Inspection on 28/11/08 for The Grange Centre

This is the latest available inspection report for this service, carried out on 28th November 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Grange Centre 25/10/05

The Grange Centre 23/08/05

The Grange Centre 18/11/04

The Grange Centre 11/05/04

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Insight - Eastchurch

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Dovedale Court

Extracts from inspection reports are licensed from CQC, this page was updated on 27/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Grange Centre Rectory Lane Bookham Surrey KT23 4DZ     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: Jane Jewell     Date: 2 8 1 1 2 0 0 8 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 31 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: The Grange Centre Rectory Lane Bookham Surrey KT23 4DZ 01372452608 01372451959 C Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Grange Centre Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 22 Number of places (if applicable): Under 65 Over 65 0 0 0 learning disability physical disability sensory impairment Additional conditions: 22 22 22 The maximum number of service users to be accommodated is 22. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Physical disability (PD) Sensory impairment (SI). Date of last inspection Brief description of the care home The Grange is registered to provide care and accommodation for up to twenty two residents who have a various disabilities including learning disabilities. The Grange Centre is situated in its own extensive grounds on the outskirts of Bookham in Surrey and consists in the main of two premises. The main building is a Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home large Edwardian building converted over the years into its current use for staff accommodation, supported living units, workshops and offices. Many original features are maintained and it has a rich history in providing vocational and education textile work since the early 1920’s. There are on-site educational and recreational facilities for residents including a horticultural centre, a creative textile workshop and an independent living skills department. There are also two shops, which sell some of the produce from these activities. The Grange also own a cluster house in the community and are in the process of creating a shop in the town centre. Gloucester Lodge a purpose build single story residential home built in the grounds of the main house in 2002. The home is made up of three separate residential units and five self contained flats. Each unit has its own lounge and dining area. There is a garden area which surrounds the home which has many attractive features including seating and wheelchair access. Care Homes for Adults (18-65 years) Page 5 of 31 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: The information contained in this report has been comprised from an unannounced inspection undertaken over seven hours and information gathered about the home before and after the inspection. The manager had completed an Annual Quality Assurance Assessment form prior to the inspection and the information contained in this document has been used to inform the inspection. A registered manager Monique de Vos facilitated the inspection which consisted of a tour of the premises, examination of the homes documentation and in-depth discussion with six residents, seven staff and a group discussion with five residents. Three relatives were also consulted about their experiences at the home. There were twenty two residents living at the home at the time of the inspection. Care Homes for Adults (18-65 years) Page 6 of 31 Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: Residents live in a clean, homely environment, which has been decorated and furnished to a high standard with their bedrooms furnished and decorated according to their individual lifestyles. A range of environmental adaptations ensures that residents independence is able to be promoted. Residents lives are enriched by excellent practices in the promotion of independence, meaningful occupation, leisure pursuits, choice and being enabled to live chosen lifestyles. A resident said the best bit about living at the home is being able to be yourself you dont have to conform to anyone else. Integral to the ethos of the home is ensuring and respecting residents rights to make decisions about their daily lives. Residents commented: I choose what I want to wear and buy all my own clothes and Get up and go to bed when I want. The home meets the needs of a wide range of residents including residents who live supported lives and residents who have physical needs. All residents spoke positively about their experiences at the home and a sample of their comments includes: I really enjoy it here I am independent and I enjoy what I do I have a lot of flexibility in my day as long as I tell them where I am going I am pretty much free to come and go as I please nice happy home Best bit is the staff seam to really care about residents I have my own flat which I am in charge off and then work during the day in textiles I really enjoy being independent I enjoy it I get to work in textiles most days I really like living here as I have my own life there is not anything I dont like about living here. A relative commented: I cant believe our luck that we managed to get a place at the grange as it is just so good. A staff member said there has been a steady improvement over the last two years. The fact that residents care about each other is a positive sign The culture here is very resident focused. Residents benefit by being supported to maintain relationships with their families and friends. Relatives said that they can visit at any reasonable time and how welcomed they are made to feel. Mealtimes and arrangements for eating are tailored to meet the individual residents needs and what events and activities were occurring that day. A resident said: you get a choice of what you want. Staff make a positive contribution in residents lives as residents benefit from a supervised, well trained and enthusiastic staff team that know them and who are robustly recruited. A sample of comments received about staff included: very good great friendliness Staff very kind Staff helpful Staff very nice caring one big happy family. There is a well-motivated and knowledgeably management team who promote good care practices, strong leadership and who run the home in the best interest of residents. The manager was due to leave on the day of the inspection and it was clear Care Homes for Adults (18-65 years) Page 8 of 31 how well respected they were by staff, relatives and residents. Suitable interim management arrangements have been put into place until a new manager is in place, which include the active involvement of the responsible individual. The home regularly reviews aspects of its performance through a program feedback from residents and relatives. What has improved since the last inspection? 