skills and abilities). There is also information about how the person wants to stay healthy, safe and well and what support they need to achieve this. Reviews focus on asking what has worked for the individual, where there is progress, achievements, concerns and identifies action points. Each individual’s preferred communication style is clearly recorded. This also helps staff to understand the person’s unique behaviours, moods, signals and temperaments. We recommend that the home purchase a camera so that relevant records can be adapted with photographs to make them more meaningful to people using the service. The home has introduced imaginative ways for ensuring that people’s views are taken into account and that their personal wishes or goals are being met. We saw records known as “Service users talk time”. Each person meets with their keyworker on a weekly basis to plan activities and discuss other issues such as their relationships and feelings. For the newest person, staff had consulted them every week to see how they were settling in. The key staff then completes a monthly summary report to show what the person wants to happen next. One person’s comments included “I get on well with (name of staff) my keyworker.” Records seen identified that one individual wanted to go to a football match and have a TV in their bedroom. Staff had begun to plan for achieving these requests. Individual diaries are used daily and records seen were thorough, relevant, and also gave a sense of that person’s experience of their day. We saw risk assessment plans for both people which were generally well written. Plans show that action should be taken to lessen risk, whilst encouraging independence for people. A risk assessment also tells the staff how to make sure that each person is kept safe from anything that might harm them. Examples seen included personal care, safety in the home, accessing the local community and management of epilepsy for one individual. We were also told about one incident where a person’s behaviour had challenged the service. This resulted in some physical damage to property, the risk plans were promptly reviewed and additional guidelines were put in place. One person had a plan that covered two different areas of risk and it was not clear how each one was managed. Management of risk could be therefore be improved by ensuring that each assessed risk is recorded separately. Staff need full details on how to support the person with each individual risk. The AQAA identified the home’s planned improvements over the next 12 months as, “To work with individuals on using a key so that they are able to lock their own bedroom.” And “To acquire a mini-bus for the home to enable service users to be able to pursue their preferred activities particularly the ones that Vancouver Road cannot provide in-house.” Vancouver Road DS0000070564.V358768.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 Quality in this outcome area is good We have made this judgement using a range of evidence, including a visit to this service. People can take part in activities that are appropriate to their age and culture and are part of their local community. The home supports people to follow their personal interests and activities. Relationships with family and friends are well supported and daily routines ensure that people’s individual rights’ and responsibilities are recognised. People who use the service are offered a healthy diet and enjoy their meals at times that suit them. EVIDENCE: We looked at records relating to the two people’s lifestyle. Each individual has the opportunity to take part in leisure activities which are important to them. One person enjoys playing their electronic keyboard in their bedroom. The other person likes to listen to a particular radio station and watch sports on TV. People have an individual planned activity programme, which takes account of their preferences, interests, experiences, age and capabilities. These activities Vancouver Road DS0000070564.V358768.R01.S.doc Version 5.2 Page 14 are regularly reviewed to ensure that they meet any changing needs. In addition, people have a weekly talk time with their key staff to reflect upon and plan activities. Both individuals attend a nearby day centre and are supported to use their local community. Activities include bowling, cinema, shopping and eating out. Any specialist communication and behaviour needs are clearly recorded to enable staff to support them appropriately and minimise a potential incident of aggression. For one individual, the staff team have introduced a timetable of prepared activities that are planned with the person each day. Records showed that this has helped to ease the person’s anxiety, as they require routine and structure in their daily life. As a new service, the home has plans to provide a wider range of social and leisure activities once more people have moved in. The manager advised that there are plans to offer other activities such as horse riding and swimming. The service has the benefit of a separate activity room and small hydro pool / spa in the rear garden. On the first floor there is a sensory room where people can relax. There is some indoor entertainment including a widescreen television, DVD player and music system. Each person has a “home day” whereby they are encouraged to join in with domestic routines such as cleaning and tidying their bedrooms, laundry care or meal preparation. Care records include details about each person’s social network 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. We saw staff speak respectfully with each person and both people were relaxed and happy in the company of staff. The home offers a varied choice of menu that is based upon people’s personal preferences. 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. Staff consulted individuals and supported them to make their own snacks and drinks during the visit. Vancouver Road DS0000070564.V358768.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 Quality in this outcome area is good 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. