Inspection on 09/04/09 for Cascade II

This is the latest available inspection report for this service, carried out on 9th April 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cascade II 14/04/08

Cascade II 17/09/07

Cascade II 15/08/06

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Cascade II 37 Gladesmore Road Haringey London N15 6TA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Shamash     Date: 0 9 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Cascade II 37 Gladesmore Road Haringey London N15 6TA 02088000760 02088094900 cascade2@cascade-care.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Cascade Care Ltd care home 5 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 5 The maximum number of service users who can be accommodated: 5 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Cascade II is a residential care home providing personal care to five male younger adults who fall within the category of mental disorder. The home specialises in offering a supportive environment for men with a history of mental health difficulties, who may also have a forensic history. This may involve being discharged from more structured institutions under provision of one of the sections of the mental health legislation. The home is privately run by a provider who also runs a number of similar residential care homes. The home is a large three-storey terrace house that is well decorated and maintained. The ground floor contains the communal kitchen/diner, the first floor contains the communal lounge, and residents bedrooms are located on all three floors. There is a bath/shower room with toilet on the first floor and a separate toilet as well Care Homes for Adults (18-65 years) Page 4 of 35 Brief description of the care home as the laundry area on the ground floor. There is a rear garden that has been covered in decking. The home is situated in a quiet residential area off of Green Lanes in South Tottenham, which is near to Stamford Hill, with local shops and with access to various forms of public transport. CQC inspection reports are available from the office at the home or from the CQC website - www.cqc.org.uk The overall aim of the home is to provide the highest quality of care, in a homely and safe environment, for men with a history of mental illness who may also have a forensic history. Weekly fees as at April 2009 are in the range of 1100 -1400 GBP depending on need. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took approximately six hours. The deputy manager who was temporarily working in the role of acting manager while the registered manager was seconded to another home, was on duty for the majority of the inspection. I was also assisted by two other members of staff during the inspection. Five people were resident in the home at the time of my visit, including one new resident admitted since my previous random inspection. I was able to talk to the new resident and two further residents during the visit. Other residents did not wish to speak to me or were out during the visit. I received two completed feedback forms from residents, and a current Annual Quality Care Homes for Adults (18-65 years) Page 6 of 35 Assurance Assessment from the service, which were also taken into account as part of this inspection. I also conducted a tour of the premises and inspected a range of documentation including health and safety certificates kept in the home. What the care home does well: What has improved since the last inspection? Risk assessments for residents were being reviewed at least six monthly and these now addressed more relevant areas including self-medication, collecting prescriptions, cooking etc. There was a strong improvement in the quality of staff interactions and key working sessions with people living at the home, so that people living at the home feel confident about the support that they can expect, and are able to work together on meaningful goals including development of further independence skills. There was evidence that residents were being supported to attend routine healthcare appointments, and that these were being monitored. Care Homes for Adults (18-65 years) Page 8 of 35 Some improvements had been made to the home environment, however there are further issues that now need to be addressed. Staff had been provided with updated training in safeguarding adults, medication administration, first aid, and health and safety. Following the inspection the deputy manager advised that further training was also booked in food hygiene and counselling skills, and regarding specific mental health issues, to ensure the safetyand meet the needs of people living at the home. There was a significant improvement in the supervision of staff members to ensure that they work in line with best practice. The quality assurance systems for the home were also clearer, including the views of people living at the home and other stakeholders. Regular staff meetings and resident meetings were being arranged, addressing a range of topics relevant to the running of the home. The service users guide had been updated, and the fire risk assessment had been updated as appropriate for the safety of people living and working at the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 9 of 35 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are given adequate and current information about the home, and have their needs assessed and agreed with them prior to moving into the home to ensure that the home can address them effectively. Evidence: One resident had moved out and a new person had moved into the home since the previous inspection, so that the home remains fully occupied. I was able to meet with the newest resident prior to their going out. They spoke highly about the home, noting Ive tried other supported accommodation but this is the best, its cleaner and the staff are friendlier. I inspected three residents files in detail, including that of the newest resident. All contained a range of comprehensive assessment information from both health and social care professionals as well as from in-house assessments. There was evidence that this information was kept up to date with care planning approach (CPA) review meetings in place. Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: The deputy manager advised that the home continues to have good working relationships with the mental health professionals involved with people living at the home. Records indicated that these professionals continue to keep in touch with their respective clients on a regular basis and this was confirmed by three residents spoken to. The statement of purpose and service users guide provide a range of relevant information for prospective residents to the home. As recommended the service users guide had been updated to include more detailed information about the complaints procedure and information about how the home carries out quality monitoring. Care Homes for Adults (18-65 years) Page 13 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs and aspirations are recorded within their care plans. The plans are reviewed regularly with the individual residents to ensure that their changing needs continue to be met, and there had been an improvement in the standard of individual support provided. Residents are supported to retain and maximise their independence by making as many decisions as possible for themselves and taking responsible risks. Evidence: The three residents files inspected all contained current care plans that were based on detailed assessments of each persons needs including cultural and social needs. The plans were clearly laid out and detailed the individual needs as well as giving clear guidance to staff on how to address these. There was also documented evidence that the plans were regularly reviewed with individual residents, and this was confirmed by staff and residents spoken to. Some agreed restrictions had been placed on peoples Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: freedoms, with documented evidence that these had been discussed with residents as appropriate. This was confirmed by residents spoken to. Restrictions include the use of alcohol, illegal substances and where people may smoke. All people living at the home spoken to advised that they received a high level of support from staff, enabling them to make progress with their identified goals. The home has a satisfactory risk management policy and the deputy manager was able to provide a clear description of how this is implemented in a number of situations. All risk assessments were being reviewed regularly as appropriate, with signatures recorded to evidence that residents had been consulted about these. I noted a clear improvement in the quality of key working interactions and recording for one-to-one work with people living at the home. Records indicated that more sophisticated relationships were being built up between staff and people living at the home, and people spoken to felt a greater level of support was being provided by the staff team than on previous occasions. One person told me Staff are nice to me - even though I sometimes get agitated when Im unwell. When I was unwell recently they cleared my room and hoovered for me - they really looked after me. Observation of interactions between staff and residents within the home indicated that these were supportive and appropriate. Records of some key working sessions included requests from residents for furniture items or contact with a health care professional. Discussion with the deputy manager indicated that these issues had been addressed. However, although key working records had improved significantly since the previous inspection, it is recommended that recording sheets be modified to include a section on progress on goals set/requests made since the previous session. This would also be a beneficial addition to resident meetings, to evidence responsiveness and continuity with previous sessions. This may include undertakings by residents or staff members, or requests for issues to be addressed with management, social workers etc. Care Homes for Adults (18-65 years) Page 15 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home take part in a range of activities both at home and within the local community. They are also supported to develop and maintain relationships with relatives and friends to the extent that they wish to. People are supported to make decisions for themselves regarding their daily lives. They enjoy balanced and varied meals of their choice that are culturally appropriate. Evidence: Staff and residents confirmed that people living at the home are encouraged to participate in activities both inside and outside of the home. However, given peoples complex needs and preferences, structured day activities are taken up on an intermittent basis. Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: One person continues to work part-time as a volunteer at a charity shop. Apart from this, the deputy manager advised that people living at the home choose not to pursue employment or training opportunities and this was confirmed by those spoken to. One person told me that they find college courses to be very stressful. Participation in daily activities was documented and was being monitored by the home. Discussion with staff and residents and recording within care plans indicated that residents were encouraged and supported to express their different cultural, social, intellectual, emotional and sexual needs as appropriate. One resident had gone out to meet their partner during the inspection, another had been visited by staff from a local relevant cultural centre, however they had chosen not to attend this service. All residents are able to go out independently, and I observed people coming and going throughout the day of the inspection visit. One resident told me that they enjoy cycling and going out for walks regularly. Inspection of files and the visitors book indicated that people living at the home continue to have positive contact with relatives or friends, and this was confirmed by staff and residents spoken to. The deputy manager advised that residents access a range of community facilities including local sports facilities, shops, clubs and pubs and that the home continues to offer outings to local restaurants, pubs and other community facilities, although these are usually taken up on a one-to-one basis. Residents confirmed that they were encouraged to be involved in the local community, but advised that they rarely participated in group activities with the home, out of personal choice. One resident had moved out of the home into a more independent setting since the previous inspection. The home is commended for the support provided to them enabling them to develop their independence skills. The deputy manager advised that residents continue to have an annual opportunity to go on holiday with residents from other homes belonging to the provider