Inspection on 03/10/08 for 267 Walmersley Road

This inspection was carried out on 3rd October 2008.

CSCI found this care home to be providing an Poor 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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

267 Walmersley Road 14/07/09

267 Walmersley Road 08/10/07

267 Walmersley Road 20/03/07

267 Walmersley Road 09/03/06

267 Walmersley Road 31/10/05

267 Walmersley Road 26/02/05

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 267 Walmersley Road 267 Walmersley Road Bury BL9 6NX     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lucy Burgess     Date: 0 3 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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 35 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 35 Information about the care home Name of care home: Address: 267 Walmersley Road 267 Walmersley Road Bury BL9 6NX 01617612484 01617373907 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Pendleton Care Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 The home is registered for a maximum of 6 service users to include: up to 5 service users in the category of LD (Adults with learning disabilities) and 1 identified child with a learning disability. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection Brief description of the care home 267 Walmersley Road provides a specialist residential facility for up to six young people who have Aspergers Syndrome and high functioning autism. The house is sited on a main road, has good public transport links and is accessible to community facilities. The current range of fees vary depending on the individual assessed needs of people. Care Homes for Adults (18-65 years) Page 4 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was a second key inspection carried out by 2 inspectors, which included a site visit and took place over one day, for a period of 8 hours. The service did not know that the inspectors were going to visit. During the inspection care and medication records were looked at as well as information about the staff and health and safety including how the home is kept safe. The inspectors also looked around the building. Care Homes for Adults (18-65 years) Page 5 of 35 As part of the inspection process the provider’s are asked to complete a selfassessment survey information document (Annual Quality Assurance Assessment). This was sent to the home before the inspection and had been completed by the manager and returned to us prior to the site visit. Other information was gathered from the feedback surveys we sent out. We received 10 completed surveys from people living at the home, relatives and staff. We also spent time speaking with people, a relative, visiting health professional and staff as well as observing practice. Comments have been added to the report. Discussion and feedback was held with the manager and area manager throughout the day. What the care home does well: What has improved since the last inspection? What they could do better: Consideration should be given to ensure that sufficient staff are provided at all times and that shifts are clearly shown on the rota so that people receive the level of support they need. Rotas need to be more flexible ensuring opportunities for social and leisure activities are not impacted on and restrict peoples daily routines. The person centered plans should be completed with each person to show that they have been involved in planning the support they need and in a way which they would choose. Up to date monitoring should be carried out where concerns have been identified in relation to a persons health care needs. Information should be reviewed and up dated to show any changes and the level of support required so that their health and wellbeing is not affected. Staff must not work unsupervised until a satisfactory criminal record check has been received ensuring people are not placed at risk. Information about the service and relevant policies and procedures need to be reviewed and amended to include the recent changes that have taken place within the service, so that people are fully informed. People using the service need to have an individual written contract that gives clear information about what facilities and support they can expect from the home during Care Homes for Adults (18-65 years) Page 7 of 35 their stay, including specialist services. This needs to be signed by the registered manager and the person using the service and by a third party if necessary. Some members of the staff team need to undertake safeguarding training to ensure that they know what action to take to protect people living at the home from abuse. Care needs to be taken to ensure that there are sufficient numbers of permanent staff in place that have the experience, qualifications and skills to meet the complex needs of the people living at the home. All members of the staff team need to be provided with necessary induction and basic training to ensure that it can meet the specialist needs of people using the service effectively. Medication should only be administered by staff who have been suitably trained to do so and have been assessed as being competent and confident in carrying out such task ensuring practice is safe and people are not placed at risk. Staff must receive a minimum of six supervisions sessions per year ensuring they are supported and directed in delivering the standard of care required. The manager must ensure that positive working relationships are developed and maintained ensuring people are involved and listened to when reviewing and developing the service delivery so that this is in the best interests of those living at the home. To ensure that people benefit from a well run home the organisation must submit an application for a registered manager to the CSCI. A review of the quality of care provided by the service needs to be undertaken to ensure that the service is being run in the best interests of the service users. Bathroom water temperatures continue to be too low and do not ensure people living at the home can have a hot bath. This is compounded by poor water pressure. 