Inspection on 11/11/08 for 135 Tennyson Road

This inspection was carried out on 11th November 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

135 Tennyson Road 30/06/06

135 Tennyson Road 25/01/06

135 Tennyson Road 08/09/05

135 Tennyson Road 21/03/05

135 Tennyson Road 16/12/04

135 Tennyson Road 29/03/04

135 Tennyson Road 15/10/02

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Claremont House

Oak Ridge

Coopers Mill Ltd

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Paradise Lodge

Bilney Hall

Extracts from inspection reports are licensed from CQC, this page was updated on 30/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 135 Tennyson Road 135 Tennyson Road Luton LU1 3RP     The quality rating for this care home is:   one star adequate 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: Andrea James     Date: 1 1 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. the things that people have said are important to them: They reflect 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 © (2008) 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: 135 Tennyson Road 135 Tennyson Road Luton LU1 3RP 01582721257 Telephone number: Fax number: Email address: Provider web address: eileen.wright@advanceuk.org Name of registered provider(s): Type of registration: Number of places registered: Advance Support Ltd care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 135 Tennyson Road was a mid-terrace house owned by Advance Housing and Support Limited and situated in Luton. The home provided accommodation for four adults who have learning disabilities. The first floor consisted of three single bedrooms, a utility room, a toilet and a bathroom. The ground floor consisted of a lounge, single bedroom, ground floor toilet/shower room, and a kitchen/diner. A pay phone for people using the service was also available The home offered access to a bus stop at the end of the road and the buses go to Luton, Harpenden, St Albans, Watford and London. The local shops and a memorial park were available nearby. Stockwood Park was also available in ten minutes walking time and there were also churches nearby. The home had a ramped access to the front door intended for wheelchair access and a pleasant garden at the rear of the house for staff and people to enjoy. 4 0 4 Over 65 0 4 0 Care Homes for Adults (18-65 years) Page 4 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: one star adequate 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 quality rating for this service is a one star. This means that people who use the service experience an adequate quality outcome. This was an unannounced inspection carried out on the 11th of November 2008. The manager was present for the duration of the site visit which lasted for six hours. The report consists of information received from people using the service, care staff, and other evidence gathered from questionnaires and the Annual Quality Assurance Assessment (AQAA). The report followed a case tracking methodology where a sample of people were Care Homes for Adults (18-65 years) Page 5 of 31 selected at random to see what it was like for them living at the home. These peoples care plans were inspected and where possible, they and their key workers were spoken to. What the care home does well: What has improved since the last inspection? What they could do better: The home should ensure that effective guidelines and infrastructure are implemented to ensure people with Mental health needs have the support they need to live a fulfilling lifestyle. Opportunities should also be offered to all the people using the service in regards to activities and stimulation by ensuring sufficient numbers of staff are rostered on to support people. The environmental standards should be reviewed to ensure all areas of the home are safe for people to use and is in good decorative state. This includes ensuring all taps have running water that is of a safe temperature. All radiators are covered to prevent scalding and trip hazards are removed from the pathway of people needing to access areas of the home. All rooms should also be decorated, doors re- varnished and some flooring replaced to ensure safe hygiene standards. The staff team should be provided with specialist training to include an awareness of Mental health. There is also a need to ensure mandatory trainings are updated for all Care Homes for Adults (18-65 years) Page 7 of 31 staff. Sufficient numbers of staff should be provided to ensure all people using the service are offered opportunities to access community resources. 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 8 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 9 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. The home had good procedures in place to ensure people using the service received sufficient information about the service and peoples needs were satisfactorily assessed. Evidence: The home had a Statement of Purpose and a Service User Guide, both documents were reviewed in 2008. The Statement of Purpose was reviewed in September 2008 to reflect the homes ability to meet the needs of people with Learning Disabilities and Mental health. The manager said this was because they had taken on a new person with Mental health and had applied to vary their conditions of registration. We were informed that the home was also intending to admitt another person with Mental health if the application for variation was sucessful. The home had one new admission since the last inspection and the files inspected suggested satisfactory needs assessments were undertaken prior to and during the stay of this person in the home. The needs assessment document seen clearly stated Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: the diagnosed illness of the person,medical intervention, life skills,religion, social, family, diet, hearing