Inspection on 21/11/08 for 178 London Road

This inspection was carried out on 21st November 2008.

CSCI found this care home to be providing an Poor 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

178 London Road 06/11/07

178 London Road 08/02/07

Similar services:

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Hillview Farm

Dalewood Respite Care

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: 178 London Road 178 London Road Waterlooville Hampshire PO7 5SP The quality rating for this care home is: zero star poor 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: Christine Walsh Date: 2 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. 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 41 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 41 Information about the care home Name of care home: Address: 178 London Road 178 London Road Waterlooville Hampshire PO7 5SP 02392231983 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Royal Mencap Society Name of registered manager (if applicable) Mrs Karen Smith Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 3 0 care home 3 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 3. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 41 A bit about the care home 178 London Road is a converted detached property owned and managed by The Royal Mencap Society. The home has been refurbished to provide an environment for three service users who have a learning disability. This includes a seperate self-contained unit with a lounge, bedroom, kitchen and bathroom for one service user and en suite facilities for other service users. The home is staffed twenty-four hours a day and has its own vehicle to assist service users to access the community. The home has its own vehicle to transport. aff are provided for 24 hours per day. Care Homes for Adults (18-65 years) Page 5 of 41 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: zero star poor 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 6 of 41 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is zero stars. This means the people who use this service experience poor quality outcomes. This site visit formed part of the key inspection process and was carried over one day by Mrs C Walsh regulatory inspector. The manager, deputy manager and senior member of staff assisted the inspector with the visit. The manager completed an Annual Quality Assurance Assessment (AQAA) document, which was returned to the Commission for Social Care Inspection prior to the visit to the home. In addition Have Your Say service user, staff and health care professional comment cards were received. The AQAA informed us that the service ensures the diverse needs of the service users are respected and told us that the home encourages service users to access the community in respect of their individual beliefs and cultures. The AQAA goes on to tell us that the service promotes a culture of diversity which is reflected in staffs learning and development which includes service specific training such as autism. The information obtained to inform this report was based on viewing the records of the people who use and work at the service, speaking with the service users Care Homes for Adults (18-65 years) Page 7 of 41 and staff, and by observing care and support practices. A tour of the home took place and documents concerning health and safety were viewed. The people who use the service are referred to as service users throughout the body of this report. What the care home does well The home does well to ensure all service users have a person centred plan that details the support they need with their every day activities. The plans are easy to read and descriptive on how the staff must support the service user. This is to ensure a consistency of care. The personal plans include communication passports, support required to minimise risks and manage challenges the service user and staff maybe experiencing. The staff do well to ensure the physical and psychological needs of service users are being met, providing them with support to access health care professionals such as GPs, dentists, psychologists, community nurses and to take their medication. The service users have complex communication and social needs which proves difficult at times to judge if the service user is unhappy. The home has a complaints procedure in place which has Care Homes for Adults (18-65 years) Page 8 of 41 been developed in a picture format but does not currently meet the communication needs of the service users living in the home. However the staff are confident that they can recognise when a service user is unhappy by the behaviours they present. Complaints received from relatives and other stakeholders are dealt with promptly. Staff are trained to protect service users and to inform someone immediately if they are concerned that the service user is at risk of harm. 178 London Road offers a homely environment. It has been adapted to meet the physical and the unique behaviours of the service users. Individual bedrooms are personalised and decorated to service users choice and liking. The manager and her staff are skilled and competent to meet service users needs, they go through a thorough interview and induction process and receive mandatory training such as moving and handling and food hygiene. They also receive training specific to service users needs such as communication, Autism, abuse awareness, and managing challenging behaviour. There is evidence in comment cards received from staff that they are feeling valued, better supported and training has improved. Care Homes for Adults (18-65 years) Page 9 of 41 What has got better from the last inspection Following the last visit to the 178 London Road in November 2007 the home was issued with five requirements, three of which referred to reviewing the levels of staff