Care Home: Zion House

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What the care home does well What has improved since the last inspection? CARE HOME ADULTS 18-65 Zion House Zion House Trevellas St Agnes Cornwall TR5 0XS Lead Inspector Lynda Kirtland Unannounced Inspection 28th May 2008 11:00 Zion House DS0000064502.V362345.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 Zion House DS0000064502.V362345.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. Zion House DS0000064502.V362345.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Zion House Address Zion House Trevellas St Agnes Cornwall TR5 0XS 01872 552650 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) Mrs Paula Elizabeth Stevens Mr Malcolm Stevens Position Vacant Care Home 8 Category(ies) of Learning disability (7), Physical disability (1) registration, with number of places Zion House DS0000064502.V362345.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users to include up to 8 adults with a learning disability (LD) Service users to include up to 1 adult with a physical disability (PD) Total number of service users not to exceed a maximum of 8 Date of last inspection 18th July 2006 Brief Description of the Service: Zion House provides residential care for eight adults with a learning disability, one of whom also has a physical disability. Mr and Mrs Stevens are the registered providers, and also live on the premises. Zion house is set up as a home where people who already have a reasonable level of independence can continue to develop their personal and social skills. The home is situated in the hamlet of Trevellas, which is between St Agnes and Perranporth on the north coast of Cornwall. The home has a vehicle to provide transport for people who use the service who need to access resources in the wider community. Accommodation is provided on the ground floor with 8 single bedrooms. People who use the service have access to a lounge, dining area, kitchen, and bathroom / toilet facilities. Three of the bedrooms are within a recently built extension, and provide en suite facilities. There is a garden with a sitting area, which people who use the service can use. The home is accessible for people with a physical disability. The range of fees at the time of the inspection is £324-£1300 per week. There are additional charges e.g. for hairdressing, chiropody, and newspapers etc. Zion House DS0000064502.V362345.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 3 stars. This means the people who use this service experience excellent quality outcomes. A key inspection took place on 28 May 2008 and lasted for approximately six hours. The purpose of the inspection was to ensure that people who use the service needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that people’s placements in the home result in good outcomes for them. Information received from and about the home since the last inspection has also been taken into consideration in making judgements about the quality of outcomes for the people living there. The inspection included meeting with the people who use the service. Other activities included an inspection of the premises, examination of care, safety and employment records and discussion with the staff and registered providers. We talked to the people using the service, and asked staff about those people’s needs. We also looked at the care plans, medical records and daily notes for two people. This is called case tracking. There were opportunities to directly observe aspects of people’s daily lives in the home and staff interaction with them. We received seven surveys from the people who use the service of which some commented ‘I could not be any happier…. It’s a home from home’ and ‘ they (staff) are never too busy to spend time with me and listen to me’. Three surveys from relatives were received and some comments include ‘they provide a caring and supportive home for each person which gives a feeling of security, for relatives too’. Two staff members completed surveys and spoke positively regarding the support, training and management of the home. A health professional commented ‘ exceptionally good at person centred planning and meeting individual needs, the staff are conscientious, hard working and caring…. A excellent home …. Highly recommended’. The Commission received the Annual Quality Assurance Assessment, which is a questionnaire that the registered person completed. The AQAA describes the services and facilities that Zion house provide and identifies what areas they do well in and where they want to make further improvements. What the service does well: People who use the service have lived at Zion House for a number of years and it was evident from talking with them, and observations of their daily lives that they are relaxed and enjoy each other’s company. It was also observed that Zion House DS0000064502.V362345.R01.S.doc Version 5.2 Page 6 staff interaction with people who use the service is also relaxed, managed at the individual persons pace and with appropriate humour. People who use the service have access to written and pictorial information about the home. The home operates like a shared domestic dwelling with staff support provided where it is needed to assist them to develop and maintain their skills and independence. People who use the service are encouraged and supported to develop their skills and independence in many ways. They are involved in developing their own care plans with assistance and support from staff. They attend reviews so that they know why they are placed at the home and via their person centred planning process identify what aspirations they are aiming to achieve e.g. developing a particular element of self-care to promote their skills and independence. They have opportunities to make decisions about important aspects of their lives, with assistance from staff, if they need it and are supported to take risks so that they can enjoy fuller and more active lives in and out of the home. Access to health care is appropriate for the individuals needs and the medication systems in the home are robust so that the risk of medication errors is to a minimum. People who use the service have access to social/ educational/ employment activities. People who use the service told me of holidays that they are intending to go on, day trips that they have been