and communication. There was evidence available to suggest people received annual reviews and for the new admission CPA meetings were also held on a regular basis. People spoken to said they were included in the assessment processes and the reviews . Letters recorded in individual files suggested people were invited to attend these meetings and the assessment documentations were signed and dated by individual people using the service, the social workers and the home. There was evidence seen for all people using the service that they had a contractual agreement in the form of a license agreement. This document was signed and dated by the people using the service or their representatives and the manager of the home. Care Homes for Adults (18-65 years) Page 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual needs and choices were identified in peoples care plans and clear interventions were satisfactorily recorded for most of the people using the service but further development was needed to ensure people with Mental health needs have clear interventions to reflect changing needs and risk assessments have clear risk levels identified. Evidence: The care plans inspected suggested peoples needs were accurately and clearly reflected with consistent care interventions. Care staff spoken to were also knowledgeable about the needs of the people they cared for and all spoken to were consistent with the information recorded in the care plan documentations. The care plans inspected had a photo of the person, the date of admission, the weekly planner which detailed the activities to be undertaken,current abilities for eg if the person is able to bath without staff support and a summary of the care plans which Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: recorded overall aim and objectives. The objectives included for example in one persons care plan their ability to cook a meal. This person spoken to said he was allowed to cook on a regular basis. On the day of the site visit he was observed peeling potatoes and preparing vegetables. The person proudly spoke to us and said I cook, go to work three times per week and attend the Elvis club. The care plans also showed how the home helped people to manage their own money and maintain relationships. One person said I have a girlfriend I want to get married. Where the care plan stated for example that a person needed support the support was recorded in more detail, for one person who needed support for arthritis there was a management programme in place. There were also several risk assessments in place to include the use of mobile phones, cooking, being in the house alone, bathing, hot water, smoking and medication.The risk assessments were detailed but the level of risk posed to the person was not identified and as a result could put people at risk as staff could deliver inconsistent care. The home needed to ensure that sufficient interventions are in place for people with Mental health needs. The current person diagnosed with Mental health had a care plan stating his needs in regards to daily living but further development was needed to ensure clear interventions such as relapse indicators and risk assessments are in place to state how care staff should care for this person. On the day of the inspection this person was escorted into the community and posed a threat to the care staff and members of the public, as a result the manager had to quickly go and assist the care staff and diffuse the situation. The care plan documents for this person failed to have relapse indicators or satisfactory risk assessments. It was suggested that risk assessments be put in place for this person accessing the community to involve having two staff to escort him. The daily activities for this person was also very limited due to the fact that the persons Mental health needs was unpredictable. The manager said the recent behaviors have only just began. The staff team appeared to lack confidence in meeting this persons needs. There was evidence that some people were able to make decisions about their own lives with assistance and support from the staff team. One person was able to go to the shops to purchase new curtains for his windows on the day of the site visit. One person said I go to work and take the bus on my own, I enjoy it. The service encouraged people to participate as much as they can in the daily running of the home. People spoken to said they were able to perform daily chores around the home to include cleaning their rooms, preparing their meals, laundering their clothes, going food shopping and general cleaning of the home. Care Homes for Adults (18-65 years) Page 13 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities were made available for people using the service to have personal development and their dietary needs were met, but further development was needed to ensure all people using the service receive sufficient stimulation through activities provided. Evidence: The care plan documentation and other evidence seen on the day of the inspection suggested most people were given sufficient opportunities for personal development. One person said I want to get a flat and the staff are helping me to develop my skills. The care plan documentation and recent reviews suggested this persons long term goals were identified and objectives were set in line with developing the persons skills. The home also provided various equipment to aid development to include personal computers, music systems, mobile phones and employment where possible. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: There was also opportunities for people to develop with the activities provided in the wider community. People spoken to said they attended weekly clubs both during the day and in the evenings. The home also provided advocacy and befrienders for people to ensure they are able to participate in community activities. Staff spoken to said we try where possible to stimulate them and meet their needs but sometimes we do not have enough staff for activities. One person said I go out to restaurants with my sister on a regular basis and I like that because I get to have a meal out. He also said I go to the pub to have a drink. The opportunities recorded for activities offered to this person was not sufficient during the day, as he spent most mornings watching television while others are out. His care plan states he doesnt do anything until after lunch. He was observed sitting in the lounge and making cups of tea during the site visit but when taken to a doctors appointment posed challenging. There was evidence to suggest people were enabled to maintain family and other relationships where appropriate. People spoken to said they had visits from their family on a regular basis. One person saw his sister weekly, while another said he had a girlfriend who he visits. The dietary needs of people using the service was of a satisfactory standard. People spoken to were very health conscious and spoke how they used the information provided to them to make choices about what to put on the shopping list which forms the basis for their menu planning. The home failed to provide a menu but the food eaten on a daily basis were recorded which showed healthy choices were eaten. One person said I like burger and the staff will give me what I want when I ask. The food stocks seen on the day suggested sufficient food was available for consumption. The care staff said they supported people to prepare meals and all the people using the service and care staff sits to have a meal of an evening. Care Homes for Adults (18-65 years) Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home had made appropriate arrangements for the personal and health care needs of most people, but for one person his health care needs in regards to Mental health was not comprehensive as a result one individual failed to receive health care support in the way he should. Evidence: Peoples health care needs were met in a very comprehensive way. All people had in place Health Action Plans which were written in a person centered way to reflect medical conditions, skin care, physical health, eating, drinking, smoking, eye health, continence, emotions and weight. The AQAA ( Annual Quality Assurance Assessment) tool received by the Commission stated that these plans were implemented with the assistance of the people using the service and external professionals. The Mental health needs for one person needed further development, although information was seen to suggest people with Mental health had reviews and medication changes there was a need to ensure the Mental health assessments were undertaken and relapse indicators implemented. Staff spoken to said this persons Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: Mental state had deteriorated but very limited infrastuctures were in place to meet his needs. The home s AQAA (Annual Quality Assurance Assessment) stated that they were working on new policies to be implemented to reflect the needs and wishes of people in the event they became ill or if they died. The policy on terminal illness, ageing and death provides guidelines for staff including guidance on how to address specific cultural and religious requirements for individuals. This information was located in some peoples files. The home had satisfactory medication policies and procedures in place and evidence seen suggested these procedures were reviewed on a regular basis. The medication policies included medical history of people using the service, the side effects of medication that could affect the people taking the medication and the temperatures of the storage facilities used for medication. The home had Medication administration record sheets ( MARS) which were satisfactorily maintained. The medication stocks inspected were stored with evidence of receipt and disposal procedures. Staff were observed administering medication to people in a confident and professional manner. The manager said all staff received medication training on an annual basis, staff spoken to were able to confirm this information. Care Homes for Adults (18-65 years) Page 18 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. People were safeguarded and their concerns listened to, as a result people using the service were protected. Evidence: The home had satisfactory policies in place for receiving and dealing with complaints and compliments. Since the last inspection the home received one complaint which was satisfactorily resolved and information seen suggested the policies were followed. People spoken to said if they were not happy about something they would speak to the staff. The home also received one safeguarding referral with regards to the safety of one person and as a result new guidelines were implemented. The home manager said staff had safeguarding training which was confirmed by the staff spoken to and the training records. There was however a need to ensure up to date safeguarding policies and procedures are in place as the policy seen was dated 2001. Care Homes for Adults (18-65 years) Page 19 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided a comfortable and welcoming environment for people who use the service but further development was needed to ensure people were safeguarded and the decoration was modern throughout. Evidence: On the day of the site visit we were able to tour the environment and found the home to be clean and free from offensive odours. During the day people were seen to be undertaking their daily chores, which included cleaning of bedrooms and communal areas. Although the home was clean there were some areas that detracted from the homeliness that the