to the needs of the service users. One referred to ensuring all staff recruitment records are in place including relief staff. Another was made in respect of providing evidence that staff had been deemed competent to administer invasive medications such as those used in epilepsy. The requirements in respect of staffing levels there is evidence that some improvements have been made and there is evidence that the manager continues to recruit the right staff to meet the service users needs. Although an experienced clinical specialist would not sign individual to say staff are competent to administer invasive medications, such as rectal diazepam, they have signed to say the written policies and procedures and the training they have received is appropriate. There is evidence that all staff have the required recruitment checks in place to ensure service users are not placed at risk. Care Homes for Adults (18-65 years) Page 10 of 41 What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 11 of 41 If you want to speak to the inspector please contact Christine Walsh 33 Greycoat Street London SW1P 2QF 02079792000 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 12 of 41 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 13 of 41 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 . To ensure the home can meet prospective peoples needs they will carry out a pre admission assessment prior to the person moving in. To ensure the home can fully support the care and social needs of the people who currently use the service they must ensure assessment plans reflect their needs and contractual agreement with placing authorities. Evidence: The Annual Quality Assurance Assessment (AQAA) told us that the home has an accessible Statement of Purpose and Service User Guide. It also goes on to tell us that 178 London Road is a purpose built service designed to meet the changing needs of the service users. This was tested by viewing in depth one service users personal plan and briefly viewing two others. These personal plans included assessment documents and evidence of review meetings with the placing authority. Care Homes for Adults (18-65 years) Page 14 of 41 Evidence: The home is currently fully occupied and has not admitted any new service users since August 2006. The current service users moved to the home following the closure of a larger home. The manager told us that a comprehensive transition process took place which included assessing their needs, compatibility with other service users and visiting the home on several occasions to view its transformation and make decisions on decoration. The manager informed us that this process involved the service users families and staff who had previously worked with them. The home is currently fully occupied and does not intend to admit other service users in the near future. There is evidence in the service users personal plans that the information in the admission document has been used to inform staff of the support they require. There is evidence that reviews have taken place for the service users since moving into the home which reflect their continuing needs and the support they require. Although whilst viewing personal plans and speaking with care staff it became apparent that changes had occurred in the support required for the service users since their last review. These had not not been changed in the personal plan or contractual agreement with the placing authority. Care Homes for Adults (18-65 years) Page 15 of 41 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 . The home is in the process of developing a person centred approach for the people who use the service and the home plans to develop personal plans further to reflect goals. Changes to assessed needs must be reflected in personal plans to inform staff of the support required and to ensure sufficient staff are available to meet needs. The service encourages and support the people who use the service to make decisions and choices about their lives. The home must however consider what the outcomes could be for people with complex needs if their choices cannot be fully met when they wish. The service does well to identify and minimise the risks to people who use the service by ensuring that detailed information is available to inform staff. The risk assessments must however reflect the actual support people who use the service require when accessing the community, as stated on their most recent review. Evidence: Care Homes for Adults (18-65 years) Page 16 of 41 Evidence: The AQAA told us that all service users have a comprehensive support plan that incorporates written and pictorial usage. These cover every aspect of support the individual requires. The plans include goals and aspirations for the future. This was tested by viewing the person centered plans and risk assessments for three service users, by meeting with service users about the care and support they receive, observing practice and speaking with staff. The service users living at 178 London Road have complex communication needs. There was evidence that the service has adopted a person-centered approach to the care and support they provide to the service users. This includes supporting the person making choices and decisions about their everyday needs and wishes. The plans have been developed using a person centred approach, these provide information on how to support the service user with specific care needs and social activities. The plans also include the service users daily routine a communication passport and how to defuse behaviours or situations that may challenge. Discussion with two members of staff told us that staff have a good understanding of person centred care, meeting goals and aspirations. Current pictorial plans however provide limited information on the service users goals and aspirations, one plan told us the