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. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 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 10 of 31 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. Although prospective residents and their representatives have some information about the home to aid decision making, this needs to include a wider range of information and be in a more accessible format. The home is able to identify and meet the needs of residents. The way in which prospective residents would be assessed ensures that the home admits only those residents whos needs can be met by living at the home. Evidence: There is a range of information available about the home this includes a Statement of Purpose and Service User Guide. Although they contain some information about the home this must be expanded to ensure that prospective residents, current residents and their representatives have a range of information upon which to make informed decisions. It has therefore been required that the statement of purpose must included all areas listed in the National Minimum Standards and more actually reflect the aims Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: of the home and the vast array of services and facilities being provided. The manager was aware of the need to make the service user guide in a more accessible format for ease of understanding including audio and picture format. Documents seen for a recent admission showed that the resident was accommodated following a comprehensive assessment of their needs. Information about their needs was gathered from a variety of sources including the resident, their representative and health care professionals. The needs assessment then forms the basis of their care plan. This helped to ensure that staff were aware of their recorded needs prior to them moving into the home in order to aid a smooth transition to the home. A newly admitted residents family spoke of the various opportunities to visit the home in advance to assess the quality, facilities and suitability of the home. The manager confirmed that the length and type of any visits depends on the individuals needs and preferences. The first six weeks of residency is looked upon as trial occupancy. Permanent residency is subject to a full review of care needs with the residents their representatives and care manager. Residents ages range from 21 years to 78 years, the majority of residents are assessed as having low to medium level of need and include some residents who have physical needs, or who live supported lifestyles and some residents who need support to manage their behaviour. Through observation, looking at records and speaking to residents and relatives, evidence was gathered that the home is meeting the wide range of residents needs. All residents consulted with spoke positively about their experiences or those residents observed demonstrated many signs of well being. A sample of comments about experiences at the home included: I really enjoy it here I am independent and I enjoy what I do I have a lot of flexibility in my day as long as I tell them where I am going I am pretty much free to come and go as I please nice happy home Best bit is the staff seam to really care about residents I have my own flat which I am in charge off and then work during the day in textiles I really enjoy being independent I enjoy it I get to work in textiles most days I really like living here as I have my own life there is not anything I don’t like about living here. A sample of relatives comments included: I cant believe our luck that we managed to get a place at the grange as it is just so good He never really had friends before and here one big happy family and now he really does have friends A staff member commented there has been a steady improvement over the last 2 years The fact that residents care about each other is a positive sign The culture here is very resident focused. Care Homes for Adults (18-65 years) Page 12 of 31 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. Good care practises need be underpinned by a more person centred approach to care planning which reflects the full range of residents needs. Integral to the ethos of the home is ensuring and respecting residents rights to make decisions about their daily lives. The home generally balances well the rights of residents to take reasonable risks as part of an independent lifestyle, however clear guidance must be provided for staff on the risks of managing some challenging behaviour to ensure a consistent approach. Evidence: Five plans of care were inspected, which did not always reflect all aspects of the health, personal and social care needs of residents in order that their needs can be planned for. The home maintains a daily record for each resident on events and occurrences. The tone of language used was respectful however examples were noted Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: whereby the notes were largely repetitive and were not linked to residents care plans and their individual goals. For example where individual goals and care needs had been identified there was little reference to how these were being met in the daily notes in order to provide the accumulative evidence needed to accurately review care plans and personal goals. The manager and senior staff were in the process of reviewing the care planning documentation with a view to making them more person centred and demonstrated a good understanding of the work that needed to be completed to ensure that residents needs are more accurately assessed