service tries to create. There were some areas that was in need of redecoration as it had become worn and was not in the line with other modern parts of the home. We identified that effort had been made to ensure hot water temperatures within the home were safe but this work was still not completed and as a result the water in the bathroom was excessively hot. We were informed by the manager that the work men had disconnected the water in the hand basin of this bathroom and as a result people using the service had no water to use. The radiator in this same bathroom was also excessively hot and due to the limited space in this room people who use the service Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: could be burned as a result. Staff spoken to said they found it very difficult when supporting people in this bathroom, as the gap between the radiator and the bath was very limited. One toilet which had lino flooring was discoloured and the gap between the toilet and the floor was dark brown and appeared very unhygienic. People who use the service gave us a tour of their bedroom which was personalised to meet individual needs and personalities. One person however had no headboard and as a result had to use the wall for support. Another room seen was also in need of redecoration as the paper had become discoloured. One door was discoloured and in need of revarnishing. The home had one bathroom, one shower room and two toilets which were sufficient to meet the needs of people using the service. The shower room was cluttered with mop buckets and mops which suggested these could become a trip hazard to people wishing to use the facility, especially when one of the person using this facility was wheelchair bound. The communal space provided for lounging and dining were spacious and satisfactory for meeting peoples needs. Care Homes for Adults (18-65 years) Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were supported by a competent and effective staff team, but further development was needed to ensure sufficient numbers of staff are available to provide effective stimulation to people and staff are trained in areas of speciality to provide expert care to people using the service. Evidence: The home employed five care staff, two worked on a full-time basis while three worked on a part-time basis. The home had no senior support workers and as a result the manager worked as a part of the rota as well as undertook on call duties. Staff spoken to said they had to work on their own in meeting peoples needs. On the day of the site visit the carer was on her own with the occupants of the home. This was concerning as one person was taken into the community and then became challenging and the manager had to be called to assist. We observed that extra members of staff were rostered on in order to take other people to individual appointments. During conversations with staff we were informed that one person was not able to access some activities due to the fact that there were not sufficient staffing levels and his behaviours were unpredictable. This persons activity programme was inspected and found to be sparing. One staff said we try to Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: stimulate them and meet the needs but at times there is not enough staff to meet individual peoples needs in regards to activities. Staff files inspected suggested satisfactory recruitment procedures and policies were in place. Three staff files inspected had application forms, references, medical clearances and criminal records bureau checks. The files also contained induction handbooks and supervision records. Staff spoken to said they enjoyed their job and felt supported by the manager. They commented that they recieved supervision on a regular basis. Two members of staff said we have a family environment and we are able to approach our manager, she is sociable. People spoken to said I like the place, they look after you. Another person said staff treat me well, they give me my tablet every day because I am not well. We observed that the staff team carried out their work in a competent and professional way. One staff said its a good place to work, we work as a team and the care we give is excellent. They also commented that they received regular training. This was evidenced through various certificates and training records inspected. Four staff had achieved their NVQ level 2 in care and all other care staff have embarked on their NVQ level 3. There was also evidence that several staff had undertaken mandatory training in 2008 but further development was needed to ensure staff received training in mental health awareness, medication, infection control and health and safety. Care Homes for Adults (18-65 years) Page 23 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 adequate 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 appears satisfactory to meet the needs of people, but further development was needed to ensure the manager works in a supernumerary position, a senior member of staff is on shift at all times and people were safeguarded, as a result peoples safety could be compromised. Evidence: The home was run by a new manager recently appointed in February of this year. She was promoted from a team leaders post from one of the sister homes in Advance Support where she worked for 5 years. She has her NVQ level 3 qualification and is in the process of completing her Registered Managers Award. She has recently applied to the Commission for registration but to date have not received an interview (10/11/08). The rotas inspected suggested that the manager worked as a part of the care team and was not supernumerary. When questioned she said she worked 28 hours as the manager of the home and the rest as a care assistant. She also has to undertake sleep in duties once per week. This was concerning as