service user would like to go on holiday (this is an accepted goal), another said they would like a hot tub in the garden. This information is based on the staff knowing the service users and their likes and dislikes. To date the goals are in the process of being achieved. The AQAA told us and this was confirmed by a member of staff that a system known as multimedia will be used in the New Year to develop person-centred plans in an accessible format for the service users. It is hoped that this system will support the service users to make decisions and choices and have a say on how they wish to be supported. There is little evidence that the service users have been involved in developing and reviewing their personal plans to date, we were informed that next of kin do get involved. Mixed views were received in comment cards in respect of the quality of care plans and the information staff receive about the service users, this included a Have Your Say comment card from another agency. Comments told us that there is not enough staff to enable service users to make choices, which require support in the community and to provide continuity of care. This was discussed with the manager and other staff at the time of the visit who confirmed improvements were being made. Comments from staff told us that they always strive to do their best and meet the needs of service users. Following the last visit to the service it was issued with five requirements of which two refer to having the required staffing levels to meet the individual needs of each service user and support them to be involved in a range of activities. The manager told us that Care Homes for Adults (18-65 years) Page 17 of 41 Evidence: staffing levels have improved, but there is evidence to suggest that not all needs especially those relating to activities are being met. Have Your Say comment cards from staff tell us that restrictions are placed on service users going out because of the lack of staff. In the six years I have been working with the Mencap there has never been enough staff. The service users dont get their entitlements. In answer to how do you think the home can improve an advocate told us: By trying to retain staff who are committed to meet the goals and aspirations of the service users. The care given is inconsistent as too many different staff come and go or leave. It was observed on the day of the visit that staff appear to understand the complex needs of services users and the support they require, this includes relief staff. Relief staff are employed and trained by the Royal Mencap Society. Staff were observed offering choices at a level the service user will understand, which included using alternative communication aids such as objects of reference. The response and demeanor of a service user at home at the time of the visit told us that they were happy with the choices being offered. The home undertakes a comprehensive range of risk assessments, which although generic have been completed using a person centred approach. It clearly tells the person reading the assessments the aim of the activity, the risks involved and how to minimise the risk. It was noted through discussion and viewing service users risk assessments and annual reviews that two of the three service users require two to one support in the community. This is to minimise risks to them and others. We were told by staff that certain members of staff are confident to support service users on a one to one basis in the community because they know them well and feel confident supporting them. The home must consider the impact or message sent to services users if these arrangements cannot be met by all staff, or when staffing levels are low and the service user wishes to go out. The risk assessments and service users contractual arrangements with placing authorities must reflect what it actually happening and been agreed. Each service user has a risk assessment in respect of what support they require in the event of a fire in the home. Evidence tells us that service users are at potential risk from fire as fire safety procedures are not being followed as recommended by fire safety legislation, these include checks on fire alarms and fire safety training for staff. An immediate requirement was made in respect of fire safety training for staff. Care Homes for Adults (18-65 years) Page 18 of 41 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 . When there are sufficient skilled staff on duty the people who use the service take part in age, peer and culturally appropriate activities. The home ensures the people who use the service maintain contact with family and friends and socially engage with their peers. Further improvement could be made in supporting the people who use the service to socially engage in their local community. The home is in the process of progressing person centred approaches, this will assist the people who use the service to develop skills and support staff to have a better understanding of the rights of the people they support. The home ensures the people who use the service receive regular meals of their liking. Improvement could be made in balancing the nutritional value and content to promote a healthy lifestyle. Care Homes for Adults (18-65 years) Page 19 of 41 Evidence: The AQAA told us that the home does well to provide activities based on an individuals likes and aspirations, they try new experiences, balanced against acceptable risk and access the community and facilities. This was tested by viewing personal plans, daily activities, menu plans, observing practice and speaking with staff. On the day of the visit each service user was engaged in an activity which included attending day services, baking cakes and shopping. A member of staff provided information on the range of activities the service users engage in and how this is supported