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. EVIDENCE: The AQAA stated “All personal and healthcare support is maintained with privacy and dignity; people are encouraged to be as independent as they are able to, in this area. The support is always on how the individual wants us to support them.” As stated within other parts of the report, records told us that each person’s individuality is recognised and this extends to how they have their personal and healthcare needs met. People’s preferences about how they receive personal care were recorded in their care plans. Examples were “likes to shave after a bath” and “I like to choose my own clothes”. The AQAA identified that “Staff at Vancouver Road are currently working with Service users on their individual health action plan using Caretech formats.” Vancouver Road DS0000070564.V358768.R01.S.doc Version 5.2 Page 16 We saw detailed health action plans for both people that give a comprehensive overview of their healthcare needs and how staff should support them. One individual has epilepsy and the staff work in partnership with other healthcare professionals to enable the person to lead an active life as far as possible whilst managing their health condition. Records showed that guidelines were in place for staff to follow when the person experienced a seizure. Staff do require some further training however and this has been discussed later on in the report under ‘Staffing’. People are supported to use other NHS healthcare facilities in the local community. Plans included details of GP involvement as well as Consultant, dentist, optician and routine hospital appointments. Staff keep a record of all appointments, outcomes and any follow up action required. These systems show that healthcare needs are being monitored reliably in the home and that staff take appropriate action to address any changes. People who live in the home do not have the capacity to manage their own medication. The home has a detailed policy on the management of medication and all staff have received medication training through CareTech. Records confirmed that an appropriate healthcare professional reviews medication regularly and each person has a written profile to specify what medication is required. When we asked, staff showed a good knowledge of the medicines that people were prescribed and what they were used for. The home uses a monitored dosage system, with most medication being delivered in blister packs by the dispensing pharmacist from “Boots”. The manager advised that he plans to organise future training for staff through Boots. Medication was stored correctly with up to date records kept for its receipt and disposal. Guidelines for the use of ‘as required’ medication were in place to ensure that staff are clear about when and how to administer this type of medicine. Vancouver Road DS0000070564.V358768.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 Quality in this outcome area is good We have made this judgement using a range of evidence, including a visit to this service. Arrangements for dealing with complaints or concerns ensure that people feel listened to and their views are acted upon. Arrangements for protection from abuse are well managed and help ensure that people living in the home are safe. EVIDENCE: The AQAA stated, “Service users at Vancouver Road are provided with a clear and effective complaints procedure, these are currently in written formats. Service users have family members that they often see and will again raise any concerns or issues on the individual’s behalf. All staff have attended adult protection training and there is a Vancouver Road local safeguarding procedures in place.” 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. As people using the service have different communication abilities, it would be better however if the home supplied them with a complaints procedure that they can understand more fully. The manager and staff are keen to develop the home’s records and adapt them with pictures and photos so that they are more meaningful to people who have communication difficulties. We have received no complaints about this service since its registration and there were none recorded in the home’s complaints book. The home has policies and procedures for safeguarding adults that give clear, specific guidance to staff working at the service. A flowchart for reporting any safeguarding concerns was available on the notice board in the office. This helps staff know when incidents need Vancouver Road DS0000070564.V358768.R01.S.doc Version 5.2 Page 18 external input and who to refer the incident to. Records showed that all staff had received training in safeguarding. Other training around dealing with physical and verbal aggression has also been arranged for staff. Vancouver Road DS0000070564.V358768.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): 24,26,27,28 and 30 Quality in this outcome area is good We have made this judgement using a range of evidence, including a visit to this service. People are provided with safe, comfortable and homely surroundings in a house that is kept clean and well maintained. People have spacious bedrooms and two of the rooms have additional living space for their personal use. Overall, bedrooms are designed and furnished to reflect the person’s individuality and meet their needs. People need lockable storage space however for safekeeping their possessions. EVIDENCE: There is lots of space both inside the home and outside, within the enclosed rear garden. People have the benefit of a separate activity room and spa bath. The shared living areas provide a choice of communal space for people to meet relatives and friends in private. Since the home was registered, some additional work has been completed. A ramp with non-slip tiles and handrails has been built for the front entrance. All the exposed pipes and wiring below the hand basins have been covered. A side gate has been fitted to the property and the keypad entry system for the front door is now linked to the fire alarm. Vancouver Road DS0000070564.V358768.R01.S.doc Version 5.2 Page 20 This means that people are provided with a safer environment. Some people may present behaviours that can challenge the service and the layout of furniture and fittings has also been adapted so