Inspection on 23/09/08 for 14 Westfield Lane

This inspection was carried out on 23rd September 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

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 14 Westfield Lane 14 Westfield Lane St Leonards-On-Sea East Sussex TN37 7NG two star good service The quality rating for this care home is: 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: Michele Etherton Date: 2 3 0 9 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. 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 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: 14 Westfield Lane 14 Westfield Lane St Leonards-On-Sea East Sussex TN37 7NG 01424756632 01424751641 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hastings and Rother Primary Care Trust Name of registered manager (if applicable) Mrs Joan Hesmer Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 6 0 care home 6 learning disability Additional conditions: 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) The maximum number of service users to be accommodated is 6. Date of last inspection A bit about the care home 14 Westfield Lane is situated on the outskirts of St Leonards on Sea, with local shops approximately a quarter of a mile away; Hastings town centre with its shops and access to rail services is approximately two miles away. The home is purpose built with all accommodation in single rooms at ground level. It is registered to accommodate six adults with complex needs and a learning disability. The registered providers are Hastings & Rother PCT Learning Disability Service who manage nine other homes within the Hastings, St Leonards and Rother area. The property is leased to Downland Housing Association who are the landlords and are responsible for maintenance of the home. It is not possible to identify the fees for each resident as they are all placed by the East Sussex Adult Social Care Department under a contract. The Statement of Purpose and Service User Guide are available on request from the home. 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 How we did our inspection: This is what the inspector did when they were at the care home A key unannounced inspection of this service has been undertaken, this has taken account of information received from the service and about the service by CSCI since the last inspection, including an Annual Quality Assurance assessment (AQAA) completed by the manager. The AQAA has been completed to a reasonable standard and provides us with some of the information we need, some areas would be improved by more supporting evidence to illustrate what actions the home has taken to address previously identified shortfalls within the service and current and future plans. The inspection includes an unannounced site visit to the home on 23rd September 2008 between 9:30 am and 16:00 pm. During the visit a tour of the home has been un dertaken, we also consulted with staff on duty, and met all residents, owing to their special communication needs we have been unable to consult directly with them to obtain their views about the service but have spent time observing some of their daily routines and the support they receive from staff. Survey responses have been sought from residents and other stakeholders but only limited responses have been received, we will endeavor to analyze and incorporate any survey information that arrives before the final report is issued. As a new registration but not a new service all key standards have been assessed except that pertaining to recruitment, this is to be assessed by a CSCI representative separately and will take an overview of recruitment practice for all care homes registered with the PCT. During our visit we examined a range of documentation including support plans, risk assessment information, menu records, medication records and storage, staff supervision and training records, complaints, accident and health and safety information. In arriving at our judgment we have tried to be proportionate in considering compliance with regulation and outcomes for the residents alongside the overall risks and impacts of identified shortfalls. What the care home does well The home provides pleasant and homely accommodation for residents within the community. Residents are provided with some activity each day and opportunities to make use of community facilities each week, they are supported and enabled to participate in some daily household routines, and their independence is maintained and promoted. They enjoy an annual holiday. The service has developed good links with families and liaises well with other agencies, actively seeking the interventions of other professionals where residents experience change. The service is responsive and flexible. Staff have opportunities to receive a range of training. What has got better from the last inspection Staff have told us that staffing levels and continuity for residents has improved and that they feel better supported. The PCT has provided the home with a computer and access to the INTERNET, the manager and staff welcome this. AQAA information tells us that: all residents have person centered planning and that residents and other stakeholders are involved in developing this. That support plans for each resident have been condensed and made easier to read. That guidelines are in place to support risks and residents are provided with opportunities to participate in activities more reflective of their own interests and take responsible risks. A wider range of activities is on offer, and residents make full use of local and community facilities. The complaints procedure has been developed into a more accessible format. Storage of old equipment and furniture in need of disposal is more responsibly and discretely stored, plans for upgrading of an underused bathroom and some upgrading of decoration has occurred and is continuing, plans for new carpeting in some areas have also been approved. AQAA information informs us that the home has demonstrated a commitment to the formal training of staff and they now have 80 of staff trained to NVQ level 2. Improvements have taken place in the recruitment of staff to ensure managers and residents have a more active role. managers hours have changed to enable them to undertake their management responsibilities more fully and enable them to have a more supernumerary role on the staff rota. The frequency of staff supervisions has increased. What the care home could do better The inspection has highlighted shortfalls in the update of staff training in mandatory core skills, we are particularly concerned