by staff. These activities include swimming, attending music sessions, going for walks and drives in the house vehicle. The same member of staff spoke positively about plans to support the service users to access alternative activities and their plans for the festive season, which includes a Christmas meal with families and arranging an evening out. It was established however that community based activities only take place if there are sufficient staff on duty and how the service user if feeling. A member of staff said: X may miss going out if X is in a bad mood as more staff are needed in the home We were informed that some behaviours have decreased recently, but comment cards received from staff told us: Staff shortages are a problem at London Road. Mainly 2-1 outings We could do better to meet the service users needs especially at weekends The concerns regarding service users access to external activities was raised at the last visit to the service and the visit before that. Although there is evidence staffing levels are improving and new staff starting in the very near future, access to community currently remains restricted. Service users are supported to maintain contact with family and friends, this was evidenced in records held in their personal plan. The information tells the reader about relationships that are important to them and the contact they have with those people. Daily notes record if contact has been made with family and friends, which includes visiting or being visited. Another member of staff told us that the home has strong family involvement who play an important part in the daily lives of their relative, assisting with the development of personal plans and supporting their relative to make decisions. Through observation the staff showed us they treat service users with respect and uphold their dignity, privacy and individual choices. Information in personal files inform the reader, the name by which service users wish to be to known by, and what Care Homes for Adults (18-65 years) Page 20 of 41 Evidence: behaviours and non-verbal clues are telling staff about how they are feeling. A member of staff spoken with at the time of the visit was aware of their roles and responsibilities in respect of providing an individual approach and valuing service users for who they are. The member of staff went onto to tell us they are aware of the core values of dignity, privacy, choice, respect and promoting independence. A member of staff told us that there is a four week rolling menu that is led by what they know the service users like. On viewing the menu plan it was noted that it did not include all the nutritional requirements needed in a healthy diet. This was discussed with the member of staff who said they would re look at the menu plans. Staff are provided with information about each service users likes and dislikes and care plans are in place to reflect the support required to minimise the risk of obsessional behaviuors around eating and maintaining a healthy weight. Service users are informed of what is on the menu using pictures, some pictures were found to be obscure and not reflect what was actually being prepared on the day of the visit. The member of staff said a certain picture had been used as is looked similar to what was being prepared. The value of using such a communication tool in this way should be reviewed. We were informed that service users have limited in put to the planning and preparation of mealtimes as there are a number of high risks associated to this activity. This was reflected in service users risk assessments Care Homes for Adults (18-65 years) Page 21 of 41 Evidence: Care Homes for Adults (18-65 years) Page 22 of 41 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 . The home does well to ensure the people who use the service receive the appropriate support with their personal care, health care and medication in the way in which they require. Evidence: The AQAA told us that they work closely with external providers, community teams, doctors, psychologists and epilepsy team to ensure consistent appropriate support. Service users are supported to attend appointments and their medication is reviewed every six months. There are good medication systems in place to ensure safe practice. This was tested by viewing personal plans and medication records, observing practice and speaking with the manager and staff. The personal plans provide detail on how service users wish to spend their day including what time they like to get up, go to bed, when they like to bathe and how to support them with their personal grooming. A member of staff said they were aware of service users individual support needs as all Care Homes for Adults (18-65 years) Page 23 of 41 Evidence: staff are encouraged to read the plans, be involved as a keyworker to support service users with their everyday needs and be involved in reviewing their personal plans. There was evidence of reviews taking place. Two relief staff who were spoken with provided verbal information, which told us that they are aware of the service users daily needs and how they like to do things, they demonstrated that they have an understanding of autism and the importance of providing a consistency of care. They went onto tell us that they had got to know service users daily needs and routines through observing other staff and reading the service users personals plans. The manager told us the service has good links with primary care and specialist health care teams. Service users personal plans provide evidence that their health care needs are monitored and reviewed. The plans also provide information on specific health care needs, what action is required and how staff must support service users with these health care needs, such as supporting them whilst having an epileptic seizure. The health action plans tell