on, and their attendance at day centres, work placements and clubs. Activities are planned with the individual so that they have a choice as to who to attend an activity/ holiday with which makes the activities more person centred. Daily records also demonstrate the level of activities that take place for each individual both in and outside of Zion House. People who use the service have clear information on what is expected of them and their rights as residents of a care home. They are aware, for example, that they will be expected to help out with household tasks such as cooking and cleaning, so that they can develop their skills and independence and know what to do if they wish to make a formal complaint about something they do not like. People who use the service participate in the choices of and preparation of food. People who use the service chose what to have for lunch during the inspection. They are encouraged to live and eat healthily. People who use the service are appropriately supported with their personal care so that they maintain their dignity. Staff were observed to assist them with their needs quietly and unobtrusively. Zion House is decorated and furnished to a good standard throughout. People who use the service were consulted about the décor and furnishings so that Zion House DS0000064502.V362345.R01.S.doc Version 5.2 Page 7 the home is personalised to reflect their tastes and preferences. It was clean and tidy throughout. The staff team demonstrated throughout the inspection positive interactions with people who use the service and assisted them with personal care needs in a discrete manner. Staff have had a comprehensive and valuable induction to the home. Staff confirmed access to training is available. The inspector was welcomed to the home in a friendly manner by staff and People who use the service. All were aware of the reason of the inspection. What has improved since the last inspection? The home’s statement of purpose and Service Users guide has been recently updated. The Statement Of Purpose is presented in written format. The Service Users guide is presented pictorially and in written format and sets out in clear concise language/ pictures all about the home, what to do if you have a complaint and how to keep safe. It is clear the registered provider has put a lot of thought and time in producing this document and one that, in my opinion, is a model to be used for other homes. There is a robust policy in respect of safeguarding both for people who use the service (pictorial) and for staff (written). Staff confirmed that during weekly house meetings safeguarding has been discussed and that they have used the method of ‘role play’ to share with the people who use the service how to manage ‘stranger- danger’ situations. Suitable equipment to promote independence has been gained following consultation with relevant health professionals. Since the previous inspection the registration of the home has increased to 8 people. A new extension has been built which provided en suite bedrooms to three people who use the service. These have been built to a high specification, with all relevant building certificates in place. People who use these rooms said how pleased they were with them and the décor, which they picked. The registered providers have identified ongoing maintenance work to the home, which will improve the homes appearance further. Furnishings throughout the home are to a good – high standard. In discussions with people who use the service and staff, plus surveys, all felt that there were sufficient staff on duty at all times. Staffing levels have increased since the last inspection, resulting in three members of staff are on duty at all times plus waking night cover. In discussions with staff they felt that the increase in staffing has meant that there are now more opportunities to do individual activities with people who use the service, rather than group activities. Likewise people who use the service have more choices regarding Zion House DS0000064502.V362345.R01.S.doc Version 5.2 Page 8 the holidays they go on and who with. People who use the service confirmed that they do more activities now and from their discussions it was clear that these are enjoyed. The staff team are experienced in working in the area of learning disability. Out of the nine staff employed eight have a minimum of a NVQ level 2. One person is actively working on her LDAF qualification. All staff has a individual training programme and staff, plus documentation confirmed that access to training courses such as medication, health and safety, infection control, manual handling has occurred. Staff training in the areas of dementia and autism has occurred as recommended at the previous inspection. A fire inspection occurred in February 2008 and work identified to be rectified (add extra door hinges and change wording in a document) has been completed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Zion House DS0000064502.V362345.R01.S.doc Version 5.2 Page 9 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 Zion House DS0000064502.V362345.R01.S.doc Version 5.2 Page 10 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, Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The homes Statement Of Purpose and Service Users guide inform People who use the service of the services and facilities that Zion House provide. The document s are presented in pictorial and written formats. EVIDENCE: From observations and talking with people who use the service it was evident that they are settled in the home, and that they get on well with each other and with the staff. A copy of the home’s Statement of Purpose and Service Users guide is accessible at all times. The Statement Of Purpose is presented in written format. The Service Users guide is presented pictorially and in written format and sets out in clear concise language all about the home, what to do if you have a complaint and how to keep safe. It is clear the registered provider has put a lot of thought and time in producing this document and one that, in my opinion, is a model to be used for other homes. As there have been no new admissions for some years, plus none are planned, the admission process was not inspected on this occasion. However the registered providers were able to verbalise what processes they would follow if a new admission occurred and the need to ensure a full assessment, in consultation with the individual, their family or advocate, and relevant professionals takes place. Zion House DS0000064502.V362345.