that half of the staff team are out of date in moving and handling training and that for the current resident group this is a key area of support provided by staff, whilst we are not concerned that staff competencies on a day to day basis are inappropriate we consider it important that staff awareness of changes in practice is updated to ensure they work to current best practice and that both staff and resident health and safety is promoted at all times. We are similarly concerned that half of the staff team are still to update Adult safeguarding training to ensure they respond appropriately to safeguarding incidents, whilst we can be confident that the manager who has received recent training can advise and guide staff appropriately in the interim it is essential that all staff receive this updated training to understand their roles and responsibilities within the multi disciplinary protocols agreed for East Sussex to protect residents from harm. A number of good practice recommendations have also been made where we consider the service could improve existing arrangements in respect of clarity, recording and accessibility of information relating to license and contractual agreements, risk information, menu and activity information, medication, complaints, fire drill frequencies and further development of the quality assurance programme. 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 Michele Etherton The Oast, Hermitage Court Hermitage Lane Maidstone ME16 9NT 016 2272 4950 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 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 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents feel they have been given enough information about the service but we feel this now needs updating and should make clear costs residents are responsible for. The needs of residents are assessed prior to admission to the home. Evidence: Current residents have informed us through survey feedback that they feel they had enough information about the service prior to their admission. All residents have their own copies of Statement of Purpose and user guide information and this is in more accessible formats but needs updating to reflect the recent change to a new PCT. We looked at license agreement and resident contract information and found that only license agreements have been developed into an more accessible format with picture references. We have found that Information about residents responsibilities in respect of transport costs differs from that in contractual information which remains in a standard format. It is recommended that existing accessible information is updated to reflect the change of PCT, and that license agreement and contractual information are equally accessible in format and contain consistent information in respect of resident financial responsibilities, in particular arrangements for funding transport costs. All of the current residents have lived at the home for some years and there is evidence that their needs were assessed appropriately prior to admission. 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 . resident support plans more fully reflect individual routines and preferences but may not always incorporate agreed changes. Residents benefit from opportunities to make choices and decisions but this could be improved upon by better use of pictorial prompts and reference objects. A risk strategy is in place but this needs to more fully reflect risks posed by individual residents and those they are subject to, there is a need to review risks at least annually. Evidence: We examined a sample of four support plans these have improved and are more person centered and reflective of the individual residents support needs, information is sufficiently detailed to inform staff and has supplementary guidelines around specific needs. In examining records we noted discussion and agreement by staff to minor changes in support for two residents, examination of the support plans in question highlighted that these changes are yet to be incorporated, whilst these omissions are not likely to place either resident at risk, they would if implemented enhance their experience of support from staff and should be progressed. We would suggest that greater attention is given to ensuring the cross referencing of information from other sources where this has impact on the daily routines of residents. Residents with relatives support in addition to a health professional have told us that: The staff are always observant to my needs and keep me occupied and happy Very pleasant and helpful staff who are always providing very high quality care Evidence: When we read one resident file and observed staff practice we noted that although demonstrating kindness and patience with the resident concerned they were not adhering to established guidelines for working with that resident, but with other residents we noted that observation of staff practice and support matched with guidelines for support viewed. This discrepancy has been discussed with the manager who thought that our presence in the home may have affected the way in which support was offered, it is important that support is delivered consistently to residents irrespective of the distractions that may occur during the course of each day. We received limited but mixed feedback from residents about the amount of decision making and choice they have in their daily lives with one saying they always make choices and decisions and another saying they sometimes do, staff reported that they tried to facilitate choice and decision making by offering alternatives wherever possible, records we examined also evidenced residents making some choices in their day to day lives, one resident we spoke with told us they had gone on holiday to Scarborough but had not made the decision to go there they wanted to go to Butlins next time. Opportunities for residents to make decisions and choices would be better supported by use of more accessible information in the form of pictorial prompts and reference objects. There is an established risk assessment strategy and we looked at risk assessments on some of the resident files viewed, we found in one case that records within the resident file highlighted a concern in respect of taking others medication but this had not been developed as a risk assessment with clear information as to the risk reduction measures in place for this resident, although staff had an understanding of the risk and managed it in their everyday practice, we also noted some risk assessments had not been updated since 2007 although others were seen to have been, it is recommended that risk formats are reviewed to provide a more person centered and individualized focus on risk and that risks are reviewed a minimum of annually. 