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 8 of 35 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 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to assess the needs of people however as no new placements have been made new documentation could not be reviewed to ensure that appropriate information had been gathered making sure the service is suitable and able to meet the persons needs. Evidence: During our last visit we asked for an updated copy of the homes statement of purpose. This was due to the number of changes that had taken place with regards to people working for the service. A copy of this has been provided however is now subject to further review following a majority shareholder takeover, which has recently taken place. We also asked that steps were taken with regards to the outreach service, which the home is not registered to provide. The previous responsible individual had acknowledged that alternative arrangements would be made ensuring that this provision was no longer provided from the home. This is to be addressed by the new Care Homes for Adults (18-65 years) Page 10 of 35 Evidence: owners. Following our last visit 3 people have since moved out of the home seeking more independent accommodation of an alternative placement elsewhere. No other placements have been made. Placements were made some time ago and assessment information has previously been examined and found to be very detailed. Specialist staff who now no longer work for the organisation had undertaken this. During our last visit we were told that the assessment process was under review. As no further placements have been made we were unable to review the process followed or the new documentation. This will be explored during future visits to the home. Arrangements in relation to staff training and development are insufficient. The current staff team have not received the necessary specialist training required to meet the specific and complex needs of people living at the home. Without this there is no assurance that they assessed needs can be met. We have also not yet been able to establish the contract arrangements for each person and whether the current service provision reflects what has been agreed. This information was needed to establish if the number of staffing hours provided were sufficient considering that staff at the home were also being utilised to support the outreach service. The area manager explained that copies of such information could not be found and therefore is still unclear. We were told that the new management team would explore this. Care Homes for Adults (18-65 years) Page 11 of 35 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. People using the service have an individual plan, which describes what their needs are and how they would like to be supported by staff. Evidence: At present there are only 2 people living at the home and they have done so for sometime. We briefly looked at one of their care and support plans. Information had been gathered from a number of people including the person themselves, their relatives, staff, a behavioural therapist and staff from the development centre. Information detailed a lot about the person including a personal history, likes and dislikes, transport, communication, social interaction, imagination and flexibility of thought, sensory, medical details, prescribed needs and support guidelines around daily routines. This information had been seen on previous visits and was gathered during the assessment period prior to agreements being made and people moving into the home. Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: There were two files in place. The first contained information in relation to person centred planning. The front sheet had been signed by the person it belonged to however the majority of records were incomplete. We were told that this was still a work in progress with this person. Once completed a copy would be kept in the persons own room, if they wished. The second file had more information about what the person does on a day-to-day basis. This included a lot of old information, which had recently been reviewed and updated. Information included the weekly planners, SMART objectives dated 2006 and a behavioural management plan, initially dated 2004 and updated November 2007. New goals had been set in May 2008 and were linked to the pathway to independence information. This person was being supported in several areas as preparation for attending college. Visual prompts were being used to evidence what had been achieved. This file is used both at the home and when attending the development centre so that continuity is offered. Review sheets are completed detailing what activity has been undertaken how this was achieved along with further areas of development. Risk assessments had also been completed. These outlined potential hazards, consequences, and degree of risk and control measures. Areas covered included, diet, unsupervised time within the community, animals, self-harm etc. Information seen had been implemented in 2004 and reviewed in July 2007 and December 2007. Periodic reviews are also completed by the key worker ensuring information is up to date and reflects their current support needs. Each person also has an individual communication diary, which is used to share information between the team and is accessible to the person should they also wish to read it. One staff member spoken with has worked at the home for sometime and has a good understanding about each person, their needs and behaviours. Whilst acknowledging that some of the changes have been difficult they also expressed that areas of improvement have also been made. Care Homes for Adults (18-65 years) Page 13 of 35 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. Suitable arrangements need to be put in place to ensure that people receive a flexible service, which meets their aspirations, needs and wishes. Evidence: We were told that people spend time each week planning their weekly activities with staff. These are based on each person’s needs and wishes. Both residents were at home when we arrived. They appeared relaxed and were happy to speak with us. During the day one person was supported by staff to the cycling track whilst the other person stayed at home and prepared what they needed as they were visiting family for the weekend. As outlined earlier the aim of the service is to support people to increase their independence and daily living skills. People are encouraged to be involved in household tasks such as washing and ironing, and keeping their own rooms clean. Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: They are also encouraged and supported to pursue their own interests. One person is involved in regular exercise and uses an exercise bike, goes swimming, cycling and uses a trampoline with support from staff members. Another person meets weekly with the behavioural therapist as well as attending the development centre, which had helped in managing their anxiety. People also enjoy spending time listening to music, watching television or using the Internet. The Internet had been fitted with a security system and monitoring device regarding access. From observations made both people appeared relaxed and were happy. One person appeared to engage better in conversation and chatted easily with us. We also found that at times staffing levels were minimal and did not provide any flexibility in the way people access support. Comments provided further within the report from staff show that people are not always able to take part in activities away from the home in the evenings or weekends. Information within the AQAA also stated that rotas had been revised to accommodate the training needs of staff and their childcare commitments. During our visit the support staff on duty was supporting the outreach service therefore leaving the manager to support 2 people at the home alone during the afternoon. Comleted surveys were received from the people living at the home. As pointed out by the manager, staff had provided support in completing the questionnaires and in discussion with each person had felt that the most approriate response was made. Both people also commented in the feedback surveys that they were only sometimes able to make decisions about what they did each day. This is not acceptable and does not afford people the level of support required to meet their individual needs. A vehicle is provided for those people who are not able to use public transport effectively. Previously staff hcve commented on the suitability of the car due to seating arrangements and risk, however this remains unchanged. The manager explained that no issues had occurred whilst traveling in the car and therfore did not evidence that there was any risk. People at the home continue to have contact with their families. One person stays with family each weekend and weekly courtesy calls to relatives are made to promote better communication and sharing of information so that issues do not arise. In relation to meals, one person now prepares their own with minimal staff support, whilst the other is supported. Both are encouraged to follow a healthy diet, which has seen one person lose a considerable amount of weight. Each person is given a food allowance, which they can use to spend on items of their choosing. This is in addition Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: to the main shop. The kitchen was checked and found to be clean and tidy. Care Homes for Adults (18-65 years) Page 16 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to all necessary health care however safer systems need to be developed ensuring people are supported in a way which safely meets their needs. Evidence: People living at the home continue to receive varying levels of support depending on their needs and wishes. Support continues to be provided to both the staff and individuals themselves by the service’s behavioural psychotherapist and the development centre. Support workers are made aware of how to support and communicate with people as well as being aware of any changes in their behaviour. Staff have access to good written guidance as well as permanent longstanding staff that have good background knowledge, skill and experience. People living at the home are registered with a local G.P, dentist and optician and where necessary specialist health care professionals such as chiropody and dietician. Records of appointments are maintained. Concerns had been identified with one person with regards to their weight/diet. A referral had been made to the dietician and support provided. Records stated that the persons weight was to be monitored weekly Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: however from the records we found they had only been weighed once in January, April and June. Information should accurately reflect the monitoring needed so that people are supported in a way, which ensures their health and well being is not affected. Any changes in the level of support required should also be reflected in the plan. The medication system was looked at. Items are stored safely and signed for on receipt. One item is stored as a controlled drug. Stocks were checked and found to be correct and records had been signed by the person receiving the medication as well as a member of staff. Other administration records are also maintained and accurately recorded what had been administered. Information is also recorded listing the items prescribed for each person and any contra-indications, which staff may need to be aware of. People are also asked to sign a consent form agreeing staff support with the administration of medication. We did find that new staff that had yet to complete medication training had been administering medication. The manager must ensure that the necessary training is arranged. Due to staff working alone at times it may be necessary for them to support with medication due to changing needs and therefore as an interim measure a competency assessment should be completed ensuring the practice followed by staff if safe and that people are not placed at risk of harm. Care Homes for Adults (18-65 years) Page 18 of 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear systems need to be in place ensuring people feel confident that they will be listened to and any concerns are resolved to the satisfaction of those involved. Evidence: Up to date policies and procedures are now in