Inspection on 23/01/09 for 13-15 Constitution Hill

This inspection was carried out on 23rd January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

13-15 Constitution Hill 01/02/08

13-15 Constitution Hill 03/08/06

13-15 Constitution Hill 19/01/06

13-15 Constitution Hill 16/08/05

13-15 Constitution Hill 25/02/05

13-15 Constitution Hill 02/09/04

Similar services:

Chesham House

Argyll House

Coopers Mill Ltd

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Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 13-15 Constitution Hill Norwich Norfolk NR3 4HA 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: Judith Last Date: 2 3 0 1 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. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 40 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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 40 Information about the care home Name of care home: Address: 13-15 Constitution Hill Norwich Norfolk NR3 4HA 01603789450 NOFAX# Pugandmark@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr M Talbot, Mrs J Talbot Name of registered manager (if applicable) Mr M Talbot Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 16 16 0 0 care home 16 learning disability mental disorder, excluding learning disability or dementia Additional conditions: 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: Learning Disability - Code LD Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 16 Date of last inspection 0 1 0 2 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 40 A bit about the care home 13-15 Constitution Hill provides support to 16 people who may have either mental health problems or learning disability. The home is close to the city centre and pubs, shops and takeaways are nearby. Everyone has their own bedroom. No one has to share a room. Two Edwardian houses have been joined together. This means that there is lots of space, including a large lounge Page 5 of 40 Care Homes for Adults (18-65 years) and conservatory. People can use the garden. It costs from £360 a week to live there Care Homes for Adults (18-65 years) Page 6 of 40 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 Care Homes for Adults (18-65 years) Page 7 of 40 How we did our inspection: This is what the inspector did when they were at the care home Before we visited the home we reviewed all the information we had about it. This included information the manager was asked to send us. We also had letters from two of the people living in the home. Care Homes for Adults (18-65 years) Page 8 of 40 We visited the home unannounced and spent about six hours there. While we were there, we looked at and listened to what was going on. We looked around parts of the home, and spoke with three of the people living in the home. Care Homes for Adults (18-65 years) Page 9 of 40 We also spoke to three staff. During our visit, the main method of inspection we used was case tracking. This means we look at records to see what they say about peoples needs. We then find out from discussion and observation what happens in the daily lives of people living at the home. This helps us to see what outcomes they experience. We use this information and the rules we have, to see how well Care Homes for Adults (18-65 years) Page 10 of 40 people are being supported in their daily lives. What the care home does well The owner/registered manager - Mr Talbot - is regularly at the home providing support and advice to the staff about their work. People living there benefit from a relaxed and friendly atmosphere. They particularly single out the manager and the day-to-day manager and tell us they are easy to talk to if they have concerns or worries. Care Homes for Adults (18-65 years) Page 11 of 40 There are good links with other professionals who can help with supporting people and keeping them well. Some staff, including the dayto-day manager, have worked at the home for a long while. This means they understand people’s needs. They were able to tell us about peoples needs and how they were expected to meet them. One person told us they think the staff are very professional. Staff understand and respect people’s right to make decisions about what they do and the support they need. They give people extra support and advice if they need it. Care Homes for Adults (18-65 years) Page 12 of 40 The staff team have been successful in supporting people to be more independent, to improve their daily lives and to recover from difficulties. What has got better from the last inspection Peoples individual plans have been tidied up so they are more organised and staff know where to go for information about how to support people properly. Care Homes for Adults (18-65 years) Page 13 of 40 There has also been some improvement in setting out peoples individual goals and what they want to achieve. People told us that staff talk to them about the support they need and what is written in their files. This means people are more involved in planning their care. The records of the support that staff give to individuals are now kept in separate books. This means that people can now see their records and helps protect their confidentiality A worn carpet has been repaired so that people are not so likely to trip over it. Care Homes for Adults (18-65 years) Page 14 of 40 Copies of training certificates have been put into staff files. This means it is easier for the management team to see when training needs to be updated and to show staff have some training to help them support people effectively and safely. Mr Talbot has started to look more at the quality of the service and what other people think about it. This will help him identify more clearly what needs to improve and to show that people living in the home are able to influence the quality of the service they receive. Care Homes for Adults (18-65 years) Page 15 of 40 What the care home could do better