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 . Activity opportunities can vary in frequency and quality, location limits residents local community presence but staff support them to access the wider community and its facilities. Residents are enabled and facilitated by staff in maintaining links with important people in their lives. daily routines promote Independence and involvement in household tasks. Residents benefit from a well balanced diet but their involvement in menu selection and records of food intake could be improved. Evidence: We looked at activity planners for four residents and also looked at daily records which tell us what residents have done each day, whilst it is clear that residents are being provided with opportunities to go out this does not reflect the same level of activities as detailed on individual activity planners. We noted that during the period 2/9/0822/9/08 activity planners indicated each of the four residents we sampled should have experienced a minimum of four outings weekly each, daily records for the same period indicated that they had in fact experienced only seven outings each for the whole period. Whilst it is clear that residents are being provided with activity opportunities the frequency, quality and variety of this can be inconsistent, where alternatives to planned activities are offered the reasons for this should be made clear and residents provided with a means to be actively involved in choosing the alternatives on offer. We recommend that activity programmes are revised to reflect achievable activities and should incorporate an element of those aspirations expressed by residents through resident and life plan meetings. Evidence: The more rural location of the home makes it more difficult to sustain a local community presence for residents although clearly residents are supported to make use of facilities in the wider area. From discussion with residents and staff and reviewing records we are confident that residents are enabled and facilitated to maintain links with important people in their lives, and that these people are involved in planning meetings at the request of the resident. Residents independence is promoted and they are encouraged to take an active role in household tasks however minor, there is a need to ensure this does not become a replacement activity rather than a means to maintain independence and uphold the right of residents to take an active role in the running of the house. Residents benefit from a nutritional and balanced diet which takes account of their personal likes and dislikes, records of food intake do not evidence alternatives being offered although we observed residents being offered some choice in dessert and staff told us they would offer an alternative if residents made clear they did not want to eat the meal provided, food records we looked at are insufficiently detailed to evidence that alternatives are routinely offered and record of food intake fails to record individual residents and whether they are maintaining a good diet, and we would recommend that staff record in daily record information what residents have eaten as a main meal each day, also that the development of pictorial menus is progressed to ensure residents can be more actively involved in the development of menus and individual meal selection. Residents ate together at lunch and support from staff was observed to be discreet and patiently given, residents were asked what they wanted from a general selection for lunch and were given visual prompts to aid decision making. 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 . Staff understand the preferences of residents within their daily routines. Residents are supported and enabled to access routine and specialist health care appointments. Medications arrangements are satisfactory but would benefit from suggested improvements Evidence: Staff generally have a good understanding of the daily routines of residents and their individual preferences, omissions we noted in individual resident records of agreed changes in staff practice have been addressed elsewhere in the report. We looked at health action plan and evidence of contacts with health professionals, we found that residents are being supported to access health routine and more specialized health appointments and found only one resident where a dental appointment is still to be organized. Medication administration and recording is satisfactory although we would recommend that all creams drops and liquid medications are dated upon opening for audit purposes. We have also asked the home manager to be mindful of the storage requirements should controlled drugs medications be issued to a resident as current facilities would not meet legislation requirements. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents are aware of the complaints procedure but their concerns may not always be interpreted as such by staff. Systems are in place to safeguard residents from harm but they would be better protected by improved awareness and understanding by staff of new procedures and their roles and responsibilities therein Evidence: Residents have told us through survey information completed with relatives that they understand the complaints procedure, a more accessible version has been developed and has been provided to all residents and is on display. An examination of some resident files indicated staff have access to information about residents communication styles and records demonstrated staff have a sound knowledge of residents verbal and non verbal signs of distress or concern and yet none of these incidents have been interpreted as complaints by staff, consideration needs to be given to doing so where staff can link distress to a specific incident and where it would be reasonable to expect an able bodied resident to make a complaint in similar circumstances, the home should consider the aid of an advocate in looking at how this could be progressed. We have expressed concern at confidentiality of complaint recording under the present system and further thought needs to be given as to how this can be improved, these are recommendations. We are unaware of any adult alert issues relating to the home at this time and the training matrix viewed indicates all staff have previously received training in adult safeguarding however half the current team are now long overdue updates, particularly with recent