us how a service user may show pain and how the staff must respond. There was further evidence to tell us that regular appointments are made with various health care professionals such as dentists, GPs and visiting a centre for mobility aids and equipment. The service has systems in place for the administration of medication. The home uses a monitored dosage system (MDS) supplied by a local pharmacy. Medications are received, recorded and disposed of using systems as recommended in the Royal Pharmaceutical Guidelines. It was noted that the medication cupboard was clean and tidy, although service users monies and other valuables must be stored elsewhere. Each service user has a list of medications prescribed, which includes regular and as required medication. As required medications are supported by care plans that detail when the medication needs to be administered, such as when a service user has a seizure. In addition each service user has a medication pen picture which describes what medications they are on, the dose, what the medication is used for and its side effects. The manager told us that only staff who have undertaken training are responsible for ensuring service users receive their medication. A member of staff confirmed that they receive training from the service, which covered such areas as storage, procedures for administration and side effects. Following the last visit to the home it was issued with a requirement in respect of having confirmation that staff are competent to administer invasive medications such as rectal diazepam. The manager provided us with a letter from a consultant who confirmed she was happy with the training content but could not deem staff competent. New guidelines from the consultant were also seen and demonstrate the home has attempted to meet this requirement. Care Homes for Adults (18-65 years) Page 24 of 41 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 . The home ensures it listens to and acts upon the concerns raised by the people who use the service. The home ensures the people who use the service are safeguarded from potential risk of abuse, neglect and or self-harm. Evidence: The AQAA told us that they have a comprehensive complaints policy and procedures in place, which also reflect compliments made of staff and the service. The AQAA goes onto to tell us that they take immediate effective measures to ensure safety of service users from possible abuse. All staff undertake adult protection training. The AQAA tells us it could do better, and seek to improve in the next twelve months an accessible complaints procedure. This was tested by viewing the homes current complaints procedure, the complaints log book, a service users behaviour support plan, management of service users personal monies, Have Your Say comment cards and speaking with staff. The home has a booklet which has been devised by the Royal Mencap Society which tells the reader the service about cares about what they think and asks the reader to tell them about any concerns they might have. In each service users file there is a complaints flow chart, which includes pictures of staff and the manager. A member of Care Homes for Adults (18-65 years) Page 25 of 41 Evidence: staff told us that the current format is not accessible for service users and there are plans in the New Year to improve this area of support. A member of staff said: If a service user or relative tells me they have a concern about the home I would go to management or higher and reassure the concerned person. Another said: I am confident that any concerns about the any of our service users will be addressed through all the relevant channels. The member of staff went onto say that they know from certain behaviours if a service user is unhappy and will try and establish what it is that has upset them and put it right for them. The AQAA tells us that the home has received three complaints in the last year. The manager provided evidence that these complaints had been dealt with through the service complaints procedure. A record of the nature of concerns/complaints, the action taken and the outcome is kept. The manager told us that staff are provided with safeguarding of vulnerable adults training, which provides them with the knowledge to identify various types of abuse and how to report these. A member of staff spoken with at the time of visit confirmed that they had received training and was aware of their roles and responsibilities in maintaining service users health and wellbeing and reporting incidents of concern. Some service users have complex needs and present with behaviours that challenge. There are detailed intervention plans in place and the home monitors the wellbeing of service users on a regular basis. When required support is sought from specialist health care teams who are skilled in managing challenging behaviours. The manager told us that staff have received training in managing challenging behaviours and all staff are confident to support service users when their behaviour is challenging. This was supported by a member of staff who was spoken with at the time of the visit. Service users are supported with the management of their money. The home has systems in place for the safe management and monitoring of service users spending. Care Homes for Adults (18-65 years) Page 26 of 41 Evidence: Care Homes for Adults (18-65 years) Page 27 of 41 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 . The home ensures the people who use the service live in a comfortable, clean and spacious environment that meets their physical and social needs. The home ensures the people who use the service live in a home that is clean and the risk of cross infection is minimised by staff having received training. Evidence: The AQAA told us, the home has been purposely designed to meet the needs of the service users which includes a safe and secure garden. Service users bedrooms and bathrooms reflect their individual needs. The AQAA tells us it could do better to ensure gardens are maintained and kept tidy and redecoration takes place when required. They plan to redecorate the communal lounge areas and a service users bedroom in the next twelve months. This was tested by walking around the home and viewing maintenance records. 