There are four things that Mr Talbot must do by law. One of these is to make sure that medication records are always full and accurate. (Mostly these are good but there was one recent mistake where something was not recorded properly on the medication charts.) One fire exit was blocked but Mr Talbot told us he would clear it. He says it is not needed as a fire exit. There are other ways out of the house. He should talk to the fire service to make sure the arrangements are safe and that every one knows the arrangements. Care Homes for Adults (18-65 years) Page 16 of 40 One item of furniture we saw was missing knobs, making it difficult for someone to use properly. It needs repairing or replacing. Proper, formal and professional supervision is needed so staff are monitored and developed properly and so Mr Talbot can be sure they are performing well in supporting people, in line with the objectives and philosophy of the home. There are some other things that Mr Talbot should think about doing as good practice. Care Homes for Adults (18-65 years) Page 17 of 40 Mr Talbot should continue to look at how he can increase the opportunities people have to be involved in the running of their home and to be able to influence the quality of the service they receive. This could include increasing regular opportunities for residents to have meetings Where people have skills they should be encouraged to develop these so they do not feel their independence is being taken away.” Mr Talbot can provide full details about the things he has been asked to do, or has already done since our visit. Care Homes for Adults (18-65 years) Page 18 of 40 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Judith Last CPC 1, Capital Business Park Fulbourn Cambridge CB21 5XE Her telephone number is 01223 771300 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 19 of 40 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 20 of 40 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 . Peoples needs are assessed so that staff are clear about how they wish to be supported. Evidence: Files show that peoples needs are assessed and also that information is gathered from other professionals who are involved with those who are thinking about moving in. This includes information about abilities and problems, as well as any diagnosis that may relate to peoples mental health. One person specifically commented to us about independence skills they had and said that the deputy manager knows about them as they had talked about them. Care Homes for Adults (18-65 years) Page 21 of 40 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 . People feel they are involved in planning the care and support they need. They feel their needs are met but improvements are needed to records so that these do justice to practice, promote consistency and recognise achievements. Evidence: We looked at support plans for three people and these have improved since our last visit. For example, there is a sheet that sets out the goals for each persons care. However, the goals for individuals are combined to reflect a variety of aims on the same sheet. This makes it difficult to see how people are making progress. We spoke to staff and the day-to-day manager about the changes for one person since our last visit. The information we were given was consistent and showed that the person had made considerable progress around their eating, with staff support. However, the assessment of need and individual goals have not been updated sufficiently regularly to show this achievement clearly. Records show reviews take place with social workers. One person told us yes, I go to Care Homes for Adults (18-65 years) Page 22 of 40 Evidence: them. Another told us yes when we asked if staff talked to them about the things they wanted to do and the help they needed. There are risk assessments compiled at reviews, setting out where people might be vulnerable. We asked a staff member about one person whose needs we were tracking. They gave us information about what would happen if they did not return to the service at the time agreed and if staff were not able to track them down. The actions that would be taken and the timescales for these, were consistent with what had been agreed in the records and signed up to by the person concerned. People told us they feel they can talk to Mark and the day-to-day manager about their home. There are occasional residents meetings. However, they do not take place regularly to discuss the operation of the home and for people to participate in decisions about how it is run. The records are not all in plain English and so would not be easily understood by everyone living at the home. For example, technical language is used to describe the harmful effects of fizzy drinks discussed at a meeting in February and in June. We asked about people participating in the recruitment of staff. We were told that this is an informal basis with prospective staff members meeting residents together and so that the management team can assess their reactions and behaviour, and see what residents think. We were present (at someones request), when one person spoke to the day-to-day manager about some concerns they had. This was handled sensitively by the staff member who emphasised how important it was to respect peoples confidentiality. Since our last visit, daily records for each person are being kept separately. This means that they or their representatives can get access to the information without risking compromising the confidentiality of others. Care Homes for Adults (18-65 years) Page 23 of 40 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 have opportunities to fulfil their recreational, social and spiritual needs. Staff are aware that some people may have complex needs that compromise their opportunities. Evidence: Some people living at the home have jobs. While we were there two people