changes to the locally agreed multi agency protocols, staff told us that they would report any incidents to the manager and whilst we are satisfied that the managers practice is updated and she would be able to advise and guide staff through the alert process appropriately, all staff should be updated to understand their roles and responsibilities under the Sussex multi agency protocols and ensure incidents are handled appropriately at all stages particularly in the event of the managers absence, we have required the provider to ensure staff training in this area is updated within the timescale stated. We have looked at arrangements for recording and Evidence: monitoring resident finances and have examined cash balances and records for two residents these have been found to be accurate. We have noted behavior guidelines in place for some residents, our observations confirmed staff have an understanding of these and try to implement them but this can sometimes be undermined by the presence of visitors who may be unaware of appropriate responses to make, it is for staff to be proactive in these instances and encourage visitors to make the appropriate responses and ensure continuity for residents. 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 comfortable environment that will benefit from planned upgradings internally and more imaginative use of external space. Fire arrangements are satisfactory but staff need to be more regularly reminded of actions to take in the event of a fire. Evidence: Residents live in a clean comfortable and homely environment, that would benefit from further planned upgrading to an underused bathroom and in some communal areas. residents have access to a large patio area and the garden which is on two levels has an accessible path but this has been allowed to become overgrown, a greenhouse which although inaccessible can be approached by residents to the doorway is unused, more imaginative use of the greenhouse and planting alongside the pathway would enable residents to participate more fully in garden activities and this should be considered. We found resident bedrooms that we viewed to be pleasant and reflective of individual preferences in respect of colours used, and were personalized with photos and personal possessions of interest or significance including sensory stimulation. As with other PCT homes we have visited we note that many of the residents have purchased their own bedroom furniture and in some instances specialist equipment for their use, and this has occurred under previous PCT responsible for the home. Whilst it is accepted that residents may actively choose to purchase items over and above what the provider is required to provide, there should be a clear rationale recorded for how such decisions in respect of significant resident expenditure are made, the manager is reminded of the need to ensure all such future large purchases are managed in this way. We have looked at the fire log and this tells us that in most cases tests and checks of fire alarm and fire fighting equipment happen routinely as does annual servicing. There Evidence: is evidence of a fire drill being conducted in the last 12 months but we would recommend that all staff participate in a minimum of two annually, and fire drill records should clearly evidence staff participants of drills for audit purposes. One bathroom remains underused because of accessibility issues for the majority of residents, although this has been outstanding for some time a review of provider visit records highlighted that permission has been granted for the upgrading of the bathroom and quotes are currently being sought for this work to be undertaken, in view of this we would recommend only at this time that these works are progressed in a timely manner in view of the lengthy delays already experienced by residents in having a wider choice of bathing facilities. residents benefit from having a range of equipment and aids to support their day to day care and support, in all but one case equipment had been appropriately serviced, the exception being a hoist used by only one resident and a service is booked for one weeks time. We have reminded the manager of the need to ensure that all equipment is serviced to manufacturers guidelines as failure to do so compromises existing moving and handling, risk and health and safety policies established by the PCT. As stated we found the home to be maintained to a good standard of cleanliness, staff told us that they have access to protective clothing and have a sound understanding of precautions to take in the event of occasional management of soiled laundry. 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 feel better supported and staffing levels are improved but continue to have some impact on residents activity levels. Managers and residents are more actively involved in staff recruitment processes. There is a commitment to formal staff training but shortfalls in ensuring basic core skills are updated could compromise resident and staff safety. Evidence: We looked at AQAA information provided by the home which tells us that at the time of completing the form nearly 1/3rd of available shifts were being covered by agency staff, at the site visit we spoke with the manager and staff about staffing levels and looked at staff rotas, staff tell us that the immediate impact of changing to the new PCT is that on staffing levels, they consider there has already been a significant improvement providing greater stability within teams and continuity for residents, the rotas we viewed indicated a reduction in usage of agency cover, however as several of the residents need two staff for moving and handling, staffing levels are still tight and without the supernumerary position of the manager could impact on activities for residents, with some evidence of staffing problems impacting on cancellation of some activities for residents. The AQAA information provided by the home tells us that 80 of the staff team are now NVQ 2 trained and the service is to be commended for its progress in this area. A newer staff member we spoke with was able to confirm for us that a sound recruiting procedure is in place with opportunities for prospective applicants to visit houses prior to the offer of a post and meet with residents, the staff member commented that Im glad I was offered the post at Westfield Lane as I was struck at my initial visit by how homely and friendly it felt. From our discussion with the manager and staff in addition to a review of the training matrix we are aware that new staff experience a period of two weeks induction during which they act in a supernumerary capacity, and their competencies are routinely assessed during this period by the manager. A review of Evidence: the training matrix indicates that whilst all staff have received training in mandatory areas, updates for nearly half of the staff team in many key training areas are considerably overdue, however we did note that some staff are now rostered onto courses as recorded on the staffing rotas. We consider that the provider is required to ensure all staff undertake to maintain frequency of key mandatory training in line with with policy, procedure and health and safety requirements of the service and this should be undertaken in a timely manner. Staff we spoke with feel well supported by their manager and feel positive about the changes the new PCT is implementing, review of staff supervision arrangements with staff and from records confirmed this is now occurring regularly, as are team meetings. 