and staff have the necessary guidance to support them. The home has a developed system in place for enabling residents to take responsible risks as part of an independent lifestyle. Core risks faced and posed by residents are assessed and measures to reduce or manage the risk are generally recorded for staff to follow. However an example was noted whereby staff spoke of the actions to take to help manager a residents challenging behaviour but this was not recorded on their risk assessment to ensure that there was a consistent approach by all staff. Staff were observed using a variety of communication tools to provide appropriate choices for residents regarding food, drink, activities and personal care. Staff were able to give many examples of the impartial support they had provided to individuals when residents were making more significant decisions about their lives. Residents said I choose what I want to wear and buy all my own clothes and Get up and go to bed when I want. Residents participate in the day to day running of the home in accordance with the range of their individual preferences and strengths. The home is proactive in involving residents in as much of planning their day as possible. Residents were observed helping to make lunch and other light domestic chores. Staff demonstrated an awareness of good practices about confidentiality, ensuring that sensitive information is kept secure and knowledgeable about the circumstances under which information must be shared with management and others. Staff are also aware that residents have the right to ask that some information not be shared with family or others. Care Homes for Adults (18-65 years) Page 14 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents lives are enriched by excellent practices in the promotion of independence, meaningful occupation, leisure pursuits, choice and being enabled to live chosen lifestyles. Residents benefit by being supported to maintain relationships with their families and friends. Mealtimes and arrangements for eating are tailored to meet the individual residents needs and what events and activities were occurring that day. Evidence: Central to the ethos of the home is the promotion of residents personal development with a view to enabling residents to move to supported accommodation or to maintain Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: life skills and independence. Many good examples were noted where residents have the opportunity to maintain and develop social independence, communication and living skills. This is to be commended. Much effort is made to enable residents to undertake work in the community or around the centre. The vast majority of residents attend the workshops within the centre. Many residents spoke of their work in textiles where they produce items for sale. Other residents spoke of their involvement in the horticulture programme where they also undertake work in the community. It was clear from discussion with residents that having meaningful occupation significantly promoted their wellbeing and again practices are to commended. As part of enabling independent lifestyles several residents, in the main, organise their own leisure pursuits. For some who need support, a range of leisure activities is provided. On the day of the inspection residents and staff were looking forward to a party organised by the centre. Residents also spoke of going to dance clubs, local pubs and cafes, various leisure facilities, theatres, shopping and bike riding. Staff spoke about being able to be spontaneous in organising leisure pursuits for example if the weather was nice going out for a drive or a walk and meal out. The centre has five vehicles in order to access the community and wider leisure interests. Residents spoke enthusiastically about holidays they have been on this year including group or individual holidays. Relatives commented upon how welcomed they are made to feel when they visit, this included being offered beverages or meals and staff being friendly and approachable. Relatives consulted felt that the home was good at communicating with them and supporting their relative to keep in contact with them. The centre produces news letters and has a relatives forum. There has also been a meet the carers meetings. The staff were sensitive to the potential vulnerability of residents, and mindful of issues around informed consent and adult protection, when residents become involved in intimate relationships. All residents consulted mentioned flexibility in the daily routines and respect for personal freedom and lifestyles being respected. A resident said the best bit about living at the home is being able to be yourself you don’t have to conform to anyone else. On the day of the inspection, it was observed that the routines of the home were reflective of individual needs their lifestyle and individual programmes. Residents were able to move around the communal space freely, choosing which rooms to be in and what level of company they wanted to enjoy. Residents are able to help plan menus, shop for food and in some cases help prepare Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: meals and snacks. Menus showed that a varied and balanced diet is provided which includes fresh produce. Staff spoke of the flexibility in the menus and that several alternative meals are usually also prepared. A resident said: you get a choice of what you want. All residents consulted with spoke positively about the meals. Care Homes for Adults (18-65 years) Page 17 of 31 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. Residents benefit from personal and health care support that is individual, respects their privacy and dignity and encourages them to remain as independent as possible. The medication systems are generally well managed with some practices recommended in order to further promoting residents safety. Evidence: Staff were observed providing dignified and sensitive support to residents which helped to maximise choices and independence. Staff were knowledgeable about the personal care support needs of residents and were sensitive to how this should be provided to respect residents rights and dignity. However, as previously stated staffs knowledge of how to support a residents challenging behaviour must be recorded in order to ensure