returned from their work places and we saw two people going shopping, including running errands for others. One person told us Ive been out today. Another told us that they met up with a friend for lunch when they were in town for an appointment. One person told us I go to church in the summer. It was clear from these discussions, from Mr Talbots survey and from records that people are encouraged to make use of community facilities as independently as possible. Care Homes for Adults (18-65 years) Page 24 of 40 Evidence: The home supports people to gain skills for independence where they have expressed a wish to move on and records show this. People are encouraged to do their laundry (and sometimes need prompting about wearing clean clothes). One persons care plan is, according to staff, going to be revised and more detailed to show how staff are to support the person gaining the independence skills they feel they will need to move on to a home of their own. However, one person says they used to do more as part of daily routines where they lived before. They say they are not doing these now (like keeping their room clean). They told us its taking my independence. Two people say they can do what they like and decide what I want to do. One told us about keeping contact with friends and family and another met a friend for lunch. Another told us Im interested in words and they had books in their room to support this interest. People also have access to a wide range of books in the lounge and to a games table in the conservatory. Mr Talbot says in information sent to us, that they could do better in staff encouraging people to socialise more by using this table. It is clear from records that people are able to maintain friendships inside and out of the home. One person told us I visit my family and one that Ive got a boyfriend. One person had a visitor while we were there. A staff member told us about people having visitors and one person likes to see them in their own room, where they have armchairs provided for the purpose. Risk assessments reflect peoples vulnerability to exploitation and records show staff counsel people about their behaviour from time to time. While we were there, a staff member spent considerable time talking to someone about difficulties they were experiencing in their relationship with another person living at the home and how this could be handled better. People say they like the food. One person told us we can say what we want. While we were there, one person declined the main meal on offer, preferring a sandwich. This was provided without question and after discussion about what sort. We saw lunch being served and the evening meal. It was clear from remarks that people generally prefer this at a set time and staff took time to explain why the lunch was later than the preferred time. Staff say that menus are to be revised and this will be discussed with people living in the home. People can use the kitchen under supervision if appropriate but are not routinely involved. Records show that people are given advice about healthy eating and this is reflected in one of the care plans we looked at. We have commented in the last section about the advice given to people who might be badly affected by the amount of fizzy drinks they Care Homes for Adults (18-65 years) Page 25 of 40 Evidence: consume. Care Homes for Adults (18-65 years) Page 26 of 40 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 have their personal and health care needs met as they require and prefer. Evidence: We know from previous visits that the home encourages people to be independent with their personal care. Records have shown us before that people are given reminders and prompts, or assistance if they are unwell. Support plans show staff have guidance about reminding people sensitively when this is needed to maintain or improve hygiene and may neglect themselves in this area. A staff member we spoke to told us about how this might be managed and the information matched what we had seen in one care plan. This means that staff are clear about how they should be offering to support people. Records show regular involvement of other health professionals. This includes members of the community learning disabilities team if appropriate, and community psychiatric nursing staff. Discussion with one staff member showed that physical causes for health difficulties (such as maintaining continence) are eliminated before conditions are attributed to mental health problems or behavioural issues. Care plans do not wholly reflect goals about enabling people to recover their mental Care Homes for Adults (18-65 years) Page 27 of 40 Evidence: health and how staff are to do this. However, daily records show that staff are aware of and responsive to, changes in peoples mental health. We looked at the way medicines are managed and discussed this with two people who look after their own. The management team look at whether someone can manage their own medication safely. One person is able to manage part of their medicines safely and keeps one tablet bottle by them in case of anxiety. They told us Its there when I need it and I can take it straight away. They keep it locked in their room for safekeeping. They had got in a muddle with some of their other medicines so they receive staff support to help manage those. The second person had managed their medication for some years before moving to Constitution Hill and was being supported to continue doing this for themselves. They told us Ive done it for a long time. The people we spoke to kept their rooms locked so that others could not access their medicines. Neither have any other separate lockable facility (tin, cupboard or safe) for storage. One other person who met with us and whose records we saw was waiting for a review to tweak their medication and get this right, and they knew that an appointment was being arranged