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 health safety and welfare of residents is generally well supported Evidence: AQAA information about the service has been completed to a reasonable standard, but would benefit from improved detail about steps the service has taken to address previously identified shortfalls and more information about current and future plans. From discussion with the manager and a review of staff rotas we can see there is progress in the manager filling a supernumerary position on the staff rota rather than being counted into the daily staffing ratio, improving staff levels have clearly reduced the occasions when the manager has to cover shifts but rotas indicate there continue to be times each week when the manager is counted as the third person on duty. The service has been provided with a computer and access to the INTERNET, the manager and staff commented positively about the benefits of this. Staff reported they felt supported by the manager. The frequency and content of regulation 26 visits has improved but the depth of such visits needs to be reviewed to ensure that shortfalls identified from this inspection are picked up through this process more readily. Some progress has been made in the development of quality assurance, with a programme of quality audits involving residents being implemented, it is too soon for analysis of overall feedback to be undertaken but there is a need for the service to also implement a system of quality audit and review of internal systems and this should incorporate those stand alone audits already in place i.e medication, finance, health and safety, an annual report of findings from quality assurance is also still to be developed, we are aware that a quality assurance programme is under development and on this occasion would Evidence: recommend these shortfalls are addressed. AQAA information tells us that many policies and procedures have not been updated for some time and with the move to another PCT are being replaced, it is clearly of importance that staff have access to up to date policy and procedure to inform their practice, and to ensure that they are compliant with current PCT policy and changes in guidance and legislation. We have been advised within the AQAA information completed by the service that all health and safety tests checks and servicing are up to date, at the site visit we examined some servicing records, we found that all equipment servicing is in date apart from one hoist used by one resident this was overdue a service but this was confirmed as booked for the following week, the service had been unable to evidence that electrical installation servicing is still in date but this has been provided post inspection. We examined accident and incident reporting and found this to be satisfactorily completed. Whilst we consider shortfalls in staff training may compromise staff and resident safety we can see that these are starting to be addressed albeit slowly, these shortfalls are not compounded by others in key areas and we therefore consider the health and safety of residents to generally be well supported. 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 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 23 13 All staff to receive regular updates of Sussex multi agency protocols 23/12/2008 so that staff understand their roles and responsibilities and ensure incidents are handled appropriately at all stages 2 35 18 All care staff are required to 23/12/2008 complete mandatory training for moving and handling, first Aid,food hygiene, fire safety, infection control, adult safeguarding and medication in compliance with Service policies and health and safety legislation In order to protect and promote the health safety and welfare of residents staff should be kept updated of current guidance and best practice 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 5 Contractual information should be developed into a more accessible format and should make clear the terms and conditions of residents stays including their financial responsibilities in particular transport costs. Contractual and license agreement information with regard to residents financial responsibilities should be consistent in both documents. Risk assessment information should be more individualized to reflect risks posed by a resident and those they are subject to, these should be reviewed at least annually. Activity pogrammes to be revised to reflect achievable activities and aspirations and interests expressed by residents through life plan and resident meetings The development of pictorial menus and the use of picture reference for alternative meal options should be pursued. Records of food intake by residents should be individualized to enable monitoring that a good standard of nutrition is being maintained All creams, drops and liquid medications to be dated upon opening Consideration to be given to how verbal and non verbal signs of distress and unhappiness are interpreted by staff and whether some constitute complaints. A review of the present system of recording complaints to improve confidentiality All staff should participate in a minimum of two fire drills annually, records of drills should clearly record the names of staff participating The home should evidence analysis of resident feedback and how this influences service development, systems for internal audit and review of the service are to be implemented and findings of quality assurance should be published annually 2 9 3 12 4 17 5 6 20 22 7 24 8 39 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. - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!