Inspection on 30/10/08 for 2 Abell Gardens

This inspection was carried out on 30th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

2 Abell Gardens 28/11/06

2 Abell Gardens 24/10/05

2 Abell Gardens 21/04/05

2 Abell Gardens 15/12/04

2 Abell Gardens 24/06/04

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 2 Abell Gardens Furze Platt Road Maidenhead Berkshire SL6 6PS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Dickens     Date: 3 0 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: 2 Abell Gardens Furze Platt Road Maidenhead Berkshire SL6 6PS 01628780975 02085689783 j.smith@owl-housing.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Owl Housing Ltd The registered provider is responsible for running the service Name of registered manager (if applicable) Dr John Willem Smith Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 6. 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). Date of last inspection Brief description of the care home 2 Abell Gardens is a residential home offering twenty-four hour care. The home is registered for six residents with learning and associated physical difficulties. Owl Housing Ltd, a non-profit making organisation is registered to provide the care. The house is a bungalow with six bedrooms; all of the bedrooms are single and although none of them have en-suite facilities, they all have handwashing basins. There are Care Homes for Adults (18-65 years) Page 4 of 31 6 Over 65 0 Brief description of the care home communal toilets, a shower room and one bathroom, and there are a variety of aids and adaptations around the building to allow residents to move about more independently.The home has its own transport. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was unannounced and took place over 6 hours. The inspection was carried out by Mrs. Helen Dickens, Regulation Inspector. The Manager was on leave and therefore the the care staff, and later the Service Manager, represented the service. A partial tour of the premises took place and a number of documents and files, including three residents assessments and care plans, two staff recruitments files, quality assurance information, and the annual quality assurance assessment (AQAA) were examined as part of the inspection process. A number of questionnaires returned to CSCI about this service earlier in the year were also considered in writing this report. Care Homes for Adults (18-65 years) Page 6 of 31 The current fees are 1208.24 per person per week. What the care home does well: What has improved since the last inspection? What they could do better: Two new Requirements were made as a result of this inspection. The first concerning the environment where there were a number of shortfalls including lack of maintenance and refurbishment, and reduced bathing and showering facilities. The second concerns the review of current arrangements for monitoring health and safety at the home, to ensure shortfalls are identified and dealt with in a timely fashion. Care Homes for Adults (18-65 years) Page 8 of 31 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be confident that their needs and aspirations would be assessed prior to them being offered a place at the home. Evidence: Most residents have lived at 2 Abell Gardens for many years and the last admission to the home was 2 years ago. The AQAA states that this resident has a pre-admission visit and was assisted to draw up a care plan. The home supported this person through the transitional period. This residents file was checked and there was an assessment of his needs recorded. Assessments by home and other professionals assessments were on the file, including a hospital assessment for people with learning disabilities. It was not possible to discuss details of the transition with this resident but the inspector sat with this person and observed that they were happy and settled at the home. The AQAA also states that full assessments would be carried out by people qualified to do so, and in accordance with Owls assessment policy and procedures. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents know their assessed and changing needs will be reflected in their care plans. Residents are encouraged to make decisions in their daily lives though currently some choices are limited and this needs to be addressed. Sensible risk taking is encouraged but more work is needed to ensure all risks are properly assessed and these risk assessments are kept under review. Evidence: Residents at this home each have an essential lifestyle plan which sets out their needs and how these will be met. Three were sampled by the inspector and all had detailed guidance on how they would like their support to be delivered. One residents file was noted to contain particularly detailed personal care guidelines. All three had good guidance to staff on how best to communicate with them, and guidelines for managing various behaviours. Residents have been involved in drawing up these documents and in their reviews. The reviews seen had been done to a high standard and involved relevant parties including care managers, family and the resident themselves. Care Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: plans are currently reviewed 6 monthly which is recommended in the NMS for younger adults. However, it was explained to staff (and the manager on the telephone the next day) that those residents aged over 65 should have their care plans reviewed every month as recommended in the NMS for older people. Residents have opportunities to make decisions in relation to their daily living and activities. They were heard to be given choices about how they spent their day, and one resident who asked if they could be taken out in the afternoon had this request discussed in more detail (as it was cold outside) and then was assisted to dress more suitably, and was taken out for a short walk. There were many instances during the day when residents were offered choices including flexible mealtimes. Residents rooms were personalised and three residents spoken with in some detail said they had been involved in choosing