place with regards to complaints and protection. However we were advised that some of the detail will need to be amended to reflect the recent change in ownership and management. Staff training is provided in relation to adult protection. Information provided on the AQAA stated that ‘all managers receive accredited training as trainers to allow them to deliver Adult Protection Training to the homes staff and that we ensure that all staff receive the training. However information provided on the training matrix dated 6 October 2008 showed that only 3 staff have received the training, 1 in June 2008 and the 2 others in 2006. Arrangements have been made for the remaining members of the team to attend training in November 2008. The managers must ensure that this incorporates the local authority procedure and that staff are aware of their responsibilities in reporting any allegations ensuring people are protected. In relation to complaints and concerns issues have been raised about the service. As these were not resolved to the satisfaction of those involved this has resulted in 3 placements breaking down and people moving from the home. One matter was Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: investigated by the local authority in line with their safeguarding procedure however was unresolved. The new management team must ensure that professional relationships are maintained with people using the service, their relatives or representatives as well as social care professionals ensuring that any issues or concerns are dealt with promptly and appropriately so that this does not affect the running or reputation of the home. Completed surveys were received from people living at the home, whilst one person said they did not know how to make a complaint both were aware of who they would speak to if they were not happy about something. Relatives also confirmed that they were aware of the procedure in place. Care Homes for Adults (18-65 years) Page 20 of 35 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. 267 Walmersley Road provides comfortable accommodation, affording people the privacy and space they need. Evidence: 267 Walmersley Road is a spacious detached property situated on a main road and provides comfortable, homely accommodation to those who live there. It is tastefully furnished to a good standard reflecting the age group and the needs of those living there. The larger second lounge had been rearranged to accommodate some exercise equipment as well as two computers, which now have access to the Internet. There is also a further seating area to relax and watch television. Parts of the home have been re-painted since the last inspection. The house felt warm and comfortable and there appeared to be of a good standard of hygiene and cleanliness throughout the building. Whilst the carpets are occasionally cleaned, some areas including the hall, stair and dining carpets are in need of replacing. The area manager stated that the organisation Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: was looking at individualised budgets for the homes so that services could plan any refurbishment needed. Care Homes for Adults (18-65 years) Page 22 of 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems need to be improved with regard to how staff are recruited, trained and supported in their role making sure that they have the knowledge and skills required to meet the specific needs of people at the home. Evidence: The current staff team comprises of the manager, 2 senior support workers and 4 support staff, 2 of which work regular night shifts. Since our last visit 4 staff have either left the service, are on maternity leave or have moved to other services within Pendleton Care. The level of need of the current service user group remains complex. Recent changes have taken place to the rota, which has been agreed by the staff. Cover is provided between the hours of 8am and 9.45pm, with a wake-in staff member at night. On examination of the rota it was evident that staffing levels have been reduced further due to the low occupancy and did not accurately reflect the staff on duty. Rotas must clearly state the hours worked by each member of the team, including the manager and any changes, which may have occurred i.e. staff sickness etc. They should also clearly identify the staff member and hours provided to support the outreach service. So that we can clearly see what hours are being provided to support the people at the home. Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: Feedback from staff within the surveys suggested that staffing levels provided were of a minimum and did not afford people the opportunity to follow activities of their choosing outside of the normal office hours. Comments included, sometimes staff work alone at weekends and evenings which means people cannot access activities and they, service users, get stressed at times and on occasions staffing levels are low. Other comments from staff also reflected the need for people to be able to access and take part in more activities. We will review this in more detail during our next visit. As it is difficult to establish the contract arrangements for support it is difficult to determine the staffing ratio required however staff rotas should be arranged to accommodate the needs and wishes of people living at the home and not those of the staff. The manager should explore this ensuring sufficient staffing is provided at all times. The manager stated that little agency cover has been required. However when this has been necessary a regular agency is used so that people are offered some continuity in support. Due to the staff changes recruitment has taken place with 2 staff joining the team in June and September this year. Recruitment information is not routinely held at the home but at the main head office. To evidence the recruitment process the service completes a copy of the CSCI Annex 4 proforma, which is then signed by the responsible person to confirm the information recorded is accurate. We found that on the two files examined an employment history had been seen, written references had been sought and verified, a POVA 1st check had been carried out along with a