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): 6,7,8,9,10,Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use the service are aware of their care plans, which fully address their health, personal and social care needs, including needs relating to their individual and diverse backgrounds (age, religion, culture and ethnicity, abilities, gender and sexual orientation). They are able to take safely managed risks and make important decisions about their lives so that they develop their skills and independence. EVIDENCE: People who use the service, their family, advocate and relevant professionals are involved in the development of individual care plans and their subsequent reviews. The care plan has specific headings to address their health, personal and social care needs, including their individual and diverse needs. These are in written form. Care plans provide people who use the service with specific goals to work towards, and inform and direct staff in how to support the individual to achieve this goal to encourage them to fully maximise their skills for independent living. In discussions with staff all said that they found the care plans easy to understand and were aware of the care planning processes. People who use Zion House DS0000064502.V362345.R01.S.doc Version 5.2 Page 12 the service have an identified key worker who ensures that the care plan is kept updated and the person’s views are included in its development. People who use the service participate in making decisions about important aspects of their daily lives, according to their individual abilities and this was observed during the inspection. There are also formal meetings held weekly so that they can discuss issues and make household decisions as a group. Staff were observed supporting individuals who required it, to make decisions about what to do during the day. People who use the service written care plans formally consider their abilities to make decisions for themselves and daily care records provide further evidence of the choices they make in their daily lives. People who use the service can choose the level of privacy they wish to enjoy in their private accommodation. People who use the service are able to take managed risks, backed up with written risk assessments and risk management plans, particularly with regard to their engagement in higher risk activities. Zion House DS0000064502.V362345.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): 11, 12,13,14,15,16,17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use the service are able to take part in a wide range of activities in and out of the home, which are appropriate to their ages, individual needs, interests and cultural backgrounds so that they develop their skills and confidence. They are supported to maintain valued social and family relationships so that they are not isolated or institutionalised. They are informed of their rights and responsibilities so that they are aware of what is expected of them. They are provided with a wholesome and varied diet so that they enjoy their meals and stay healthy EVIDENCE: Individual care plans and daily care records provide good evidence that the person’s interests and abilities are fully considered in planning their daily activities, which are planned with them individually. This is written up as a guide but as was observed during the inspection, an afternoon trip out was negotiated with them as to where they wanted to go. On return to the home it was evident that those who had gone on the trip had an enjoyable time. Zion House DS0000064502.V362345.R01.S.doc Version 5.2 Page 14 Some activities include attendance at day centres, work placements, college, clubs, swimming, walks and pub lunches for example. A daily record plus discussion with People who use the service confirmed the level and range of activities that they participate in. At the time of the inspection People who use the service were engaged in a variety of different and appropriate activities in and out of the home, with staff support provided as necessary. In addition daily care records show that they access a wide range of community resources with staff support, depending on their individual needs and abilities. People who use the service said, confirmed by records that they are encouraged to maintain valued relationships with their families and friends, with staff support as necessary. In addition the surveys from people who use the service and relatives confirmed this. People are able to make telephone calls in private if they wish. People who use the service said they could get up and go to bed when they wish and that staff knocked on their doors before entering (also observed). Locks are fitted to bedroom doors and a lockable tin to store money and valuables are available. People who use the service are supported and encouraged to eat healthily. People who use the service said they help with the choosing of food, planning for and preparing meals with assistance from staff. Observations of people who use the service were seen to choose what they wanted to have for dinner, where they wanted to eat it. Nutritional needs and preferences are considered as part of the care planning process. People who use the service looked healthy and well nourished and said that they ‘like’, the food at the home, also commenting it is ‘good’, ‘lovely’ and that ‘there is always enough of it’. The home has an ordinary, domestic kitchen. A cook is employed to prepare the evening meals. He has relevant qualifications in catering including the Intermediate course and has sound knowledge of the records needed to be kept in respect of the handling of foods and cleaning schedules. The registered providers and cook are aware that the kitchen needs to be updated and are planning to do this in the near future. Zion House DS0000064502.V362345.