178 London Road is a large house, which has been purpose built to meet the physical and social needs of the service users and each service user has a bedroom of their own. Some of which have en-suite facilities. The bedrooms are personalised to reflect the service users interests and personality. Care Homes for Adults (18-65 years) Page 28 of 41 Evidence: The bedrooms viewed at the time of the visit were observed to be clean, tidy, comfortable and tastefully decorated. The communal areas and bathrooms have been specifically designed to meet the complex behaviours that services users may display. We were informed that they have been designed in this way to prevent injury to the service user and as far as feasibly limit damage to the environment. Some areas of the home showed signs of needing repair, the manager informed us that these are regularly reported to the maintenance department who respond in reasonable timescales dependent on the job required. The maintenance log book was viewed and demonstrated that repairs are responded to in a timely manner. The manager informed us that prior to the service users moving into the home they were involved in choosing how they would like their bedrooms to be decorated. Several visits were made to the home to view its progress and transformation. The home has an enclosed garden where there is room for relaxation, fun and a specially adapted swing. The AQAA told us that the majority of the staff have received infection control training. Training information and staff who were spoken with at the time of the visit confirmed this. There is evidence that the service provides detergents, equipment and protective clothing to guard against cross infection. The home has a separate laundry facility with a washing machine that has a sluicing facility and can wash at high temperatures. Detergents are stored safely and staff when spoken with were able to describe what procedures they use in dealing with waste products and protecting service users and themselves from the risk of infection. Care Homes for Adults (18-65 years) Page 29 of 41 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home ensures the people who use the service are supported by staff who have been appropriately recruited and trained to meet their. Further concerns remain regarding the numbers of staff available to provide a flexible approach to meet the peoples goals and aspirations. Evidence: The AQAA tells us that the service has a robust recruitment procedure that includes group work, communication exercises, scenarios and individual interviews. It goes onto to tell us that there is ongoing learning and development through staff training, which has enable staff to feel confident to make decisions with in their work area. This was tested by viewing staffing levels, the duty rota and observing practice on the day, viewing training data, recruitment records, Have Your Say comment cards and speaking with staff. At the time of the visit service users were being supported to undertake activities, which included attending day services, shopping and baking cakes. Four staff were on duty including the deputy manager who was involved in administrative duties. The home is separated into two areas, which includes a purpose built annexe for one service user, both areas have a designated staff team and separate duty rotas. Care Homes for Adults (18-65 years) Page 30 of 41 Evidence: Through discussion with staff present at the time of the visit, viewing the duty rota and speaking with the manager it was established that the home continues to have vacancies and relies heavily on support from relief staff. Five relief staff were named on the duty rota in comparison to four regular staff who work permanently in the home, two of which are full time and the others part time. We were informed by a member of staff that relief staff cannot drive the minibus, which causes problems for the service users who need and want to go out. The member of staff said at least twice a week there is no one to drive the minibus. This was apparent on the evening of the visit as two relief staff were on duty in the evening compromising any impromptu community based activity. Have Your Say comment cards received from staff and an advocate reflected that there is still a need to improve staffing levels, but they also tell us they do their best to support and meet the needs of the service users and improvements are being made. The staff appeared organised and well informed of what was going on for each service user. The staff routine includes a handover at every shift where the health, wellbeing and activity of each service user is discussed. A discussion with a member of staff who said they were confident to support the service users independently in the community, was aware that not all staff feel the same way. This does not match the contractual agreement the service has with the placing authority and must again be reviewed. Following the last visit to the service three requirements were issued in respect of staffing levels and supporting service users to access activities and have their needs met. The manager informed us that a recruitment drive had recently taken place and they were waiting on two new members of staff to join the team. The AQAA tells us that eight staff have left the service in the last twelve months, the manager said this had a large impact on the service. Staff comment cards tells us that even though the service