organisation. However none of the residents at Cascade II had chosen to be involved in this as yet. Staff also provide support for any resident wishing to organise individual breaks away from the home. Staff advised that all residents had their own bedroom and front door keys and had unrestricted access to the home and garden. Residents confirmed this. Staff on duty during the inspection were seen to treat the residents with courtesy and respect. The home has a three monthly specimen menu, and residents spoken to advised that Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: they were consulted about these. Minutes of residents meetings also confirmed consultation of food served at the home. One resident self caters with staff support. Others assist with cooking on an occasional basis. Many of the meals cooked in the home differ from the menu given the current preference of the residents at the time. Residents are from a variety of ethnic backgrounds and stated that the meals they ate met their cultural preferences. This was confirmed by inspection of food served. One resident is vegetarian and there were a variety of vegetarian foods stocked within the home. The home was well stocked with food including fresh vegetables and fruit. The deputy manager confirmed that residents continue to be encouraged to join staff for the weekly food shop for the home. One resident shops for their own food and receives money from the home for this purpose. Care Homes for Adults (18-65 years) Page 18 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive appropriate personal support in accordance with their needs and preferences, and are supported to attend routine healthcare appointments to ensure that their health needs are fully met. Sufficiently rigorous medication administration, storage and recording procedures are in place to ensure that residents are given prescribed medicines safely. Evidence: Staff confirmed that all the current residents are physically independent in respect of their personal care needs although they may need verbal prompting with certain areas of personal hygiene to varying degrees. People living at the home indicated that this was undertaken in a sensitive manner, and this accorded with my observations at the home. Records indicated that people are supported with their emotional needs, particularly through sessions with their key workers. A significant improvement in the depth of interactions was noted in records of key worker sessions on the files inspected. Staff had undertaken training in counselling skills to further promote their ability to support Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: residents with their emotional needs. Records on peoples case file included evidence that some residents are supported to attende routine healthcare appointments such as GP, local hospital outpatient departments, opticians, dentists etc. However records were incomplete for two of the three peoples files inspected. The deputy manager advised that this is because these individuals refuse to attend dentist/opticians appointments. Evidence was seen that all residents were encouraged to attend opticians appointment recently and that this was discussed at a residents meeting. It is recommended that when residents refuse to attend routine healthcare appointments, this should be recorded on their individual files, to evidence that they are being prompted and encouraged to attend these routine check-ups. Also clear notes should be kept of Care Programme Approach meetings, in the interim period until the official minutes are received, so that actions can be addressed without delay. Medication was stored appropriately within the home with the storage temperature recorded daily. Records of medication administration were maintained to a high standard with no gaps in the medication administration records. Residents spoken to confirmed that they were supported to collect their own prescriptions for medicines and take their medicines at the times prescribed. No residents are currently selfmedicating, and no homely remedies are kept at the home. The deputy manager advised that both of these areas would be kept under review. Care Homes for Adults (18-65 years) Page 20 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to express their views and any concerns they may have and can be confident that these will be addressed promptly and effectively. Appropriate procedures are in place, and staff training has been undertaken to ensure that residents are protected from abuse as far as possible. Evidence: The home has a clear and satisfactory complaints procedure that was seen displayed in the kitchen and the office. No complaints had been recorded since the previous inspection. Residents spoken to told me that they felt able to raise any concerns or complaints they might have with staff. As required at the previous inspection, the deputy manager advised that all staff members had undertaken training in Safeguarding Adults in March 2009. Certificates had not yet been received, but staff spoken to confirmed that they had undertaken this training, and were aware confident about the action to be taken in the event of a disclosure or allegation of abuse. The home also has a detailed adult protection policy as appropriate to protect residents from abuse. Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: As recommended, the deputy manager advised that it arrangements were being made for the management to undertake the Local Authority safeguarding adults training, and that staff would undertake distance learning in the Mental Capacity Act 2005 and Deprivation of Liberty standards. Care Homes for Adults (18-65 years) Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is generally clean, comfortable and adequately decorated and that meets their needs. Whilst improvements had been sustained, there remain a number of issues to be addressed within the home to better meet peoples needs. Evidence: The home is a three-storey house, with five bedrooms, a bath and shower room with toilet, a separate toilet under the stairs, a kitchen and dining area and a large lounge area on the second floor. The home was generally clean and decorated to an adequate standard. Three residents allowed me to see their bedrooms. The home has satisfactory bath, shower and toilet facilities, and paper towels and soap were being provided in these facilities as appropriate. However the ceiling in the first floor bathroom needs to be painted, and ideally