for this. Records show that staff have access to some formal training about managing medicines. The management team say staff observe and are observed until they are confident and deemed competent to administer medicines. The records were generally clear. However, we found that one person had signatures or codes omitted for their medicines due in the morning of 20th January. We asked about this because there were no codes indicating that the medication had been refused and no signatures showing it had been given. We were shown a clear and dated record that the medication had been returned to the pharmacy and refusal was recorded in daily notes. Care Homes for Adults (18-65 years) Page 28 of 40 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 . People know that their concerns are taken seriously and they feel that they are able to raise them with Mr Talbot and his day-to-day manager. There are measures in place to help safeguard people from abuse. Evidence: People we spoke to say that they find it easy to talk to Mark (the owner and registered manager) and the day-to-day manager about their concerns. They say that if they had any complaints that is what they would do. The information the manager sent to us recognises that they could do better in reminding people from time to time, how they can complain and raise any concerns they have. Daily records show where disputes have arisen between service users and concerns expressed. They show that staff act to counsel, support and advise and to try and resolve concerns before they develop into complaints. We saw leaflets on a noticeboard in the hall, providing information about advocacy services that could support people if they felt they needed this, and how to contact them. We spoke to a member of staff who confirmed that they had training in recognising and responding to abuse. Each staff member also has guidance on their personal files and information about whistleblowing. Care Homes for Adults (18-65 years) Page 29 of 40 Evidence: One person we spoke to felt that staff were sometimes abrupt and did not understand them. However, two other people told us they like the staff and one described them as very professional and said they were happy with the way they were treated. Care Homes for Adults (18-65 years) Page 30 of 40 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 comfortable and clean environment, although Mr Talbot acknowledges there is some need for refurbishment. Evidence: We looked around seven bedrooms with permission of people living at the home. Mr Talbot recognises that some of these are rather tired in their decor. One bedroom was in need of redecoration where water had leaked from a pipe and stained the ceiling. The carpet was also coming to the end of its useful life and in another room the carpet was rucked and the wall covering damaged. Mr Talbot has plans to continue with his programme of decorating so we have not made requirements. One door labelled as a fire exit was obstructed with items of furniture. Mr Talbot says this door does not need to be a fire exit and there are other routes through the home. However, he told us he would remove the obstruction. Peoples rooms are homely and they are able to have their own belongings around them. They can keep them how they like. Two people told us they are very happy with their rooms and one said Mr Talbot had put some shelf units together for their personal belongings. One bedside cabinet was in need of repair as the drawer knobs were missing. Care Homes for Adults (18-65 years) Page 31 of 40 Evidence: The main lounge is comfortable and homely. During our visit some people used this to watch television or to read. They also made use of the conservatory for meals and one person read the paper in there. There are systems for testing and checking fire detection equipment to make sure that this works effectively. Staff have guidance about infection control. The kitchen was clean with detailed cleaning schedules for daily, weekly and monthly action. The home has been awarded four stars for food safety by the local environmental health department and has been working towards implementing all recommendations that have been made, based on observation and discussion of the relevant correspondence. The laundry is small but the day-to-day manager reports that it is able to cope with the amount of laundry generated by service users. There were no concerns about hygiene or unpleasant smells noted in the areas seen. Care Homes for Adults (18-65 years) Page 32 of 40 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 . Staff have a good understanding of their roles and are sensitive to peoples needs. However, there is room to improve how staff are supervised and appraised to promote their professional development and support their work with individuals. Evidence: All of the staff have a personal file they can access. This contains copies of relevant guidance for them so they are clear about what the management team expects. There are also job descriptions for all the staff so that each knows how responsibilities are allocated. People told us that they got on well with most of the staff. Mr Talbot and the day-today manager were singled out for particular comment as being approachable and understanding. One person told us they feel that the staff are very professional. While we were there we heard staff speaking to people respectfully, quietly and offering reassurance where this was needed. One person is currently working towards a National Vocational Qualification in care, and another staff member told us they would be starting when their colleague finished. This will help provide staff with the underpinning knowledge to understand peoples needs better. Care Homes for Adults (18-65 years) Page 33 of 40 Evidence: The person we spoke to told us about training they had. We looked at staff files and saw that there are now copies of