a consistent approach. Staff support residents to follow their individual health care plans, these contain a record of any visits or contact with health care professionals. There was evidence of current involvement from a variety of health care professionals including General Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: Practitioners, Psychiatrist, specialist nurses, dentists, opticians and chiropodists. It was clear that where there are concerns regarding the health or welfare of resident’s medical advice and intervention is sough promptly. The system for the administration of medication is satisfactory with arrangements in place to ensure residents medication needs are met safely. To further promote residents safety however, it is recommended that additional instructions are provided for staff on the administration of As required medication, which make clear the individual requirements for when this medications was prescribed. This is necessary for staff to know when to administer these medicines. Hand written MAR charts should be signed and dated by the person recording and in order to fully eliminate the associated risk when copying prescribed instructions onto medication administration records, it is recommended that these records should be checked and countersigned for accuracy by a second member of staff. Care Homes for Adults (18-65 years) Page 19 of 31 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. An effective complaints procedure and appropriate adult protection policies helps to protect the rights and interests of residents. Evidence: There is an accessible complaints procedure in place for residents, their representative and staff to follow should they be unhappy with any aspects of the service. Although it is recognised by staff that some residents would require support to make a complaint and were knowledgeable on how they would support a resident to do this. Records of complaints made showed that the homes complaints procedure is followed with all concerns raised taken seriously and appropriately investigated. All relatives and residents consulted with said that they were aware of how to raise any concerns and felt comfortable to do so and that where they have raised minor concerns in the past these have been addressed promptly. The home has written policies covering adult protection and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. Staff consulted with have received formal training in safeguarding adults and prevention of abuse and showed an understanding of their roles and responsibilities under safeguarding adults guidelines. Care Homes for Adults (18-65 years) Page 20 of 31 Care Homes for Adults (18-65 years) Page 21 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean, homely environment, which has been decorated and furnished to a high standard with their bedrooms furnished and decorated according to their individual lifestyles. A range of environmental adaptations ensures that residents independence is promoted. Evidence: Gloucester Lodge is located in the grounds of The Grange Centre and was purpose built with four separate units. Three units have their own lounge dining room and kitchenettes. The fourth unit accommodates individual flats and has a shared dinning room and lounge. Much effort is made to create a homely environment. Standard of decor and maintenance is high creating a pleasant environment in which to live. During the course of the inspection residents congregated in the entrance hall. Consistent feedback was received from both residents and relatives regarding the lack of a central meeting point. This was feedback to the responsible individual who acknowledged that a central area would benefit residents. A Sample of comments included: Staff and residents dont mingle with each other not sure why, need more Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: communal space as we only have the hallway in get together and chat with each other and Environment lovely the only drawback really is that there is not a heart of the home as no central place for everyone to meet up they all have their own space but not everyone want so stay in their flat by themselves or see the same people all the time. Residents bedrooms are highly individualised reflecting their tastes and lifestyles and some have individual adaptations to them to aid independence and mobility. There are sufficient number of toilets and bathrooms located around the home including all bedrooms providing en suite facilities. The home provides a range of individual aids and adaptations to assist residents mobility and independence, including height adjustable beds, ramps, grab rails and overhead hoists. Much effort is undertaken to ensure the environment continues to be able to meet the needs of residents and where it has been identified that further adaptations are needed work is being undertaken. Bedrooms have a call point fitted to enable assistance to be summoned if needed, residents spoke of staff responding quickly when pressed. All areas seen were observed to be cleaned to a high standard, a relative commented it is always kept very clean. Systems are in place for the control of infection and staff consulted with have been trained in this area and were observed to be working in ways that minimised the risk of infection, by wearing gloves and aprons when required. Care Homes for Adults (18-65 years) Page 23 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff make a positive contribution in residents lives as residents benefit from a supervised, well trained and enthusiastic staff team that know them and who are robustly recruited. Evidence: The manager reported that in line with requirements made at the previous inspection, night staffing arrangements have been increased. Senior staff spoke of being able to increase staffing levels if residents needs increased. Staff and relatives felt that there was always sufficient numbers of staff on duty for staff to undertake their roles in a timely manner and for residents to receive the support they needed, when they wanted it. It was observed through the inspection that staff understood their roles and had a good rapport with residents and planning skills. The tasks of the day appeared well-organised and individual staff appeared confident in carrying them out. This helped ensure