the manager could not dedicate her Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: time to the management of the home. She was also on call when not at the home as she does not have a senior person to deputise in her absence. The manager commented that other home manager helps with the on-call duties. Staff spoken to said they felt supported by the manager and said she was approachable. People spoken to also said the manager was nice. The home had some quality assurance systems in place but further development was needed. The manager presented some evidence dated January 2008 from information received in 2007 which stated 92 of the people who use the service liked the meals they received and 99 felt that they were listened to. The manager said questionnaires were completed for this financial year but were being collated by the organisation. The manager ensured staff received regular staff meetings and staff spoken to confirmed this took place. The home had a health and safety policy and procedures were in place to protect people. This policy was hover, implemented in 2006 and was in need of a review. The health and safety risk assessment was undertaken on the 11th of March 2008. The fire safety checks were satisfactory undertaken and recorded in accordance with fire regulations. There was also a deaf guard in place for one person who was deaf and would not be able to hear the fire alarm should it be raised. There was a need to ensure the areas identified in the environment section of this report are addressed in accordance with health and safety, namely the temperatures of hot water dispensed from bathroom taps. This risk have been identified in several of the care homes inspected by us within this organisation for the past two years and it appears that a reactive approach is being taken, where only after an inspection is the problem addressed. Care Homes for Adults (18-65 years) Page 25 of 31 Are there any outstanding requirements from the last inspection? Yes R 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 24 12 14(2) 23 The registered person must 30/11/2005 submit an action plan, which sets out a programme for reviewing the future needs of the existing service users in the context of the suitability of these premises. Original timescale of 31st January 2005, extended to 31st March 2005. ( this was not assessed on this occassion). 2 33 18 The registered person must 30/11/2005 review the staffing ratio for people at nights. The outcome of the review must be implemented immediately to meet the needs of the service users. (This requirement was not checked at the inspection so remains open) Care Homes for Adults (18-65 years) Page 26 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 6 15 Clear interventions and guidelines must be recorded for people with Mental health to reflect their daily needs. To ensure peoples changing needs can be met satisfactorily. 30/12/2008 2 9 13 Arrangements must be made to ensure risk assessments undertaken highlights the level of risk posed to the person being assessed. To ensure unnecessary risk to peoples health and safety are clearly identified and reduced where possible. 30/12/2008 3 14 12 Opportunities must be 30/12/2008 provided to ensure all people using the service are provided with sufficient stimulation through meaningful activities. Care Homes for Adults (18-65 years) Page 27 of 31 To ensure peoples social interests and hobbies are are encouraged. 4 19 12 Appropriate interventions 30/12/2008 must be in place to ensure people with mental health have their health care needs met effectively. To enable people to take control and manage their lives. 5 24 23 Arrangements must be 30/12/2008 made to ensure all areas of the home are satisfactorily decorated to reflect the style and ambience that reflects the homes stated purpose. To ensure maximim comfort for people using the service. 6 24 13 Arrangements must be made to ensure people are safe from scalding hot water. To protect people from being burnt by excessively hot water. 7 24 13 You must protect people from being burned by providing adequate radiator covers to all radiators in the home. To protect people from burns. 8 27 13 Arrangements must be 30/12/2008 made to ensure the bathroom and toilet fooring is replaced and is in line with infection control procedures. 30/12/2008 30/12/2008 Care Homes for Adults (18-65 years) Page 28 of 31 To protect people from infection and to create a welcoming environment. 9 33 18 The Home must ensure sufficient numbers of staff are available to meet the needs of people to ensure stimulation can be provided at all times. To support peoples assessed needs. 10 35 18 All staff must recieve training in Mental health awareness. To ensure care staff are able to effectively meet the needs of people with mental health. 11 35 18 All staff must be have up to date training in Medication, Infection control and health and safety. To be able to provide quality care to people using the service. 12 37 12 Arrangements must be made to ensure a senior member of staff is available in the home at all times. To provide support to the staff team and people using the service. 30/12/2008 30/12/2008 30/12/2008 30/12/2008 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 29 of 31 1 2 23 25 Safeguarding polices and procedures should be updated to reflect current practices. All people using the service should be provided with sufficient furnishings to ensure their comfort. In this case one person failed to have a headboard on his bed. The manager should ensure she has an NVQ level 4 in care and management or the equivalent. All efforts should be made to ensure the manager works supernumerary to the rota. 3 4 37 37 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 © (2008) 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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