Inspection on 28/01/09 for 2 Seymour Terrace

This inspection was carried out on 28th January 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

2 Seymour Terrace 07/02/07

2 Seymour Terrace 20/01/06

2 Seymour Terrace 06/10/05

2 Seymour Terrace 21/10/04

2 Seymour Terrace 14/09/04

2 Seymour Terrace 04/03/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: 2 Seymour Terrace 2 Seymour Terrace Totnes Devon TQ9 5AQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rachel Fleet     Date: 2 8 0 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.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 Seymour Terrace 2 Seymour Terrace Totnes Devon TQ9 5AQ 01803867506 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): enquiries@comae.org.uk Mrs Lilah Ramsden,The Very Rev Mitred Archpriest Benedict Ramsden,Mr Simeon J A G Ramsden care home 3 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home The Community of St. Anthony and Elias specialises in the care and support of people with mental health needs. It has homes in the Plymouth and South Hams areas of Devon, and for ease of reference this is referred to as the Community in this report. People living at the home may also be identified as residents or clients of the service. The home does not provide nursing care other than through the local NHS community services. No. 2 Seymour Terrace is close to the river Dart and the centre of Totnes, with its shops, cultural and recreational amenities. Being in a terrace above road level, the home has a parking area at the rear of the building, accessed from a side road. Accomodation is provided from the basement level - where there is the kitchen, a shower/toilet, staff office and garden access - to the first floor, where there are bedrooms. The front entrance, a lounge, bedroom and a bathroom (with a toilet) are on floors between. All bedrooms are single rooms. There is stair access only between Care Homes for Adults (18-65 years) Page 4 of 31 3 Over 65 0 Brief description of the care home floors. The second floor is currently used for storage. People living at the home are supported to maintain or develop their social contacts, activities and interests through arts and activities programmes run by the Community, which are based on the individual interests and needs of those currently cared for. The home has access to the Communitys own transport, although this relies on the availability of staff drivers. Fees at the home currently range from 1500 - 1900 pounds/week, dependent on individuals needs. These include the activity programme run by the Community, and some holidays offered by the service. Not included in these fees are the costs of activities or holidays that individuals arrange independently for themselves, and personal expenses such as toiletries, hairdressing and clothes. Our previous inspection reports are available from the homes manager. 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: Date of last Key Inspection: 7 February 2007. We had since carried out an Annual Service Review, on 6 June 2008, concluding the home was continuing to provide a good service. This Key Inspection was part of our usual inspection programme. Our unannounced visit to the home took place over ten hours on a weekday. Before our visit Steve Escott, the Registered Manager, completed a questionnaire sent out by us (the Annual Quality Assurance Assessment, or AQAA). This included the homes assessment of what they do well and any plans for improvement, as well as information about people living at the home, staffing, policies in place, and maintenance of facilities. Care Homes for Adults (18-65 years) Page 6 of 31 We had also sent surveys to the home for them to give to the three people living there and to six staff. We received surveys back from one person living at the home and from four staff. We sent surveys to three healthcare professionals who support people at the home; none were returned. During our visit, we spoke with the people living at the home and with two support workers, as well as looking around the home. We checked peoples care plans, various other care-related records or policies, information relating to staff, and health and safety documents (such as accident /incident records and maintenance records). We discussed our findings with Mr Escott, who assisted us fully through the day. Information is included in this report from all these sources, and from communication with or about the service since our last inspection. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes admission processes are such that prospective residents needs and aspirations are assessed and understood before they are offered a place at the home. Information provided to them enables them to make an informed decision about whether to move into the home. Evidence: At our last Key Inspection, pre-admission assessments by external professionals and the Communitys senior staff were seen for the two people living at the home then. They provided good information on individuals needs, interests and wishes. We found this was gathered on different occasions, when staff went to meet the person in their previous accommodation and the person visited the home. We saw the assessment included any actual or potential risks relating to the persons needs or wishes, and how it was intended that the risk would be managed. There was no pre-admission assessment available for one person who had moved in more recently; the manager thought this was at the Communitys head office. The person told us they knew the home and staff prior to moving there, having visited Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: whilst living in another Community home. They said they had seen their room and discussed their admission with staff before moving in, and had been given written information about the service. Care plans with clear goals were in place for each person living at the home. Individualised risk management plans had also been written. These included actual and potential restrictions on freedoms and choices. We discussed with Steve Escott, the manager, that it would be helpful to cross-reference information, to alert readers to relevant information elsewhere in care records. The home gives prospective residents the Communitys Statement of Purpose and Service User Guide, with extra inserts about No. 2 Seymour Terrace, including their complaints procedure, and advocacy services. This provided comprehensive information. It did not include a specimen contract or terms and conditions of residency, which would clarify residents responsibilities and rights. We noted care plans included some reference to peoples obligations according to the homes contract (regarding medication). The manager explained that although they are not in the Statement of Purpose and Service User Guide, people are provided with a copy of such documents before they move into the home, with the contract discussed and then adapted for their specific needs or situation. We saw people living at the home had signed contracts in their records, which stated clearly expectations regarding housekeeping, compliance with medications, use of alcohol and drugs, individual weekly fees, and keeping a pet, among other things. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are very well supported to make choices and pursue their individual goals, being encouraged to take risks responsibly, to improve the quality of their lives. Evidence: We looked at peoples care plans, which were very well organised. They showed clearly how individuals physical, emotional and social needs and related goals were to be supported and met. Documents were seen relating to specialist mental health input. Discussion with people living at the home showed that the care plans accurately reflected their individual needs and aspirations, such as for recreational and dietary matters. Reviews had taken place three-monthly, under the Care Programme Approach. People were invited to discuss and agree their updated care plan. Some had signed them, to confirm their involvement. Support staff told us that they could also be part of these reviews, through reading and commenting on the draft care plans written by the Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: manager. The reviews reflected peoples various achievements toward their goals, as well as where progress had been slower, based on the daily care notes kept by support staff. There was a clear cycle of assessment, planning, action and review in the plans and daily care records. There were comprehensive risk assessments and risk management plans, though we noted these had not been signed as the care plans had been. Mr Escott told us people were given copies of these, with the care plans we saw they had. Details of any restrictions on usual freedoms were recorded, with the reasons for such restrictions, although these were relatively few and tailored to individuals welfare needs. We noted from care records that the kitchen was to be locked overnight, and were told this was a safety measure taken in response to past events. Steve Escott said staff would willingly unlock the kitchen if someone wanted to go in during the night, remaining available for support and safety reasons. He confirmed this restriction was regularly reviewed. Mental capacity assessments were in place for each person. Information on advocacy services was available, and we saw some people had used such services in the past. The choices available to people were evident from their care plans, from discussion with them and with staff. Some people we met were largely independent, and had made many choices about the development of their skills, use of their time and their social interests. It was clear from records that they remained fully supported by the home during such times, and that they were encouraged to move forward. In line with this, the policy for Missing persons had been adapted for each person, taking into account their usual practises or lifestyle as well as particular circumstances staff should take into consideration for each individual. We saw from care records that this promoted peoples independence, with clear encouragement that they take responsibility for choices they made, and with support or guidance on taking appropriate risks. Care records showed people were encouraged and supported to manage their own finances, including budgeting skills and setting up bank accounts in some cases. Staff did not act as appointee for anyone living at the home. Personal monies was not held by the home on behalf of individuals, except if someone asked them to safe-keep cash temporarily. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples individual lifestyle choices, relationships and aspirations are respected and appropriately supported, promoting their independence and enabling them to have increasingly fulfilling lives. Evidence: Our observations, conversations and care records reflected that people living at the home were enabled to have high degrees of independence and to lead active and varied lives if they wished to. Individual plans showed this was done within the framework of clear risk management plans. As we arrived, someone was arranging with Steve Escott to be booked in for five-aside football, climbing, a cookery session and a surfing trip. These were part of the Communitys monthly printed activities programme, which we saw. The programme included arts and outdoor activities, based on the interests and needs of current Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: service users. Hence, surfing was included, an interest identified before one person moved into the home. They told us they were able to go most weeks, with availability of a staff driver affecting the frequency. Transport is available in that the Community has vehicles that its homes can use for activities, getting people to employment or voluntary work, etc., driven by support staff. Individual activities and ambitions were also well supported. One person told us about their voluntary work, and their social life in the local community. People told us they could use the cordless phone seen in the lounge freely. One person used the homes computer to find out about local events. The development of independence and daily living skills was reflected in care plan reviews. Peoples friends visited them whilst we were at the home. Care plans and daily records showed how relationships with family and friends were being very well supported, including visits to relatives at Christmas time. The rights and responsibilities of people living at the home were clearly respected by staff we spoke with. Each person had a key to their room, and felt staff generally respected their private space; we discussed an exception to this with the manager. Staff support was offered on a flexible basis. We saw staff occupying themselves at times, because people who lived at the home had gone out or wanted privacy. But a staff member told us that even at busy times they would drop everything if certain people wanted to