the home would benefit from the facilities in this bathroom being upgraded, including fitting of a shower screen, for the comfort of people living at the home. The homes communal areas were decorated to a reasonable standard, and the lounge was bright and inviting. The home continues the practice of encouraging residents (who express an interest) to be involved in carrying out some redecoration work and gardening maintenance for the Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: home so that their independence skills are further developed. All residents spoken to were generally happy with the facilities provided. All equipment in the kitchen was working appropriately, and the kitchen was kept clean and tidy. However there were a significant number of chipped plates and other crockery still in use, and a vent cover (near the refrigerator) needed to be replaced. A new small freezer had been purchased for the home however action needs to be taken to ensure that the ground is leveled out underneath it so that the risk of it tipping over is minimised. The rear garden area was looking quite bare, and in need of some new plants to make it more inviting, and the carpet on the stairways was quite worn. Equipment in the laundry room was working appropriately, however the area behind the drier was quite dusty, and the room itself was in need of repainting. Soap should also be provided at the handwashing facilities in this room. Finally roof windows in the office and one persons bedroom remain in need of cleaning for the comfort of people living and working at the home. The deputy manager advised that crockery, cutlery and glasses for the home had been replaced shortly after the inspection visit. Care Homes for Adults (18-65 years) Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a well qualified and experienced staff team, in sufficient numbers, to support residents and to assist in meeting their assessed needs. All staff have the satisfactory clearances required to evidence a robust recruitment procedure designed to ensure that residents remain adequately protected. Staff are generally well trained, supported and supervised to effectively address residents needs, although there is room for further training in food hygiene to ensure the safety of people living at the home. Evidence: During the inspection I was assisted by the deputy manager, and two other staff members during the course of the day. The staff rota was seen and showed that a minimum of two staff were on duty for twenty four hours each day including two waking night staff. The shifts worked during the day remain: 9.00 am to 5.00 pm; 5.00 pm to 9.00 pm and 9.00 pm to 9.00 am although staff advised that there is some flexibility in providing extra staffing to support residents with particular activities outside of the home. Staff on duty matched those recorded on the rota. Three staff files were inspected. Copies of identity documents, references and Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: enhanced Criminal Records Bureau disclosures were available for all staff as appropriate. No new staff had started work at the home since the previous inspection, so that people have been working with a consistent staff team. There was evidence of appropriate induction training, from staff files sampled. Staff training summaries were also available for staff, indicating the training they had undertaken. Since the last inspection training had been undertaken in safeguarding adults, risk assessments, health and safety, first aid, medication administration, and food hygiene. Other certificates maintained on staff files indicated that staff members had current training in breakaway techniques and managing aggression, HIV and that there were a high number of staff trained or working towards National Vocational Qualification levels 2 or 3. The majority of requirements regarding training from the previous inspection had been met. However I was concerned that there were still a significant number of staff members without current food hygiene training. None of the staff members whose files were inspected had current training in this area, despite this being a requirement at the last inspection visit. Failure to comply with this requirement may result in enforcement action being taken against the home. The deputy manager advised that counselling skills training was being arranged for selected staff members. The deputy manager confirmed that the current NVQ training exceeds the national minumum standard of 50 staff trained to NVQ level 2 or above in care. It is recommended that specific mental health training should also be provided to the staff team. Residents spoken to spoke highly about the support provided to them by individual staff members, and I saw respectful, sensitive and supportive interactions during the inspection visit. Two support workers who work in the home on a regular basis were spoken to briefly, and both confirmed that they had undertaken a full induction program and had participated in a range of core skills training. Records within staff files indicated that staff members were having supervision sessions on a regular basis, which represents a significant improvement from the previous inspection visit. Staff advised that they felt well supported by the management on a day-to-day basis, and that annual appraisals were being arranged. Records of staff meetings indicated that these were being used effectively. However the deputy manager must also be provided with regular supervision, particularly in her current role of acting manager for the home whilst the registered manager is seconded elsewhere. Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: Following the inspection, the deputy manager advised that food hygiene training had been arranged for all staff in May 2009, and that mental health training was also being sourced for the staff team. Care Homes for Adults (18-65 years) Page 27 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a home that is competently managed. The home has appropriate quality assurance systems in place to ensure that the views of residents are taken into account and standards of care are consistently high. Health and safety of staff and residents is generally protected, however further attention is required in identified areas, to ensure that safety precautions remain as robust as possible. Evidence: The registered manager of the home had been temporarily seconded to work at another home, and the deputy manager was therefore in the role of acting manager at the time of the inspection visit. Discussion with her indicated that she was receiving appropriate support from the registered manager and other staff within the organisation including the operational manager. She had completed NVQ qualifications at levels 2 and 3, and was in the process of undertaken further relevant training to her role within the home. Discussion with staff and residents indicated that they felt well supported by the acting Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: manager. The home has a quality assurance system in place with annual distribution of questionnaires to people living at the home, staff and other stakeholders. The results of the most recent surveys were provided to CQC shortly after the inspection visit. A detailed current Annual Quality Assurance Audit was provided for the home indicating awareness of strengths and areas for improvement. Records indicated that there are regular staff meetings held at the home and an increased frequency of residents meetings. This was confirmed by staff and residents spoken to. As noted under standard 6, it is recommended that actions agreed at the end of each resident meetings should be brought forward to be discussed at the next meeting e.g. some residents had requested a snooker table and hallway mirror at one meeting, however this was not followed up at the following meeting. Staff and residents confirmed that the operational manager for the provider organisation undertakes regular monthly visits to the home. However there were no reports of these visits within the last three months available at the home. The deputy manager advised that all findings are handed over to the manager/deputy verbally, and the reports then follow at a later date. However the home would benefit from having full reports made available as soon as possible, to ensure that all issues can be addressed fully. The deputy manager advised that only one person living at the home was being supported by the home on an occasional basis to keep monies in the homes safe for safekeeping. Whilst records were being maintained of when monies were deposited, or returned to the resident, these were not sufficiently clear to protect all parties from financial abuse. The storage of giro cheques on behalf of this person was also not sufficiently clearly recorded. Whilst it is accepted that there are complicating factors with regard to the residents preferences for recording, the home must maintain its own record of all financial transactions to a high standard. A range of satisfactory health and safety documentation was seen including portable appliances testing, fire alarm testing, fire safety equipment maintenance, accident and incident forms. Fire doors in the home were self closing at the time of the inspection as appropriate. Records indicated that weekly fire alarm tests were being carried out regularly and frequent fire drills were also being arranged, although it was unclear whether occasional night drills were being arranged. Risk assessments were available for the home environment and these were found to be appropriate, including the homes fire risk assessment. Appropriate storage was in Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: place for perishable food items stored in the kitchen as appropriate to ensure that people living at the home are protected by appropriate food hygiene procedures. At the time of the inspection current gas and electrical installation certificates could not be found. The deputy manager advised that appointments had been made with gas and electrical contractors shortly after the inspection in order to obtain current certificates. Care Homes for Adults (18-65 years) Page 30 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 35 18 The registered person must 26/06/2009 ensure that all staff members who are involved in cooking, preparing or serving food, are provided with current training in food hygiene, for the protection of people living at the home. . 2 36 18 The registered person must ensure that the deputy manager is provided with regular supervision and that this is recorded, to ensure that she is supported appropriately, in the interests of people living at the home. . 29/05/2009 3 41 17 The registered person must 29/05/2009 ensure that clear records are maintained for giros stored on behalf of any person living at the home indicating when they are received for storage, and returned to the Page 32 of 35 Care Homes for Adults (18-65 years) owner. Clearer records must also be maintained regarding monies kept on behalf of an identified resident, to ensure that people are protected from financial abuse as far as possible. . 4 42 13 The registered person must 29/05/2009 ensure that current gas and electrical installation certificates are obtained from the home, and that fire drills are occasionally held at night so that night staff are fully aware of appropriate procedures (these may be undertaken silently if necessary) for the protection of people living and working at the home. . Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 It is recommended that key-working meeting records and resident meeting records be modified to include a section on progress made on goals set/requests made at the previous meeting, such as undertakings made by the resident or staff member, or requests for issues to be addressed with management, social workers etc. to evidence continuity and responsiveness to issues raised. It is recommended that when residents refuse to attend routine healthcare appointments, this should be recorded on their individual files, and that clear notes should be kept of Care Programme Approach meetings until the official Page 33 of 35 2 19 Care Homes for Adults (18-65 years) minutes are received so that actions can be addressed without delay. 3 35 It is recommended that specific training regarding working with people who have mental health problems should be provided to the staff team, this could be undertaken on an internal basis, to ensure that staff work in line with best practice to support people appropriately. It is recommended that reports of the findings from monthly visits undertaken on behalf of the provider organistion should be provided to the home without delay so that all relevant issues can be addressed in the best interests of people living at the home. 4 39 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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