as to ensure people’s safety. Pictures around the home have been covered with plastic as opposed to glass and the fire extinguishers placed in boxed cabinets. One bedroom clearly reflected the person’s individuality, interests, leisure needs and preferences. They had their own TV, music system, electronic keyboard as well as pictures and family photographs that were meaningful to them. The person said they were happy with their room. The other person had only moved into the home within the last six weeks and staff were in the process of supporting them to furnish and personalise their room as they wished. The vacant bedrooms were decorated to a high standard and comfortably furnished. One improvement is that people need a lockable facility in their bedrooms so that they can safely store any valuables or chosen possessions. The home was clean and tidy with good hygiene practices in place. We saw records to show that staff make a monthly check around the home to identify if any repairs or improvements are needed. Staff use a repairs/ maintenance report form to highlight any areas within the premises that need attention. The AQAA identified that, “As a home we have moved forward and listen to what our service users are telling us. Over the last month we have reviewed the situation with cupboard doors not being locked, and have agreed that the service users will ask for staff support before accessing the cupboards. This is a decision that service users have requested during their weekly 1-1 talk times.” Vancouver Road DS0000070564.V358768.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 Quality in this outcome area is good We have made this judgement using a range of evidence, including a visit to this service. Overall, people’s needs are met and supported by a staff team who get the right training, supervision and support. Some further training is needed however that is specific to the assessed needs of individuals. EVIDENCE: There is a stable staff team who have worked at the home since it first opened in August last year. Rotas were sampled and allocation allows for a minimum of two staff on each day shift with one waking staff at night and additional sleep in. There were adequate numbers of staff for meeting the needs of the two people. The AQAA stated that, “The staff team are of mixed gender and age, which provides service users with diverse range of characters to suit service users needs.” The service has good recruitment procedures which ensure that staff are vetted correctly before they begin work. This means that people using the service are protected from unsuitable workers. We looked at the employment files for two staff files and these contained all the necessary recruitment checks. Induction for new staff is based upon the required ‘Skills for Care’ core standards. The induction process should include specific details about the Vancouver Road DS0000070564.V358768.R01.S.doc Version 5.2 Page 22 home however and the different needs of the people who live there. This will ensure that new staff are fully informed about the services and support that people require. The manager had completed a training record to show what training courses staff have done and when they did them. Over half of the staff team have achieved their NVQ level 2 qualification in care. Most of the training is provided by CareTech and covers a variety of topics that are relevant to the aims of the service. We looked at training certificates for two staff. They had attended courses on challenging behaviour, autism, ‘non violent crisis intervention’, food hygiene, health and safety, first aid; report writing, moving and handling and infection control. Staff have not received training on epilepsy however and this must be arranged so that staff have the knowledge and skills to fully support individuals with such specialist needs. For what the home could do better, the AQAA also stated, “It would benefit the staff team if there were more specialised training in order to support individuals more.” Written comment cards from staff were mainly positive about their experience of working at the home. “Providing training for staff” was noted for what the service does well. Observations showed that staff respect people’s individuality and know what their specific needs are. 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. Records showed that staff receive regular supervision with the manager or deputy. These systems therefore support staff to do their jobs well and reflect upon their performance and practice. Vancouver Road DS0000070564.V358768.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, 41 and 42 Quality in this outcome area is good We have made this judgement using a range of evidence, including a visit to this service. The 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. Record keeping is well managed to ensure that people’s rights and best interests are safeguarded. The environment is safe for people and staff because health and safety practices are carried out. EVIDENCE: The manager, Chrys Diala has many years experience in working with people who have learning disabilities and has previously worked at other homes owned by CareTech. He successfully completed the required National Vocational Qualification level 4 in management in 2005 and has gained other certificates in management studies. Discussions and observation confirmed Vancouver Road DS0000070564.V358768.R01.S.doc Version 5.2 Page 24 that he is knowledgeable about each person’s unique needs and understands the importance of person centred care and improving outcomes for people. The manager offers clear leadership, guidance and direction to staff. Staff spoken to had confidence in the manager and written feedback was also complimentary. “I must confess, we get 100 support from my manager.” There were some quality assurance systems in place to measure the success of how the home is achieving its aims and serve the best interests of the people who live there. Examples include care plan reviews, regular meetings and weekly talk time for people and their key staff. The responsible individual or appointed representative 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. Records