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): 18,19,20,21 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use the service personal and healthcare needs are well met so that they are able to live full and active lives in and out of the home. Medication systems are robust so that People who use the service health needs are managed safely. EVIDENCE: Care plans address their individual personal care needs and with sufficient bathroom facilities the person is able to attend to their personal care privately. Healthcare needs are considered as part of the care planning process and regularly reviewed. A health Action plan is completed with the individual with staff assistance to identify any health care needs. In discussions with people who use the service and documentation showed that they access external healthcare providers, including specialists, when they need to. People who use the service records provide evidence that they access a range of local NHS healthcare providers on a regular basis so that they maintain good physical health and emotional wellbeing. The registered providers described how the home links with local specialist services to assist people with specific Zion House DS0000064502.V362345.R01.S.doc Version 5.2 Page 16 behavioural and emotional needs and regularly consults with external professionals to ensure their needs are managed effectively and appropriately. All staff that handles medication are appropriately trained and there are certificates to provide evidence of this. Medication records were satisfactory and a tablet count of medication tallied with records kept in the home. In talking with some people who use the service and staff it was evident that discussions have taken place around the event of a persons death and their wishes. These are then documented in the person’s individual file. Zion House DS0000064502.V362345.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, 23 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use the service are listened to and respected so that their views, concerns and complaints are taken seriously and acted upon. There are formal and informal systems in place to ensure that they are able to feel safe in the home. EVIDENCE: People who use the service were encouraged to speak to the inspector if they wished so that they could make their views known or raise any concerns. No concerns were raised. People who use the service are aware of how to raise any concerns and Zion House has a formal complaints procedure and informal opportunities (e.g. weekly house meetings, care plan reviews and 1:1 time) to raise any concerns with staff before they become serious complaints. People who use the service said if thy had concerns they would tell ‘Paula and Malcolm’ (registered providers). The home has received compliments from family members and professionals and no complaints. There is a robust policy in respect of safeguarding both for People who use the service (pictorial) and for staff (written). Staff confirmed that during weekly house meetings safeguarding has been discussed and that they have used the method of ‘role play’ to share with the People who use the service how to manage ‘stranger- danger’ situations. Staff confirmed they have been on the multi disciplinary or adult protection courses and in discussions demonstrated a sound knowledge of adult protection issues and procedures. There is also a satisfactory whistle blowing policy. Zion House DS0000064502.V362345.R01.S.doc Version 5.2 Page 18 The care planning process explains how a person’s money is to be looked after, which the individual has contributed too. The home has a policy in respect of managing peoples’ monies. People who use the service confirmed they have somewhere safe, and lockable to manage their monies/ valuables. There are records to show that staff are recruited on the basis that they are suitable to work with vulnerable adults in a care setting and appropriate checks are made. People who use the service are not isolated in the home, but take part in a range of activities in the local community and have relationships with people from outside of the home that they can communicate serious concerns to Zion House DS0000064502.V362345.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 29, 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home’s environment provides People who use the service with an ordinary, domestic setting so that they can develop their skills and independence in a non-institutional setting. Consultation with People who use the service has led to communal and private space being furnished to a comfortable and high standard. It is safe and clean so that People who use the service are protected from risks of cross-infection. EVIDENCE: From a tour of the home by People who use the service and staff it was observed that the home was furnished and decorated to a good standard throughout. People who use the service confirmed that they helped with the choices of furnishings in the home and were particularly pleased with their en suite bedrooms that they had personalised, which were attractively furnished. Suitable equipment to promote independence has been gained following consultation with relevant health professionals. Zion House DS0000064502.V362345.R01.S.doc Version 5.2 Page 20 The registered person has completed environmental risk assessments to ensure that the premises are safe. The registered providers are aware of and addressing the on going maintenance that is needed in the home. Staff were aware of COSHH and relevant lockable storage was in place to store these items. Staff have attended infection control courses. Zion House DS0000064502.V362345.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, 36. Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. There are sufficient numbers of qualified staff on duty so that people who use the service can have confidence in their competence and skills. Staff training is encouraged so that up to date research and knowledge can be gained for the benefit for the people who use the service The home’s recruitment policies and practices are fair, safe and effective so that people who use the service can be assured that staff are suitable to work in a care setting. Staff receives regular, formal supervision. EVIDENCE: In discussions with people who use the service and staff, plus surveys, all felt that there were sufficient staff on duty at all times. Staffing levels have increased since the last inspection, resulting in three members of staff are on duty at all times plus waking night cover. In discussions with staff they felt that the increase in staffing has meant that there are now more opportunities to do individual