that residents knew who would be supporting them. Staff consulted with had a clear understanding of the aims of the home and how their individual role contributed towards achieving this. The manager reported that there has been little staff turnover helping to promote continuity in the support that residents receive. Most staff on duty at the time of the Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: inspection had known the residents for some years and demonstrated a good understanding of their needs and preferences. A sample of comments received about staff included: very good great friendliness Staff very kind Staff helpful Staff very nice caring one big happy family really. Many letters of compliment were displayed at the home which praised the kindness and helpfulness of staff. The home has been proactive in ensuring that the majority of staff receive a National Vocational Qualification (NVQ ) in Care or are in the process of working towards it. The personal files of three staff were inspected and these showed that the shortfalls in recruitment practises noted at the last inspection have been addressed. Recruitment files showed that all of the necessary checks had been undertaken to ensure only staff who are suitable to work with vulnerable adults are employed. There is a commitment to improving staff skills through an ongoing training programme both in practical matters and the broader aspects of working with people who have learning disabilities. Staff consulted with said that they had all undertaken the mandatory areas of training necessary for them to work safely with residents. A training and development plan has been developed which identifies the training undertaken and planned for in order for the home to meets its aims and objectives and residents needs. The manager said that skills for care induction, which is the industry recommended minimum inductions standards is about to be introduced at the home. Staff spoke of a formal programme of supervision having just been established. All staff consulted with felt well supported by the management team to undertake their roles. Care Homes for Adults (18-65 years) Page 25 of 31 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 well-motivated and knowledgably management team who promotes good care practices, strong leadership and runs the home in the best interest of residents. The home regularly reviews aspects of its performance through a good program of self-review and feedback. A range of regular health and safety checks helps to promote the health and safety of residents and staff. Evidence: The manager has been registered to manager the home since April 2007. They hold the recommended management qualifications and demonstrated a clear understanding of the daily running of a care home for people who have disabilities. Much feedback was received that they have been instrumental in improving practices at the home since their appointment. Without exception all persons consulted spoke positively Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: about the manager, a sample of comments included: very charismatic and very proactive built this team 100 supportive and approachable fantastic so supportive open door can seek advice whenever. The manager had recently handed in their notice and the day of the inspection was the last day of their employment. It was clear that they were well respected by both residents and staff, who were all anxious about her leaving. Suitable interim managerial arrangements have been organised until a new manager is recruited. The responsible individual is based at the centre and plays an active role in the overall management and direction of the residential unit. Staff spoke positively about them especially their approachability and their willingness to land a hand. There are several mechanisms in place for the manager to obtain feedback on the services of the home and whether it is achieving its aims and objectives. These include: annual placement reviews, residents and staff meetings and feedback from relatives. Examples were noted whereby improvements to working practices and the environment have been made based on this feedback. A staff member spoke of their plans to introduce a formal quality monitoring tool to further assist in the self assessment of practices at the home. Written guidance is available on issues related to health and safety. Records submitted by the manager prior to the inspection stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. Systems are in place to support fire safety, which include: regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The manager reported that a fire risk assessment has been completed which records significant findings and the actions taken to ensure adequate fire safety precautions in the home. However this could not be located at the time of the inspection. The manager agreed to ensure that it was located and made accessible as a working document to staff. Care Homes for Adults (18-65 years) Page 27 of 31 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 28 of 31 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 4 The Statement of Purpose is reviewed to reflect the services, facilities and terms and conditions at the home and in accordance with the National Minimum Standards. That it is made available and is reviewed regularly, in order to inform prospective residents, residents and their relatives about the homes services and facilities. To ensure that there is a range of accessible information about the home to help make informed decisions. 13/03/2009 2 15 That care plans provide clear 13/03/2009 guidance for staff on all aspects of the health, personal and social care needs of service users and which make explicit the actions needed to meet these needs and which include personal risk Care Homes for Adults (18-65 years) Page 29 of 31 assessments for all service users, which are reviewed regularly and records the actions to manage or reduce any identified risks. To ensure that residents needs are identified and planned for 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 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: 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 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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