go out or chose to socialise with them, because a flexible approach was needed where individuals had fluctuating levels of wellbeing or health. Mealtime arrangements in the home reflected peoples levels of independence and their individual daily life. During our visit, one person had gone out over lunchtime; another was invited to join others, including staff, for a salad prepared for whoever wanted it. People told us they made their own meals and snacks if they wished to. One person told us he was given a daily float by the home, so he could buy his own food. The AQAA had said greater autonomy was now offered with menu planning and catering, in line with individuals requests. One person followed a particular diet of their own choosing. Food was purchased on a shift by shift basis in consultation with people living at the home, with records kept of the meals eaten. We saw contracts clearly stated expectations or house rules. Care plans reflected these, according to individuals responsibilities and tendencies. Daily notes showed Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: people did take part in household duties; one person told us they felt a little apologetic that they had not done as much as they might lately. 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. People living at the home are supported to look after their personal and healthcare needs as independently as possible, with agreed help given to ensure these needs are met safely, promoting their wellbeing. Evidence: It was clear during our visit that people living at the home were responsible for their daily routine, within safe limits. We saw support was provided within guidelines given in peoples care plan, ensuring people were given help without diminishing their independence, privacy and personal responsibility. People we spoke with indicated that generally they received support they wanted or needed, as an individual, for their various specific needs. Mental capacity assessments and mobility assessments were now part of their care plans. People told us the home ensured they had checks on their physical health. Records had been kept of their appointments with GPs, dentists, opticians, as well as attempts made to get the person to such appointments. Newer staff we spoke with were not fully aware of peoples underlying health conditions, but had had relevant training on such conditions. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: Current care records did not fully reflect what one person told us about a mental health matter, how it affected them most, and how they thought staff should support them. The person had found particular support from one staff member had been useful. The problem was noted in the persons most recent care plan review, but without suggestion of therapeutic interventions that might be tried by staff. Staff we spoke with were aware of the problem, and said such information would be passed on verbally rather than in care records, partly because of confidentiality. However, there is a risk that changes in a persons health would not be properly identified or individuals would not receive continuity of support and care, unless such information was recorded, especially if there were reduced continuity of staff. We asked the manager whether local social and health services were informed about people who would be moving to the home from outside of Devon, since their services might be called on to support them and they might need to plan their resources accordingly. We were told they were not contacted at present but also the Community employed its own consultant psychiatrist to ensure particular needs could be met. One person felt the home used therapeutic approaches and didnt just rely on medication to help people. Another felt most staff relied on medication to help them with one of their needs although a staff member had suggested another strategy, which they had found helpful. Medicines were securely stored. There was specific storage available for controlled drugs but we were told none were currently required. Patient information leaflets were kept for the medicines in use. The manager told us that the homes regular staff oversaw administration of medications, rather than staff covering from other Community homes, and we saw this happening during our visit. The homes contract stated people could self-medicate as part of an agreed plan of care. The people we met at the home were all being encouraged to take responsibility for their own medication, although the medication was still being held by the home. We saw related risk assessments had been put in place since our last visit, these being very tailored to each individual, their usual routines and possible variations to those, etc. It would be good practise to include in these risk assessments if and what the individual had been shown about the practical aspects of managing their medications. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: Care records showed that where individuals had not self-medicated as they needed to, they were given support to review the situation and re-continue towards independence. We saw they administered their own medication with a staff member present and then signed the medicines record themselves. One person we spoke with felt they could do better with managing their medications themselves, but was happy with their progress to date. Where people might have said it was their right to refuse their medication, care plans guided staff to remind them that taking prescribed medication was a condition of their continued residency at the home, which we saw was included in the contract they had signed. We found staff had completed incident forms if medication was not given or not taken as indicated in individuals care plans (if mistakes had been made, etc.), with followup including re-training of staff and individuals. The medication policy had just been reviewed, and the manager said refresher training would be carried out now. Staff recorded the administration of as required medicines in some detail, with related detailed guidelines in each care plan for when such medication should be offered to the person concerned. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can feel assured that their views and concerns will be listened to and acted upon. Staff lack some knowledge about local safeguarding procedures, so people at the home may not be as fully protected from abuse or harm as possible. Evidence: The complaints procedure had been given to each person at the home. This was in clear print, and included how to complain directly to us. Steve Escott confirmed he would be updating certain details in it. One person living at the home told us they would speak to the Communitys medical practitioner if they had a complaint. Another said they had spoken with the manager about a staffing issue, and the matter had been resolved. Staff told us there was a complaints form that people living at the home could complete, or staff would request that the on call senior staff came in to speak to someone if they had a complaint. The AQAA stated the home had not had any complaints in the previous year. Since our last key inspection, they had notified us of one complaint, which they upheld and took action to address. Care records showed that peoples day-to-day concerns were listened to, with attempts made to resolve them in consultation with the individual. This was confirmed in our discussions with people living at the home. Various policies and procedures were in place to protect people at the home from Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: abuse or harm. They told us they could use a phone provided by the home in private at any time. Their care notes included a record of their more valuable possessions. We saw the home used a checklist to ensure that people moving on from the home, to more independent living, had been given the support, skills, etc. that they needed to make the move a successful as possible and safeguard their wellbeing. Staff training included understanding and managing aggression, with de-escalation techniques as well as physical intervention. Staff we spoke with generally had a good knowledge of safeguarding, including their responsibilities to report various forms of abuse should they witness or suspect them, and external agencies to whom concerns could be reported. The safeguarding policy had out-of-date contact details for such organisations, and did not include the current local authority reporting guidance, which the manager was also unaware of. He agreed he would look into obtaining updating on this. Care Homes for Adults (18-65 years) Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a sufficiently clean, comfortable, homely and safe environment, which could be made more pleasant through additional attention to one communal area. Evidence: The tidy, pleasant-looking garden at the back of the home, with paving and seating, was used by people during our visit. The lounge had a new carpet and television. The kitchen had a bigger fridge that better met the needs of people currently living at the home, who were encouraged to make their own meals and thus kept their food in it. A third bedroom being created at our last visit was now in use. The top floor was out of use other than for storage. People living at the home told us the home was very clean most of the time. During our visit, most areas were adequately clean, decorated and comfortably furnished. The light-coloured entrance hall carpet looked stained however, although Mr Escott said it was cleaned regularly. He told us that replacements and refurbishment was done as necessary (rather than working to an annual plan, etc.). Requests for repairs, furnishings, etc.had been signed off in the log book kept as they were attended to. Cleaning chemicals, etc. were kept in locked storage. Maintenance and safety records Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: showed checks of water temperatures, the safety of electrical appliances and for risk of legionella. There were no obvious hazards, but we noted that some environmental risk assessments were dated 2005. Staff described appropriate measures for reducing cross-infection risks, and said disposable gloves were available. The laundry facilities were domestic in nature, in keeping with the size of the home and the needs of its residents, and sited separately from the kitchen. People living at the home told us they did their own laundry. The area had washable walls and floors for maintaining the hygiene of the area; we pointed out there were no soap and hand-towels at the sink provided, which the manager said he would address. 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. People living at the home have their needs met and are supported well by staff, who as individuals are suitable to work in such a care setting, and who are trained, supervised and supported well by their manager. Evidence: During our visit, Steve Escott was on duty with a support worker from another Community home, who was covering the absence of a usual staff member and who had worked at the home before. Another staff member arrived for duty later in the afternoon. Mr Escott confirmed there are usually two staff rostered for all shifts. Support staff usually worked 48 hour shifts, acting as sleep-in staff overnight. We were told occasionally there was only one support worker overnight, if the second staff rostered was absent for some reason and the one staff on duty was experienced and agreed to the arrangement. A senior staff member was always on call, should this staff member need them to come in during the night. Although staff surveys reflected a concern that staffing levels were not always sufficient to meet peoples needs, people living at the home told us they thought there were too many staff around. They confirmed they had never been prevented from doing anything they wanted to do because of staffing arrangements, apart from when Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: a car driver was not available. Staff we spoke with thought staffing levels were sufficient. We checked recruitment information for three staff employed since our last inspection. Proof of identification, two references for each person and partial copies of police checks were available at the home, with other information kept at the Communitys main office. We discussed the need to see, for example, full police checks and a record of peoples experience (such as given on the Communitys application forms, which we saw later) on our visits. Mr Escott subsequently obtained evidence required for us. How such information is to be made available for inspection in a timely way will need to be considered on future inspections. People living at the home confirmed they had been involved in the recruitment of some staff, whom they met when the individual was undergoing interview processes that included time spent at the home. The AQAA stated that of eight permanent staff working at the home, one had a recognised care qualification. The