has gone through some ups and downs it has done it best and strives to ensure the service users needs are met. There is still evidence to suggest that not all the service user goals and aspirations are being met but there is evidence that the service is taking steps to address this and all three service users are getting out at least several times a week. This area will continued to be reviewed through our regulatory activity. The manager told us that the service encourages staff to undertake a national vocational qualification (NVQ) and will support them to undertake NVQ levels 2, 3 and in some cases level 4. The AQAA tells us that the service currently has two staff trained in NVQ. The manager is aware that 50 percent of staff should have a NVQ and is making arrangements for more staff to achieve the qualification. The recruitment files for three members of staff were viewed and it was established Care Homes for Adults (18-65 years) Page 31 of 41 Evidence: that the service users robust procedures when recruiting staff. A member of staff talked through the process of how she was recruited, which included completing an application, attending an interview, providing names of two referees and personal information so a Criminal Record Bureau (CRB), Protection of Vulnerable Adult (POVA) could be undertaken. The member of staff confirmed that she did not start working in the home until all the checks were in place. Following the last visit to the service it was required to ensure all staff working in the home have recruitment checks in place including relief staff. The manager provided evidence that all relief staff recruitment checks are now held in the home. Staff undergo an induction into the home where they are supported by a named member of staff to become familiar with the needs of the service users, the ethos of the home and the way in which the service works day to day. All staffs individual training records were viewed and provided evidence that staff receive regular updated training in areas that are mandatory such as health and safety and food hygiene, and areas which are specific to the needs of the service users such as epilepsy, medication, autism and managing challenging behaviour. It was however established whilst viewing fire records and staff training records that not all staff have received training in fire safety , it could not be evidence that a member of staff working nights had received fire safety training in any form since March 2007. Information in staff records provided us with evidence that the induction process is comprehensive and covers nine modules including getting started to develop as a worker. The Royal Mencap Society also runs workshops in career progression which prepares career minded carers to prepare for a management role. This includes attending workshops in the role, rota and dealing with regulatory matters. Care Homes for Adults (18-65 years) Page 32 of 41 Evidence: Care Homes for Adults (18-65 years) Page 33 of 41 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Some improvements have been made to the management of the home, however further improvements are needed to ensure the people who use the service have a safe place to live in. Evidence: The AQAA tells us the manager holds a National Vocational Qualification (NVQ) at level four and the Registered Managers Award (RMA) and has attended specific training to support staff. The AQAA tells us it has a formal quality assurance process which has been introduced in the last twelve months and records in respect of the management of the home are available and accessible. This was tested by spending time with and speaking with the manager, speaking with staff regarding quality, looking around the building and viewing documents in respect of health and safety. The manager is currently going through the process to be registered with the Commission for Social Care Inspection and had attended a fit persons interview a few days prior to the visit. The manager was not aware of the outcome of the interview. Care Homes for Adults (18-65 years) Page 34 of 41 Evidence: The manager has many years experience working with people who have a learning disability and has worked in the home since April 2008. The manager demonstrated that she has an awareness of her roles and responsibilities in respect of meeting the needs of the service users, staff and legal responsibilities in managing and running the home. She spoke of the steps she and her staff have taken to make improvements to ensure service users receive good outcomes. These include employing staff with the appropriate skills, improving the care planning process and working towards a total person centred approach and supporting staff to develop their skills. A member of staff was complementary of the support they receive from the manager. My new manager gives me complete support, she keeps me informed and values any ideas or comments I might have. I have watched my new manager work in the house, just as we do and found this uplifting and refreshing. Other comments from staff told us that new ways of working had been introduced and improved the quality of care for the service users. I feel all the needs of our service users are being considered much more now and we, as a staff team are valued in our care and opinions. We have been introduced to new ways of working, which some of these were beyond my comprehension previously, we are encouraged to participate. The manager spoke of some of the difficulties that were encountered when starting the in home. In response to some of these difficulties a team day with staff was held. Consensus was problems with communication, respecting one another and the role of the deputy. The manager manages 178 and 176 which are situated next door to one another and is supported by deputy managers in each. The manager provided evidence that