Inspection on 28/01/09 for 22 St Peter`s Road

This inspection was carried out on 28th January 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

22 St Peter`s Road 09/02/07

22 St Peter`s Road 02/11/05

22 St Peter`s Road 04/05/05

22 St Peter`s Road 06/10/04

22 St Peter`s Road 22/04/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 26/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 22 St Peter`s Road 22 St Peter`s Road St Leonards on Sea East Sussex TN37 6JG     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: Michele Etherton     Date: 2 8 0 1 2 0 0 9 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. 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. 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 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: 22 St Peter`s Road 22 St Peter`s Road St Leonards on Sea East Sussex TN37 6JG 01424447851 01424447851 sarahbeaney@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): A S D Unique Services Ltd Name of registered manager (if applicable) Miss Sarah Joanne Beaney Type of registration: Number of places registered: 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 4. 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 22 St Peters Road is situated in a residential area in St Leonards on Sea. The home is registered to accommodate four adults with autistic spectrum disorders. The property is a three storey building with bedrooms situated on the first and second floors. The home is close to shops and amenities and there is easy access to Hastings and St Leonards. 22 St Peters Road is one of four homes owned by the proprietors Mr and Mrs Kennard. The current scale of charges for the service range from £,150 to £1,780 each week. Additional charges are made for hairdressing, toiletries and magazines. The service provides a contribution to hairdressing costs. Inspection reports are made Care Homes for Adults (18-65 years) Page 4 of 32 care home 4 Over 65 0 4 Brief description of the care home available at the home and reference to the availability of reports is also included in the home?s statement of purpose. Care Homes for Adults (18-65 years) Page 5 of 32 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: A key inspection of this service has been conducted. This has taken account of information received from the service and about the service by CSCI since the last inspection, this includes our findings from an Annual Service Review conducted last year and from information provided by the home in an Annual Quality Assurance Assessment(AQAA). We have found the AQAA to be completed to a reasonable standard providing us with some of the information we need, this would benefit from improved detail and evidence to illustrate what actions have been taken to address previously identified shortfalls within the service and current and future plans. Care Homes for Adults (18-65 years) Page 6 of 32 Our inspection of this service has included an unannounced site visit to the home on 28th January 2009 between 9:45 am and 2:20 pm. We undertook a tour of the premises with a resident for our guide, and were able to talk with them about what its like living in the home and to observe some of their daily routines. We also spoke with a further two residents, and attended a house meeting. We consulted with staff on duty and the manager. Surveys have been distributed and a good response to these received which has been helpful in compiling this report. During our visit we examined a range of documentation including support plans, risk, and menu information, medication records, staff recruitment training and supervision records, complaints, health and safety, and accident information. All key standards have been assessed during this visit in addition to those where outcomes became evident during the course of the visit. In arriving at our judgment we have tried to be proportionate in considering compliance with regulation and outcomes for the residents alongside the overall risks and impacts of identified shortfalls. What the care home does well: What has improved since the last inspection? What they could do better: This inspection has highlighted two specific shortfalls where we have required the provider to take action these are: The update of staff training in mandatory core skills, particularly in areas key to the support of residents e.g Moving and handling, infection control, SCIP, medication, safeguarding adults. Whilst we are not concerned that staff competencies on a day to day basis are inappropriate we consider it important that staff awareness of changes in practice is updated to ensure they work to current best practice and guidance to ensure that staff and resident health and safety is promoted at all times. Care Homes for Adults (18-65 years) Page 8 of 32 The development of a quality assurance programme for the internal audit and review of systems and that incorporates the views of residents. Provider visits under regulation 26 must be completed monthly and findings of overall;; quality assurance should be published as a report and made available to residents and prospective residents to evidence how influential their views are in the development of the service. We have also made some good practice recommendations where we consider the service could improve upon existing arrangements in respect of : Terms and conditions information, medication competency assessments for staff, clarity of recording in respect of part self administration of medication and the development of individual medication profiles. We have suggested minor improvements to the recording of complaints, resident finances, the content of staff files and frequency of supervision and fire drills, also that guidelines in respect of resident restraint are updated to time. We have recommended the development of a risk assessment for the management of soiled laundry in the home 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 32 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 32 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 are provided with up to date information about the service in an accessible format, they can be confident that their needs will be assessed prior to admission by a competent person and they will be provided with opportunities to visit. They will receive terms and conditions information about their stay in the home but some improvement to the retention of this information for reference purposes is needed and also the need for residents or representatives to sign their agreement to the terms of their stay. Evidence: Statement of purpose and user guide information available to prospective residents and their representatives has been updated to take account of changes to the management of the Home. Thought has been given to making this information more accessible to residents although it is accepted that not all residents will be able to make use of written information or supporting picture references. From our examination of resident files and discussion with the manager we are Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: satisfied that prospective residents are admitted only following an in depth assessment of need and are provided with an introductory period arranged at a pace that suits them. Other residents in the house have an opportunity to get to know them before they move in and their views are taken account of. An example of Terms and conditions information was available to view and the manager advises that all the residents have been given this information but copies are not kept within the home. In order to assess that residents are receiving support in accordance with the agreement these should be available within the home for reference purposes, and a facility for residents or their representatives to sign agreement to the terms and conditions should be incorporated, this is a recommendation Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each resident has a plan of care about which they are consulted and which reflects a range of information about them this is kept up to date and focuses on their skills and abilities and how these will be developed along with future aspirations and goals. Staff understand the importance of residents taking control of aspects of their daily routines and a responsible risk management strategy is in place that addresses safety whilst providing positive outcomes for individual residents Evidence: We viewed a sample of resident files and found these to contain a range of detailed information contained within a specific autism assessment and in support guidelines for staff. Information is clear, individualized and reflective of residents stated and known personal preferences in respect of their daily routines. Support information in respect of needs is reviewed in house six monthly and can involve a range of people important in the lives of the residents and who they have indicated they would like to have attend. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: Our review highlighted the homes ability to respond flexibly to changing needs of residents and provide the necessary level of support as needed, whilst acknowledging the limitations of the service. The home takes a responsible view of risk which does not just focus around keeping residents safe but supports their right to experience risk within a framework of risk reduction measures. Restraint guidelines are in place for some residents and these inform staff what level of intervention they can provide and for which they have been trained; review dates are in place but we noted one had not been updated as planned, we have addressed the need for updating elsewhere in the report. In our discussion with residents both in private and during a house meeting it is clear they play an active role in the household and some participate more in shopping, cooking and undertaking household tasks within the limitations of their own present skills levels, one resident informed us that they do their own laundry and that they manage some of their own money and medication under supervision from staff, there is evidence that the home promotes the independence of residents wherever possible and there are long term aims for some people to move into a more independent living arrangement in the future. Residents have adapted well to the need for a range of unfamiliar staff to come into the home regularly to support the increased need for staffing in response to one residents needs, the manager sees this as a positive outcome for residents who are much more confident and relaxed in the presence of strangers and with any breaks with routine. Staff survey responses indicate staff feel they are provided with enough information about the residents in the house and this is supported by the provision of relevant training, they comment that: The service does well in my view pointing residents in the right direction to health eating and helping service users to be come independent Care Homes for Adults (18-65 years) Page 14 of 32 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 lead the life they choose and are consulted about all aspects of their daily routines. They are supported to maintain important links with family and friends and their independence and the development of skills is promoted. They receive a varied diet in keeping with their personal preferences. Evidence: Residents lead busy and interesting lifestyles making use of local facilities and pursue interests and activities they want to do, they are supported to access further education or sheltered employment where possible. Residents are consulted about what they want to do and their views are influential in respect of daily routines. Residents are supported to maintain good links with families and friends and where needed visits are facilitated to relatives homes. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: The home promotes the Independence of residents and encourages their involvement in household tasks with some residents undertaking their own laundry and some cooking, residents are able to make drinks and snacks for themselves where assessed as able to , residents have keys to their own rooms and their own mail slots. Where able to residents are supported to exert some control over their own finances or undertaking partial self medication under staff supervision, this is to be developed further but the home is reminded to ensure that for those residents who are deemed to not have capacity tio undertake these activities capacity assessments to support such judgements should be in place and reviewed regualrly. Consideration should be given to providing residents with lockable facilities within their bedrooms to progress their involvement under staff supervision with their medication regime and in the management of their own monies,and would allow residents greater privacy and dignity in the support they receive in these areas. Weekday menus are set and are developed from the known preferences and suggestions of residents, weekend menus are developed through house meetings and residents are consulted and offered options to choose between. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal physical and emotional well being of rresidents is well supported Evidence: Residents are mostly self caring with only prompting and supervison needed and this is undertaken in keeping with their known preferences and in consultation with them. The home has demonstrated its responsiveness to changes in resident health and in accessing relevant health professionals for specialised support, an examination of resident records indicates that access to routine health checks and health professionals is occurring, regular weight recording is maintained. The home should consider the completion of health action plans for all residents. One resident is partly self medicating under staff supervsion but there is a lack of clarity as to who is responsible for completing the MAR sheet, as a consequence, on the day of our visit whilst other records were maintained to a satisfactory level this one record contained omissions in recording, this arrangement therefore needs review to establish who is responsible for completion of the record, this should be incorporated into a risk assessment for this activity. Consideration should be given to Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: the resident have secure storage within their won bedroom for their medication so as to increase the level of involvement and control in addition to improved privacy and dignity with these arrangements whilst still under the supervision of staff. Staff are only able to administer medication following inhouse training and completion of a competency assessment, we noted an example of this in place for a newer staff member, more formal medication training is not recorded although the manager has advised of plans to pursue this for all staff. We have addressed shortfalls in training elsewhere in the report but would recommend the routine assessment of staff competency. Individualised PRN medication guidelines are in place, and we would also recommend the development of a medication profile for each resident to inform staff what medications are in use and for what, side effect information and preferences around administration. Audit systems have been developed around the medication process in respect of monitoring completion of MAR records, and tracking of prescriptions. We looked briefly at medication storage and found this to be tidy with no evidence of excess stock or out of date medications although an in depth examination was not conducted at this time. Care Homes for Adults (18-65 years) Page 18 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. residents are consulted with and feel listened to minor improvements are suggested in the management of complaints. Systems are in place to safeguard residents from harm and these will benefit from suggested improvements. Evidence: We have examined complaints records and note that since the last inspection there have been seven recorded complaints, discussion with the manager confirmed that these have all now been resolved but the investigation process from recording of complaint to responding to the complaint is not made clear, also the home currently uses a looseleaf file for complaints information and we would recommend that an index in developed or complaints are numbered to ensure none are overlooked and these are recommendations. The home manager has advised us through the AQAA that complaints information is openly displayed for residents and that they are supported if they wish to raise an issue by staff members who act as advocates for them. One survey response indicated that a resident knew how to complaint, thought that carers always listened and acted upon what was said to them and mostly felt well treated by staff, our observation of staff and resident interactions during a house meeting highlighted that residents feel comfortable with staff and confident of expressing their own views and what they want. All of the current residents also have strong family links and regular contact and Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: would be able to use this outlet for raising issues if they could not do so directly to staff. One adult alert is currently open following an incident between two residents. Staff are receiving training in safeguarding vulnerable adults a;though some are now overdue updates. Staff receive SCIP training and restraint guidelines are in place for some residents where minimal physical interventions have been agreed we are satisfied these are generally kept under review although one we noted is now overdue, we would recommend that attention is paid to ensuring these are reviewed and updated within given timescales to ensure that staff interventions and practice are still deemed appropriate. Personal allowance monies are stored on behalf of residents for security reasons within the office, one resident has more control by being able to take money out of the cash box and complete a receipt book, with staff help the resident also monitors the balance and record this, we checked this and another during our visit and found minor disparity between the record and sum held in both cases by one or two pounds. There is clearly a need for the manager to review the present arrangements to ensure closer monitoring of resident finances and identify the cause of inaccuracies. Care Homes for Adults (18-65 years) Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean comfortable and safe environment that will benefit from suggested improvements.. Evidence: On the day of our visit a resident acted as a guide around the home and showed us their bedroom and all communal areas including the garden. They explained that they were currently awaiting someone to repair a leak in a shower and that they had also experienced a leak from an upstairs room recently that has caused some staining to the ceiling. The resident informed us that a maintenance person addressed some of the repairs, and the presence of a contractor on site during our visit confirms that where needed the home appoints outside contractors to undertake works. We advised the ceiling is to be repainted in the near future. The resident commented that they had what they wanted in their room and have clearly personalized it with an accumulation of possessions, including an additional wardrobe for extra storage, we understood also from the resident that they are planning to purchase another wardrobe to replace one in their bedroom that is broken. Whilst it is clear the resident is able to make such decisions we do not consider