the colour schemes and furniture. There are good communication guidelines in place for residents and this helps staff to support them with making decisions and choices. One resident who wanted to move to other, more independent, accommodation had had this choice clearly noted on their file and discussed in reviews with their local authority care manager. The home supported the resident in making this choice and were willing to work with the local authority if a move was deemed to be appropriate. Limitations on facilities and choices are also noted in residents files. One of the three residents activities plans sampled showed there was little choice of activities, and this is discussed under activities in the next section of this report. In addition, bathing and showering facilities at this home do not currently give residents any choice. There is one shower room where the shower is not working properly and the water cuts off intermittently during use. There is one bathroom with a specialist bath which is also not working properly. This is discussed further under the environment later in this report, and a Requirement will be made. In addition to advising staff and putting up a notice which had already been done, a written risk assessment needs to be put in place regarding the faulty bath. A requirement was not made as staff said this would be done straight away. The staff were also asked to review the practice of hanging the hazardous substances (cleaning materials) cupboard key in the laundry room which would be within reach of anyone except small children. Care Homes for Adults (18-65 years) Page 13 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to take part in fulfilling activities and be part of the local community. Family and friendship links are encouraged and residents are treated respectfully by staff. Residents are offered a balanced diet and specialist advice is taken as necessary. Evidence: Residents each have an activities plan. During conversations with residents, some were able to describe their current activities and one resident showed the inspector a box of photographs of their activities. This selection is then used daily to fix to their activities board as a pictorial reminder of what they are doing that day. The staff member who had assisted him to compile this pictorial selection talked this through with the inspector and was found to be very knowledgeable on the needs of this resident. Current activities available included outings, with one resident having their Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: own car, shopping, gardening, Brunel Day Services, cooking, make-up, art and crafts, and sport. One resident has a gardening job. The AQAA states residents are encouraged to help around the home including bringing their own laundry to the laundry room. The manager has set up individual laundry boxes for smalls with each resident having their photo on their box. Residents also help to keep their rooms tidy, help with cleaning and hoovering, and help in the garden. One resident regularly answers the homes telephone. Residents socialise with people from other Owl services, and staff said all residents went to the recent Owl Summer Ball. One of the three residents activities plans sampled showed there was little choice of activities, and some of these had not even taken place during the week of the inspection due to staff or transport shortages. Staff spoken with assured the inspector that the written plan was not an accurate record of the activities this resident had actually been offered, and they were asked to review the written plan to make sure it more accurately reflected the activities on offer and taking place. They also said that the staff were actively looking for more activities for this resident as he was not allowed to go to some day services because of his age. Whilst this issue may be taken up with the providers of those services, it is the responsibility of the home, in consultation with each resident, to ensure there are suitable arrangements in place for each resident. When looking at this residents last review, one of the goals had been to help him to develop meaningful activities that would enhance his value to other residents, and therefore more work still needs to be done. Residents are encouraged to be part of the local community and staff were knowledgeable on the opportunities available. Some residents go out to a church lunch, others use day services and sports facilities. Residents access local health care facilities including the GP surgery and the local hospital. Files sampled showed activities such as bowling with friends, working at a local farm, and going to the Darby and Joan Club as examples of community involvement. Family and friendship links are encouraged at this home and staff spoken with were knowledgeable about residents family and friendships. One resident goes home regularly and is taken and collected by staff, even though this takes several hours. This was happening on the day of the inspection. Files record family involvement including regular visits and contacts. The AQAA states residents maintain links with family and friends in various ways including by telephone, sending e-mails, and using the web cam. Residents were observed to be treated respectfully by staff and bedrooms and bathrooms were only entered with permission if the resident was in the room. Residents can have a key to their room and one was observed to have a key and Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: preferred to lock their door when going out. Residents can choose to be alone or in company and one resident said they preferred to be in their room most of the time. Staff were noted to be calm and respectful to one resident who was displaying verbally challenging behaviour. The staff involved should be congratulated for their patience and professionalism in very difficult circumstances. Residents were seen to move freely around the home with the more sociable residents frequently returning to the lounge were there was more opportunity for social interaction. Residents are