training certificates on the files. This included updated first aid training, and training in the handling of medication. A staff member told us that they felt they had the training they needed to do their job properly. Recruitment records show that references and enhanced criminal records bureau checks are obtained which helps safeguard those living at the home. People living there are not formally involved in recruitment but are asked for their views after prospective staff have been introduced to them. There are no records of interviews and peoples responses to support that people are subject to a robust and consistent process on each occasion. Supervision is still not happening as set out in standards despite being a requirement at previous inspections and with a short-term improvement. There are brief notes that sometimes consist of general reminders about work related issues, given to small groups of staff. For example, one was recorded as supervision that was a discussion of arrangements for supermarket shopping during one staff members holiday. This means that there is no formal and structured monitoring and discussion of staffs work with individuals, their performance and training needs and their understanding of the philosophy of the home. However, the staff member on duty said that Mr Talbot and the day-to-day manager were friendly and always available to ask if they were not sure of something. They felt they were well supported. Care Homes for Adults (18-65 years) Page 34 of 40 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 . The management of the home is under the control of a competent and very experienced owner/manager who helps to promote people’s safety. He has improved the way he takes into account peoples views about the quality of the service and now needs to sustain this. Evidence: Mr Talbot has been working in the business for over 20 years. Inspection in 2005 showed that the management qualifications were met. We did not check this again. From observation there was a good rapport between staff members and the owner/manager. Staff say they are able to go to him or to the day-to-day manager with queries and concerns. (People living at the home also told us this.) Since we last visited, Mr Talbot has carried out a formal survey to find out what people think of their home. These show that generally people feel comfortable and safe there. He also provided more evidence about how well the service was doing, in the Annual Quality Assurance Assessment he sent to us. We have commented elsewhere in this report about people having more regular opportunities to meet and discuss their views Care Homes for Adults (18-65 years) Page 35 of 40 Evidence: or make suggestions for developing the service. We looked at a sample of records associated with health and safety. These show appropriate safety and maintenance checks. There were records of fire testing, drills and training, and of checks on emergency lighting and fire extinguishers showing these are tested regularly. Staff confirm training in first aid and two people had renewed this training just before we visited. This means we think there are measures in place to help promote the safety and welfare of people living and working at the home. Care Homes for Adults (18-65 years) Page 36 of 40 Are there any outstanding requirements from the last inspection? Yes  No  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 1 6 15.2 Support plans must be 30/04/2008 reviewed with people at least every six months - more often if needs change. If they are not, then people may have their needs overlooked and may not have a regular say in how they want to be supported. 2 36 18.2.a Staff must have adequate 30/04/2008 supervision with the frequency and nature set out in standards. This is so the management team can make sure staff understand peoples needs and are properly supported and developed themselves. This was subject of a requirement at three previous inspections, with improvement noted at the last but one, not being sustained. Care Homes for Adults (18-65 years) Page 37 of 40 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 Description 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 Description Timescale for action 1 20 13 Where medicines are refused 27/02/2009 this must be recorded in the medication administration records. This is because the law says that there must be arrangements for proper recording of medicines. Records need to be maintained up to date and complete. 2 24 23 The manager must seek 27/03/2009 professional confirmation that the obstructed door is not required as a fire exit from the fire officer and must taken this into account in his fire risk assessment. This is so people are not at risk in the event of fire and are able to leave the home quickly and safely. Care Homes for Adults (18-65 years) Page 38 of 40 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 8 Ways of increasing peoples involvement in the running of the home should be considered - for example, increasing the frequency of residents meetings and involving those who wish, in recruitment more formally. This is so people are more fully involved and participating in all aspects of life at the home. Efforts should be made to ensure that people who have skills and interests in joining domestic routines have the opportunity to do so (with or without staff supervision as necessary). This is so people do not feel their independence is taken away and so they do not lose skills. There should be records of questions and responses given at interview. This is to help show that a robust and fair process is followed and so the home had better evidence of the process should they be challenged if someone was refused employment. 2 16 3 34 Care Homes for Adults (18-65 years) Page 39 of 40 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. 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