it the residents responsibility to replace broken furniture caused by wear and tear and the Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: provider and manager should review this in respect of all residents, decision making around expenditure of this tyoe should be clearly recorded and involve interested parties in addition to the funding authority. The AQAA tells us that residents have their own bedroom keys. We found the home to be comfortably furnished and homely, there are some signs of wear and tear which will benefit from ongoing upgrading. It is clear that there has been investment to address unscheduled problems that have arisen e.g the boiler, external rendering to prevent leaks, and these have overridden plans to upgrade some areas of the home e.g the kitchen. The house is laid out over several floors and is unsuited to any prospective or existing residents with severe mobility problems, stair cases are too narrow to install stair lifts, the home manager demonstrates an understanding of the homes limitations in supporting any resident whose mobility means they cannot use the stair case safely and this is kept under constant review for any residents affected by this. We found the home to be clean and tidy, some residents help with cleaning their own rooms and washing their laundry, the laundry is located through the kitchen and we noted that their has been occasional incontinence resulting in soiled laundry, staff are provided with appropriate protective clothing and soiled laundry is placed in red alginate bags for washing separately. The manager assures us that this is taken through the kitchen only when no food preparation or cooking is underway we would recommend the development of a risk assessment to evidence the measures in place,and would urge the manager to ensure that kitchen surfaces are kept clear at all times except when cooking is in progress to ensure infection control is maintained. Training for staff in infection control has previously been addressed through a health and safety course, we do not consider this to be adequate and this has been highlighted within mandatory training shortfalls elsewhere in the report Care Homes for Adults (18-65 years) Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff on duty and staffing levels respond flexibly to changes in residents needs, a ribust recruitment prociedure ensures residents are safeguarded but shortfalls in training could compromise this. Assessment of staff performance would benefit from suggsted improvements Evidence: Discussion with staff and residents indicates there are always enough staff on duty to ensure residents are able to access a busy programme of activities the organisation employs a pool of relief workers who can work at the homes in an emergency, staff comment in survey responses that it would be helpful to new relief staff if they could spend the first few shifts shadowing so they have an idea what to expect when they start work in the house, this also provides residents with the chance to meet them. I look forward to coming to work the staff team are friendly and help me wherever possible Everyone enjoys working and supporting each other on shift and working as a team, to support service users to acchieve their goals Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: There is a commitment to staff training but recent staff turnover has left the home with less than 50 NVQ2 qualified staff in place, however of the 6 staff currently in post including the manager the manager is qualified and three staff are in varying stages of commencing or undertaking the NVQ now and assessors were onsite for this during out visit so we are satisfied that the home takes its repsonsibilities seriously to train staff. There is a robust recruitment procedure in place and residents meet prospective staff at a second interview before a post is offered, an examination of staff files highlights that all vetting and checks are undertaken prior to commencement of staff working at the home. We found files to contain moist of the information required under schedule 2 of the Care Homes regualtions 2001 with only current phtographs needed generally across all files, one file we viewed had some important information missibng but the manager confirmed this was still to transfer across from head office and we have asked that CSCI be notified in writing when this has occurred. Records of Relief staff recruitment and training are maintained. Staff training records are well maintained and highlight that some mandatory core training is out of date, or has not been undertaken, and we require the home to ensure that all staff achieve mandatory core training within six months of commencing work and within specified intervals for updates. Competency assessments should also be considered in some areas of practice and we have addressed this issue specifically in relation to medication elsewhere in the report. Staff supervisions are being undertaken routinely but there is some suggestion within the AQAA that staff can opt to have these less often if they feel they have nothing of note to discuss, we have discussed this with the manager who we would urge to maintain frequencies of supervisons to provide opportunities for observation and asessment of staff practice, an element of formal observation should be incoporated. Care Homes for Adults (18-65 years) Page 24 of 32 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 in the home feel consulted with, the home is well managed and will benefit from suggested improvements to quality assurance. Evidence: The manager is experienced in social care and has attained the necessary qualifications to undertake her role in managing the service, from discussion during our visit and examination of training records it is evident that the manager is updating her knowledge and skills and accessing relevant training specific to the needs of the residents. We found the AQAA completed by the manager was of a reasonable standard and told us some of the information we needed to know but would clearly benefit from further evidence to illustrate what improvements have been made how previous shortfalls have been addressed in addition to future planning for the service, the content of the AQAA has been discussed with the manager during our visit. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: During our visit and in discussion with staff and the manager we became aware of two incidents where we consider CSCI should have been notified, discussion with the manager highlighted some uncertainty as to what constituted a significant event particularly where residents were not considered at risk, and we have made clear that where other agencies such as the police, fire brigade or hospital staff are involved notification needs to be made to CSCI and the manager agreed to do so in future. Feedback from staff through survey and direct discussion indicates that they feel well supported at local management level but find the provider somewhat distanced from themselves with little interaction, regulation 26 visits are infrequently recorded although staff and residents reported the provider to visit regularly but these do not usually involve consultation with themselves. The content of regulation 26 reports viewed is generally good but does not always make clear which residents and staff have been spoken with if at all. How to do this whilst maintaining resident confidentiality was a matter for discussion with the manager but now needs to be progressed. We require the provider to ensure that monthly unannounced visits to the home are conducted by someone suitably qualified and experienced to do so. Our discussion with the manager and examination of records indicates there is a five year development plan in place but this lacks clarity on timescales and detail as to how how each area is to be achieved. We found from our meetings with residents and discussion with staff and the manager that there are opportunities for residents to express their views both privately and in group forums like the house meetings and have some influence on their daily routines, the home has also been proactive in seeking views formally through surveys of residents and other stakeholders but there is no evidence of the analysis of this feedback or how it has influenced overall service development, whilst there are a number of stand alone audit activities carried out within the home they do not form part of a wider quality assurance programme for the internal audit and review of systems that incorporates the views of residents, we require the provider to address these shortfalls and to ensure that an annual report of findings is published and made available to residents and incorporated. The AQAA tells us that policies and procedures have been recently updated and reviewed and we noted that the Statement of Purpose and user guide had also been updated. We are advised within the AQAA that all health and safety checks and servicing have been carried out and a sample examination of records during our visit confirmed that electrical installation and Gas are in date. Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: We are satisfied that the home is maintaining fire safety tests and checks and residents advised us that they regularly participate in fire drills, records of these drills would benefit from clarity as to which staff also participated and we would also recommend that all staff participate in at least two annually to keep their practice updated. Records indicate residents have experienced a low level of minor accidents since the last inspection. Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 39 24(1a)(b) As part of the homes quality 31/05/2007 assurance system they must seek the views of the residents on the quality of the care provided in the home. Comments received must be included in the home?s service user guide. Care Homes for Adults (18-65 years) Page 28 of 32 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 35 18 The provider must ensure 28/02/2009 from the given timescale that all staff complete mandatory training in addition to medication and adult safeguarding within six months of this date if they have not received it and within a timely manner for updates therafter. This should evidence that moving and handling, fire, first aid, food hygeine, infection control, medication and adult safeguarding have all been completed. So that staff have the necessary competencies and skills to support residents safely and appropriately 2 39 24 The provider is required to establish a programme of quality monitoring for the internal audit and review of systems and which incorporates the views of residents. 31/03/2009 Care Homes for Adults (18-65 years) Page 29 of 32 Regulation 26 visits are to be conducted on an unannounced basis every month by someone with the necessary skills and experience to undertake this function who is not in operational day to day control of the home. The provider must ensure that an annual report of quality assurance outcomes is published and made available to residents and prospective residents So that the efficiency and effectiveness of the service can be monitored in the best interests of residents and their own views can be taken account of Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 5 Terms and conditions information must afford the facility for residents or representatives to sign their agreement and individually signed copies should be kept in the home for reference. Routine medication competency assessments should be introduced for all staff a minimum of annually. A medication profile of resideents medications, preferreed administration arrangements side effects etc shoukd be developed. Where residents are partially or fully self medicating clarity is needed as to who is responsible for completion of the MAR sheet which should make clear thre partial 2 20 Care Homes for Adults (18-65 years) Page 30 of 32 administration arrangement by the resident 3 22 Complaints information should make clear the investigation stage. An index of complaints or numbering of complaints should be introduced to ensure none are overlooked 4 23 review and updating of restraint guidelines should be undertaken within the given timescales to ensure that staff interventions and practice are still considered appropriate The manager should review the current system of managing resident finances and ensure the cause of inaccuracies are identified and minimized risk assessment in relation to the safe management of soiled laundry is to be developed and implemented to evidence infection control risk reduction measures in place Staff files to contain a current photgraph of the staff member. All documentation relating to staff recruitment to be avaialble to view on site at all times. Care staff to receive a minimum of six annual supervisons and should incorporate an observational element with some. Fire drill records should make clear which staff have attended and all staff should participate in a minimum of two annually. 5 23 6 30 7 34 8 36 9 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!