showed that any areas that need attention are acted upon. The organisation was also in the process of sending out satisfaction questionnaires to staff. The manager advised that the home plans to offer similar questionnaires to people who use the service, their families and other relevant professionals. As this is a new service and the home is not yet fully established, the overall effectiveness of the quality assurance systems will therefore be assessed more fully at the next inspection. On the whole, record keeping was good meaning that people’s rights and best interests are suitably safeguarded. The home does not have a computer however and the manager was using his own personal laptop for undertaking some organisational duties and storing records, such as the Statement of Purpose and Service Users Guide. The printer was not working which meant that staff were unable to print documents and records or adapt them into a suitable format that meets each individual’s needs. The registered provider should therefore consider supplying the home with a computer system to enable more efficient running of the business as well as improve upon outcomes for people using this service. 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. Mandatory training is provided by the owning organisation 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. Records are maintained of all accidents and incidents at the home. As required by law, the service keeps us informed of any reportable events. Detailed risk assessments were in place concerning the premises and safe working practices. These aim to safeguard the welfare of all people living and working in the home. Examples included moving and handling, house security; use of hot water and storage of knives and sharps. The completed AQAA stated that all relevant safety checks were up-to-date. We looked at some of the servicing and maintenance records. Fire drills, fire equipment and hot water temperature checks are carried out at regular intervals. To show that people refresh their knowledge of fire evacuation procedures, it would be better if the names of staff and service users taking part in a drill were recorded. The fire risk assessment for the building had not been filled in but the manager provided us Vancouver Road DS0000070564.V358768.R01.S.doc Version 5.2 Page 25 with a completed copy following the visit. In addition, certificates to show that each staff had received fire training were not in the home. The manager explained that he had experienced some difficulty in obtaining the certificates as the trainer had left the organisation. Copies were also promptly sent to us with the fire risk assessment. Vancouver Road DS0000070564.V358768.R01.S.doc Version 5.2 Page 26 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 2 2 3 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 2 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X 3 3 X Vancouver Road DS0000070564.V358768.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/A 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 YA1 Regulation 4(2) 5(2)(2A) Requirement People who use the service must be provided with the necessary information about the home. The Statement of Purpose and Service Users Guide must be available to them as well as any prospective users. Each person needs an up to date and completed contract so that they or their representative are given full information about the services that are being arranged and what the home provides for the money. Timescale for action 30/04/08 2 YA5 5 (1)(c) (3) 31/05/08 3 YA6 17(1)(a) As required by law, a photograph 30/04/08 of each person must be kept on his or her care plan. Specific areas of risk for each person must be recorded separately. This is so that staff have clear information on how each risk should be managed whilst promoting the individual’s safety and independence. 30/04/08 4 YA9 12(1 a) 13(4)(5) Vancouver Road DS0000070564.V358768.R01.S.doc Version 5.2 Page 28 5 YA26 23(2)(m) People need a lockable facility in their bedrooms so that they can safely store any valuables or chosen possessions. All staff must receive training on epilepsy, as it is specific to the needs of people living in the home. This will ensure that staff have the specialist knowledge and skills to meet individual needs in a safe and competent manner. 31/05/08 6 YA35 18(1)(c i) 19(5)(b) 31/05/08 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 YA41 Good Practice Recommendations The registered provider should consider improving its business systems and provide a computer for the home. The manager and staff would benefit from such resources to improve outcomes for the people using the service and run the home more efficiently. The printer should be repaired or replaced so that the manager and staff have the resources they need to maintain the good standards of record keeping and further develop records for people using the service. That the home purchases a camera so that records can be suitably adapted to meet people’s different communication abilities and make documents more meaningful to them. For example, photographs could be used to supplement person centred plans and social activity timetables. The complaints procedure should be adapted to meet people’s different communication abilities so that they can understand it more fully. 2 YA41 3 YA6 4 YA22 Vancouver Road DS0000070564.V358768.R01.S.doc Version 5.2 Page 29 5 YA35 The specific needs of each person using the service and information about the home should be included in the induction pack. This will further ensure that new staff are fully informed about the services and support that people require. The names of staff and people involved in fire evacuation drills should be recorded. This will further ensure that those taking part have refreshed their knowledge at regular intervals. 6 YA42 Vancouver Road DS0000070564.V358768.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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. Extracts may not be used or reproduced without the express permission of CSCI Vancouver Road DS0000070564.V358768.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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