the service has a number of tools to measure the quality of the service and seek the views of the service users and staff. Some of the service users have complex communication needs and express their needs and wishes using alternative forms of communication, such as gestures, behaviours and objects of reference. Monthly keyworker reports provide a review of the overall care the service users have received, outcomes and achievements. The manager told us she ideally likes to hold monthly team meetings but some have been cancelled due to needing staff to support and work with the service users. The Royal Mencap Society have appointed a service manager who is not in day to day operation at 178 London Road to carry out unannounced quality audits of the home, these are know as regulation 26 visits. The report provided information that observations of the day to day care is carried out, staff are met with and various administrative documents are checked. At the time of the visit a annual quality review was taking place in 176 London Road and was to be continued in 178 London Road, this was rearranged due the inspection visit taking place. Care Homes for Adults (18-65 years) Page 35 of 41 Evidence: The manager told us that she had sent out quality questionnaires to family in May 2008. One response was received which provided positive comments. There are procedures and equipment in place to protect service users from the risk of fire, there are individual fire risk assessments and there is evidence that some staff have attended up to two fire evacuation drills this year, although this has not captured all staff working in the home especially night staff. The last environmental fire risk assessment was undertaken in August 2006 but has not been reviewed since. All staff fire training records were viewed and it was established that not all staff had received any form of fire safety training in particular night staff. Testing of fire safety appliances was also noted to be inconsistent as directed in the homes own policies and procedures and what is recommended by fire safety legislation. This included not testing fire alarms weekly as stated in guidance for staff or checking fire safety appliances and lighting. In some instances the records told us that th appliance had not been checked fro up to six months. In view of the breaches observed a view was taken to issue an immediate requirement as it was felt that failure to test fire safety equipment and regularly train their staff posed an immediate risk to the service users. At the point of writing this report the manager had not responded to the immediate requirement within the allocated time frame. Substances that may be hazardous to health are securely locked away and there are notices discreetly displayed around the home. This is to remind staff to test and record hot water temperatures and follow good hygiene practices. Records seen provided evidence that all utilities such as gas and electrical systems and small electrical appliances are regularly checked to ensure they are in good working order. Care Homes for Adults (18-65 years) Page 36 of 41 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 13 12(1)(a) Residents must be supported 27/11/2007 to be involved in the range of activities identified through the care planning process in order to provide them with adequate mental stimulation. 2 20 13 Confirmation must be 06/12/2007 obtained from the local community or district nursing team that training for staff in administering bodily invasive medication meets their expectations. Any further instruction given must include an assessment of staff competence to meet residents? needs. This is an amended requirement from the report of 8/2/2007. 3 33 18 A review of the staffing levels 06/12/2007 needed to meet the individual needs of each resident must be carried out taking account of their needs throughout the day and Page 37 of 41 Care Homes for Adults (18-65 years) night. This is an amended requirement from the report of 8/2/2007. 4 33 18(1)(a) Assessed staff levels must be 27/11/2007 provided to ensure that residents? needs are met at all times. 5 34 19 schedule 2 Staff records as detailed in 06/11/2007 Schedule 2 of the regulations must be held in the home. This is an amended requirement from the report of 8/2/2007. Care Homes for Adults (18-65 years) Page 38 of 41 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 1 35 18 The home must ensure all 12/12/2008 staff receive up to date mandatory training including fire safety. All staff must be competent and skilled to ensure the health and safety of the people who use the service are protected against risks to their health and safety. 2 35 18 The member of staff working 12/12/2008 nights must receive fire safety training with immediate effect. All staff must be competent and skilled to ensure the health and safety of the people who use the service are protected against risks to their health and safety. 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 43 24 The home must ensure all fire safety equipment is 24/02/2009 Care Homes for Adults (18-65 years) Page 39 of 41 tested as recommended by the Fire Safety Service and the homes own policies and procedures. The home must do this to ensure services users are protected from the risk of fire. 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 17 It is recommended that the home seek advice from the appropriate professional re preparing healthy diets for the service users. It is recommended to avoid confusion and upset that the pictures used to inform service users what is on the menu actually reflects what the service users will receive. 2 17 Care Homes for Adults (18-65 years) Page 40 of 41 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. Care Homes for Adults (18-65 years) Page 41 of 41 - 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!