manager told us two staff, who had relevant professional qualifications gained in other countries, were undertaking a care qualification; another staff member was undertaking a care-related degree. Both staff we spoke with were undertaking care qualifications. Staff refresher training on health and safety topics was overdue but this was being addressed (- see the next section of this report). Some more specialist training was given during induction (such as on schizophrenia), along with written information. The Communitys psychiatrist was also available for general advice as well as guidance on care of each individual. There was detailed written evidence of staff supervision sessions, which included discussion of individuals practise, health and safety matters, and other topics related to ensuring people received a quality service. A file has been developed to help new staff to understand the systems and routines in the home, with an orientation checklist covering fire safety and other relevant information. We saw the staff on duty had signed this to confirm they had read it and received orientation to the home. 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. The service is run for the benefit of people living at the home, using their views and other monitoring systems to ensure ongoing improvement of the service for each individual. Whilst various health and safety measures are in place, two aspects need attention to promote the welfare of everyone at the home. Evidence: Steve Escott, the registered manager, has many years of experience in managing care services, is qualified to NVQ level 4 in Care, and has completed the Registered Managers Award. Steve Escott is also the registered manager for another of the Communitys homes in Totnes. Since our last visit, he has attended training about the Mental Capacity Act 2005 and Cognitive Behaviour Therapy. He also told us he also learns through working regularly with the Communitys Consultant Psychiatrist. Staff told us there was always at least one senior staff member on call for advice or support, and they readily came to the home if necessary. We found the homes self-assessment in their AQAA was an honest reflection of the Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: service. Involvement of and outcomes for the people living at the home were referred to in places, as evidence of the quality of the service. As a result of monthly unannounced visits carried out by representatives of the registered provider, some bedrooms were to have new carpets, for example. Staff knew about these visits and that they were part of quality assurance systems. We also saw the homes current Quality Assurance plan. This included surveys, which had been sent out recently and which would be received back by the Communitys main office. However, results were presented as a total of the Communitys services rather than for each registered service. The manager also met with people living at the home monthly, specifically for checking on the quality of the service they were receiving. This was done individually, or as a group meeting if people wanted to. Someone living at the home confirmed meetings were held occasionally or when necessary. All said they had regular contact with Steve Escott. There was also a suggestions box. Staff told us that fire drills were carried out 3-monthly. Records confirmed this, and that 5 staff had a fire training update 3 months previously. We also saw from records that people living at the home had been involved in the drills. Although there was some risk assessment in each individuals care records relating to fire safety, we did not see guidance to clarify if and when each individual might need staff support in the event of a fire. We discussed this with the manager, particularly because staff had noted changed behaviour after people had been out and drinking alcohol. Records showed weekly fire alarm tests were carried out. The manager said he would consider getting advice about a stand-alone fire detector fitted where a particular risk had been identified. We had noted it was not connected to the homes system to alert others in the building. The three staff whose files we looked at had had training in safe working practises since their employment, and all staff were first aiders. Mr Escott was aware updates were overdue for other staff, due to the Communitys training staff being absent. Weekly refresher training had just begun, to bring everyone up-to-date within 2-3 months. Manual handling training had just been given; physical interventions training was due in the next month. The AQAA confirmed that servicing or testing of equipment was up-to-date. We saw that environmental health and safety checks had been recorded regularly. The manager told us that accidents and incidents were audited by the Health and Safety Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: Officer at the Communitys head office. The completed forms that we saw showed that incidents were reflected on, and advice given to prevent a recurrence; in some cases, this including working with individuals to gain their co-operation. During our visit, someone requested their own space in the kitchen fridge for their food. The manager agreed to this providing that the individual followed food safety principles, their discussion indicating that the person had knowledge of these. Care Homes for Adults (18-65 years) Page 28 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 29 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 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 23 It is recommended that, by training or other means, staff are made aware of local multi-agency safeguarding procedures, to ensure the home has robust procedures for responding to suspicion or evidence of abuse. It is recommended that the maintenance and renewal programme for the home includes more attention to the entrance hall carpet, so that the area looks clean and more welcoming. It is recommended you seek advice from the local fire service regarding the adequacy of the current fire detection system, taking into account individuals particular risk assessments and needs in relation to fire. It is recommended that systems be put in place to ensure that staff updating on safe working practises or health and safety matters are carried out regularly in line with the services policies for such refresher training. 2 24 3 42 4 42 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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