given the opportunity to help with domestic chores around the house if they wish. The AQAA states that residents are encouraged to have an input into the weekly menu and that advice from dietitians, and the GP etc is followed. On the day of the inspection only 3 of the 6 residents were at home during the lunch period, and one was seen to be having something to eat in the dining room. Staff said that mealtimes are flexible to suit residents needs so they wouldnt necessarily all be in the dining room together. One resident had gone out for lunch to a local church club. One residents file showed that they were interested in cooking and went to college for classes. Another file showed that the resident needed support from staff in relation to their diet, and detailed guidelines were in place on this matter. One residents file showed they needed a soft diet and there were guidelines for staff both on the residents file and in the kitchen in relation to this. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive personal support in the way they prefer and require, and their health needs are met. Arrangements for the administration of medication protect residents. Evidence: Three residents care plans were sampled and, as stated earlier in this report, all had detailed guidance on how each resident would like their support to be delivered. Personal care was seen to be delivered in private. Residents had chosen their own clothes and hairstyle and some residents were currently attending a make-up course. All three files had good guidance to staff on how best to communicate with residents, and guidelines for managing various behaviours were also in place. Residents have been involved in drawing up their care plans. Some parts of the care plans and the reviews shown to the inspector were in a very user friendly format. There are flexible routines at this home with daily notes recording choices people had made, for example one resident had had a lie in on the day of the inspection. Aids and equipment are in place to support residents, including ceiling hoists, grab rails and wide corridors and doors. Specialist assessments were on file including occupational therapists reports, and reports from the speech and language therapy team. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: Current limitations in relation to bathing and showering are discussed under environment later in this report. And, as noted earlier, care plans for older residents should be reviewed on a monthly basis. Residents health needs are assessed and specialist advice sought for example speech and language therapy, occupational therapy, and the dietitian. Records of health interventions and visits from health professionals are kept, together with any treatment given. Guidelines are in place for staff on how to support residents in relation to maintaining good health as well as specific conditions such as epilepsy. Risk assessments are in place for health related topics such as moving and handling, eating and swallowing difficulties, and mobility. Residents have regular health checks and access to appropriate preventative measures such as the flu jab and treatment for hay fever. Some residents do exercises and others benefit by physical activities such as gardening and attending local sports facilities. Medication is supplied by the local pharmacy in a monitored dosage system, and the community pharmacist visits the home periodically to check that the arrangements for medication administration are satisfactory. The last visit was in August 08 and the report was seen by the inspector. It raised no concerns and noted that all staff had had medication training and that medication records were completed correctly. Medication cabinet keys are held by a designated person on each shift and the home follows Owls policies and procedures on handling medication. The AQAA states that no residents are able to self medicate at this home. The inspector noted that there were good guidelines in place for the administration of as required medication. Care Homes for Adults (18-65 years) Page 18 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that any complaints would be taken seriously, and they are protected from abuse. Evidence: There is a complaints policy in place and Owl Housing have a user friendly version available for residents. The AQAA states that 2 complaints have been received directly to the service and dealt with within the Owl complaints policy time frame. One complaint was received at CSCI and was referred back to Owl, via the complainant, to deal with through Owls own policies and procedures. Residents spoken with at the home would be able to make a complaint on their own behalf, but also there is family involvement with most residents and they could highlight any concerns. Staff were observed to deal with any concerns raised by residents in a calm and professional manner. Owl Housing has a policy and procedure in place for dealing with allegations relating to safeguarding adults. Staff receive training on this subject and the AQAA states that there have been two safeguarding adults investigations in the last twelve months, both of which have now been satisfactorily concluded. Recruitment arrangements, shared with head office, ensure that the service only employs staff after satisfactory recruitment checks have been carried out. It would be useful to obtain leaflets from the local authority on the latest safeguarding adults policy and these could be Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: distributed to staff to supplement their existing knowledge of the procedures, as well as useful telephone numbers. The records of two service users were sampled to check what arrangements were in place for supporting residents to manage their own money. Both records were satisfactory and showed that the money in each purse corresponded with the written record, and that safeguards were in place, such as checking this information at each shift handover, to protect residents from financial abuse. Receipts and records were kept which showed residents money was being spent on themselves. Owl Housing audit residents records, and individual financial records may be sampled as part of the Regulation 26 visits on behalf of the provider. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst this home benefits from being purpose built and having a bright and comfortable interior, the poor maintenance and upkeep arrangements spoil the otherwise homely environment that staff have tried to create. The home is clean and fresh throughout. Evidence: The AQAA states the home is accessible, safe and well maintained, and meets individual and collective needs. On the day of the inspection all the communal areas and three residents bedrooms were visited. There were many homely touches particularly with the colour schemes and accessories in residents bedrooms, and the bright and colourful decor in the living room and dining area. However, the home is not well maintained. As outlined earlier there is one shower and one bath for six residents, and neither are working properly. The shower shuts off intermittently and when staff demonstrated this shower to the inspector it shut off after only a few seconds. The bathroom with the specialist bath was also having problems. The parker bath had a fault on the side door causing water to leak out and the side panel can now only be operated when two staff are in the room as it falls down unexpectedly and had hit one member of staff on the back of the head. An over Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: bath shower can be used in the parker bath but again, when the water gets to a certain level, it leaks out. The bathroom floor was very wet on the day of the inspection. In addition, the following issues were raised on the day of the inspection and later with the manager: Large stretches of skirting and walls have been damaged by wheelchairs and have not been repaired or strengthened to stop further damage. Floor coverings, particularly in toilets were either worn or had gaps, making it difficult to keep them clean, and skirting in toilets and bathrooms needed attention. One toilet had a broken hand rail which was tied up with a plastic bag. The floor covering in one part of the lounge and in one residents bedroom was stained and needed attention, and in the same bedroom, the only armchair in the room was in a state of disrepair and looked not only unsightly, but had a loose arm which may have been dangerous if someone sat in it. Due to shortage of storage space there were several examples of inappropriate storage including commodes being left out, one left in the hall and another in the garden. The shower room had a number of items stored in there including two commode lids, an exercise frame and a plastic partition which staff said they didnt use. Whilst the main garden is much improved, the areas at the sides which residents rooms look onto need further work, and there was mushroom like fungus growing on the right hand side of the back garden near the house. In this area there were more dandelions than actual grass. One room looked out over rubbish bins, recycling boxes that were overflowing into the nettles and long grass, and two missing fence panels exposing building supplies and debris in next doors garden. The manager and staff explained that some of these issues were not within their remit and the housing association who owns the property had not responded in a timely fashion when the issues were raised with them. However, it is the responsibility of those registered with CSCI to ensure that appropriate facilities are available for residents use. A Requirement is being made in this regard. The laundry was visited during the inspection and found to have commercial washing and drying facilities, including sluicing for soiled laundry. The area was clean and tidy though the floor was becoming worn in places which will make it difficult to keep clean. The door to the hazardous substances cupboard where cleaning materials are kept did Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: not fit tightly, and the key to this cupboard was hanging up and within reach of any standard height adult. This is discussed earlier in the report and a review of this practice is recommended. There were good hand washing facilities throughout the home and all had soap dispensers and paper hand towels to promote good infection control. Staff do all the cleaning themselves at this home and there were no unpleasant odours in any part of the building. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by competent, qualified and committed staff, and recruitment arrangements protect residents. Training arrangements are well developed and ensure residents needs are met. Evidence: Staff were observed to communicate well with residents and there are good written communication guidelines in place for staff to follow. Residents were seen to go to or call for staff when they needed support. Staff were observed to be both committed and motivated and this was demonstrated more clearly as the day went on. It was a busy day as neither the manager not deputy were on duty, and one resident had had a fall earlier and had been accompanied to hospital by one of the three staff on duty. The two remaining staff in the morning were able to balance the needs of the residents in the home and kept calm when under pressure. A regular agency staff member who knew residents well joined the shift at lunchtime followed by some more permanent staff once they had returned from food shopping and escorting residents. Staff swapped around their roles to ensure the best arrangements were in place to meet the needs of residents. However, the staff ratios should be kept under review as the needs of some residents required 1:1 attention, and staff at this home are expected to do the cleaning, cooking, and gardening, as well as caring for residents. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: The AQAA states that 8 of the 15 care staff who work at the home have a qualification of at least NVQ Level 2 in care, which exceeds the 50 target recommended in the NMS. Recruitment arrangements are shared with head office and on the day of the inspection all the recruitment files were locked away. The inspector was able to look at all other staff records and then had the recruitment proformas for two staff faxed across to CSCI the next day, for confirmation that the recruitment arrangements were sound. These records showed that CRBs, including POVA checks had been carried out, and that references and identities of potential staff members had been checked. Staff training records are well kept and training matters are reported on to Owl Housing as part of the regular management reviews. There is a training matrix in place which makes it easy to see what training each staff member had done and anticipate when refreshers were due. One staff members record was checked and despite being fairly new to this service, they had completed all the Owl Housing mandatory training plus some additional training courses. All new staff complete a thorough induction training. Owl Housing has a rolling programme of staff training and the AQAA states that all staff are expected to participate in learning disability qualifications training. Infection control training is not currently a mandatory course for staff and this was discussed with the service manager who joined the inspection in the morning. She agreed to look at current related training to ensure the necessary elements were either already included in other mandatory training, or a specific course would need to be devised for all staff. In a discussion following the inspection, the new manager for this service said she is a trainer for infection control and therefore this training could be implemented fairly easily. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit by being in a well run home with good quality assurance processes in place. Health and safety arrangements are well developed but further work is needed to fully protect residents and those who work at this home. Evidence: The previous registered manager has left the service and a new manager has been appointed. She has been working at the home for some months whilst keeping a watching brief over another Owl service where she is currently the registered manager. Staff spoken with were supportive towards the new manager and praised the improvements she had made since arriving at the service. The manager is supported by a senior staff team and in turn reports to the Owl Housing Service Manager. The Requirements and Recommendations from the previous inspection have been met and the AQAA recognises some of the current shortfalls and has plans to make further improvements to the service. Owl Housing has well developed quality assurance systems in place including a quality Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: assurance policy, regular management reviews which are completed by each service, and Regulation 26 visits carried out by the provider. The AQAA states there are regular monthly team meetings to which residents are invited. As these are open meetings, only information relating to the service, or to all service users is discussed. Care plans are reviewed and residents are clearly involved in these, with their wishes and opinions being recorded and discussed. The AQAA states that monthly health and safety checks are carried out at the home and quarterly monitoring is carried out by the Owl Housing health and safety representative. It also states that the housing association carries out an annual inspection to enable them to plan for future repairs replacements and alterations. The home had a number of measures in place to promote the safety and welfare of residents, including guidelines for staff on how to manage residents challenging behaviours, risk assessments for activities such as going out and about in the community, moving and handling and falls. There are also risk assessments and guidelines in relation to specific health conditions such as epilepsy. Staff are trained in relevant topics such as health and safety, fire, first aid, food hygiene, and moving and handling. Equipment and adaptations are in place for the safety and comfort of residents for example grab rails, ceiling hoists, and a special bath. However, there were a number of health and safety concerns on the day of the inspection, already mentioned in the report, which suggests that current systems are not picking up and dealing with shortfalls in a timely way. A Requirement will be made in this regard. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 23 A review of the current shortfalls in relation to the environment, as set out under Standards 24-30 in this report, must be carried out and a plan with timescales for remedying these issues must be drawn up and forwarded to CSCI. For the safety and comfort of service users. 30/11/2008 2 42 13 A review of current 30/11/2008 arrangements for managing health and safety must be carried out to ensure any shortfalls are discovered and dealt with in a timely fashion. For the safety and welfare of residents, staff and visitors. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 29 of 31 1 6 Care plans for residents aged over 65 years of age should be reviewed on a monthly basis as recommended in the NMS for older people. Risk assessments should be reviewed when any changes take place, and at least annually, and a further date set for the next review. In addition, the practice of having the hazardous substances cupboard key hanging in the laundry should be reviewed. Staff to resident ratios should be kept under review to ensure there are sufficient staff to meet residents needs, including those who sometimes need prolonged 1:1 support. This review will need to take into account that care staff are expected to carry out all the cleaning, gardening and cooking of meals for residents, in addition to their care work. The service needs to ensure that specific and sufficient infection control training is given to all staff. The Health Protection Agency website can provide more information on this subject if necessary. 2 9 3 32 4 35 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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