activities with people who use the service, rather than group activities. Likewise people who use the service have more choices regarding the holidays they go on and who with. People who use the service confirmed that they do more activities now and from their discussions it was clear that these are enjoyed. Zion House DS0000064502.V362345.R01.S.doc Version 5.2 Page 22 Care staff undertakes all personal care duties plus with people who use the service assistance cleaning and some cooking tasks. From observations of staff interaction with People who use the service it was evident that they communicate with them in a competent, fair, patient manner and work with them at their pace. People who use the service said, as did surveys, that they ‘love’ the staff team and felt able to approach them with any concerns or worries. During the inspection it was observed that people who use the service have a relaxed and respectful relationship with staff and that the use of humour, as well as having more serious conversation when needed is used. New staff team members spoke positively about their recruitment, induction, and access to training and management support. There has not been a need to employ agency staffing. The staff team are experienced in working in the area of learning disability. Out of the nine staff employed eight have a minimum of a NVQ level 2. One person is actively working on her LDAF qualification. A NVQ assessor on a recent visit commented ‘ it is always a pleasure to come here as I am made to feel very welcome by staff and clients…….the residents are included totally in just about everything’. All staff has a individual training programme and staff, plus documentation confirmed that access to training courses such as medication, health and safety, infection control, manual handling has occurred. The home’s staff recruitment records indicate that staff are appointed on the basis of written application forms and equal opportunities interviews. Appropriate checks are made of their suitability to work with vulnerable adults in a care setting. A recommendation was made that in future when interviewing staff more detailed notes should be taken of the interview so that evidence can be gained as to their suitability for the position applied for. Staff, confirmed by documentation, stated that there is regular formal supervision. Zion House DS0000064502.V362345.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): 37,38,39,40,41,42 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The registered person is qualified and experienced to run a care home. The home is well run for the benefit of People who use the service. There are formal and informal systems in place to ensure that People who use the service views are accounted for in the day-to-day running and ongoing development of the home. Policies and procedures are reviewed. There are systems in place to protect service users from avoidable harm and injury EVIDENCE: The registered providers have the skills and competence to manage a care service effectively. Paula Stevens’ role is in managing the care of People who use the service and staffing. Malcolm Stevens’ main role is the upkeep and maintenance work in the home. As a team their skills are complimentary resulting in a home that is managed and maintained well for the benefit of people who use the service, staff and visitors. They both keep their training up Zion House DS0000064502.V362345.R01.S.doc Version 5.2 Page 24 to date and Mrs Stevens has a NVQ 4 in care and the Registered Managers Award. From discussions with people who use the service, staff and the surveys received, all spoke positively about the management skills of Mr and Mrs Stevens. All said that they felt Mr and Mrs Stevens are approachable and listened to their ideas or concerns. From observations, all interacted with them in a relaxed manner. An annual quality assurance process occurs, last one July 2007. Weekly house meetings, plus three monthly staff meetings, regular staff supervision and reviews via the care planning process also feed into the annual quality assurance procedure. The findings of this were positive. Mrs Stevens is aware that the findings of the quality assurance process should be forwarded to the Commission with any actions she intends to take. Records are stored confidentially, and recordings adhere to the Data Protection Act. The registered provider ensures that all incidents/ events are reported to the commission under regulation 37. Mrs Stevens has recently reviewed the homes polices and procedures so that they are appropriate to the service she provides and inform and guide staff accurately as to what is expected of them. The home’s environment appeared safe and there are written individual and environmental risk assessments in place to minimise risks to people who use the service and staff working in the home. Maintenance of the home and its equipment are satisfactory. The home’s fire safety records were completed and up-to-date. There are records of regular tests and checks of safety equipment and procedures in the home to ensure people who use the service, staff and visitors safety. People who use the service knew the fire procedure as this is practised regularly, and the fire poster is presented in pictorial and written manner. A fire inspection occurred in February 2008 and work identified to be rectified (add extra door hinges and change wording in a document) has been completed. Zion House DS0000064502.V362345.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 X 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 4 23 4 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 3 32 4 33 3 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 3 3 LIFESTYLES Standard No Score 11 4 12 3 13 3 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 3 4 4 4 3 3 3 X Zion House DS0000064502.V362345.R01.S.doc Version 5.2 Page 26 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 YA34 Good Practice Recommendations When interviewing staff more detailed notes should be taken of the interview so that evidence can be gained as to their suitability for the position applied for. Zion House DS0000064502.V362345.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Zion House DS0000064502.V362345.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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