criminal record check, CRB. We did note on one file that whilst a POVA check had been received the person had commenced working alone at night before their CRB had returned. We were advised following the inspection that this person was employed via an agency and therefore relevant checks were in place. Evidence of this also need to be made available demonstrating that the manager has satisfied himself that people working at the home are safe to do so. All new staff must be supervised until a satisfactory CRB has been received ensuring people are not placed at risk. A copy of the updated training matrix dated 6 October 2008 showed what training staff have received and what is planned/needed. Information stated that all mandatory courses are updated on a 3 yearly basis with physical intervention updated every year. We found that none of the staff had up to date training in Aspergers and Autism and that dates had only been scheduled for 4 members of the team. All the staff required Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: training in person centred planning, 3 staff required training in physical intervention, 4 staff required adult protection training and 3 staff required medication training. One of the newest members of the team appeared not to have completed any training since commencing their employment in June 2008. One person commented on the surveys, training courses are few at present. Without such training it is difficult to establish how the service can evidence that they are providing a specialist service when staff are not trained in the specific needs of people using the service. This needs to be addressed so that people are supported in a way that they choose and staff are not compromised. Further training has been completed with regards to NVQ. Of the 6 support staff 5 already hold either the level 2 or 3 qualification. The sixth member of staff has enrolled for the level 2. We also looked at staff induction and supervision. These appear to be carried out by the senior support staff and not the manager. Supervision records are held. Records for one of the new staff showed that they had received supervision in June and July. The second person had received supervision in September. The manager must ensure that staff receive a minimum of 6 supervisions sessions per year so that they supported in their role and learning and development. Staff did acknowledge in the surveys that support was provided. Some of the comments included, seniors do supervisions but the manager is accessible the majority of the time. He does not listen to staff at times though and since November 2007 supervisions are more regular, before this only a select few were done. Information was also seen with regards to induction. Both new staff had been working through the workbooks with the senior and signing off areas completed, however both documents were incomplete. One person still needs to complete areas in relation to health and safety and the second regarding policies and procedures. One of the comments in the surveys was, I think the induction period could be longer due to all the information you have to read and be aware of. Again the manager must ensure that a full and comprehensive induction is completed by new staff ensuring they are fully aware of policies and procedures within the home making sure that people are not placed at risk. Care Homes for Adults (18-65 years) Page 25 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear leadership and continuity within the team is needed so that people living at the home receive a quality service. Evidence: The home has been without a registered manager since September 2006. Following our last visit in October 2007 we were advised that a new manager had been appointed and was due to commence. Unfortunately this person only stayed with the service for approximately 6 weeks. The current manager has been in post now since the beginning of the year having worked in another service within Pendleton Care. He has previous experience of working with registered homes, domiciliary care and supported living. This has included working with children and young adults with learning disabilities including challenging behaviour and autism. He also has management experience outside of care work. At present the manager is completing a course in health and social care and intends to enroll on the management and leadership courses, which is due to Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: commence in January 2009 as well as q qualification as a physical intervention instructor. He has previous achieved a management qualification and care and welfare studies through Open University. An application to register with us has now been completed and is to be submitted to us. As identified at the last inspection and on previous visits we have expressed concerns about the staff team in terms of qualifications, experience and skill to meet the specialist and complex needs of people using the service. The current provision does not reflect that which is stated in the homes statement of purpose. It is therefore vital that the registered manager has the knowledge and skills required to offer the necessary leadership and direction for the team. The service has gone through a considerable amount of change over the last 12 months, which has in some ways has impacted on people living at the home and staff morale. Comments made in the staff surveys included, could start listening to staff/teams when they say things are not working, motivation and morale low and on occasions there is not enough staff, this is expressed to the manager but he doesn’t always listen. It is acknowledge that some of the comments received may be as a result of the changes that have taken place and that both the home and staff team now need a period of stability in order for them to develop the service providing consistent and effective support for the people living at the home. The area manager who currently oversees 4 services within the area supports the manager in his role. The area manager visits the home on a monthly basis to carry out the monthly monitoring visit in line with Regulation 26. Records of these visits are made and copies are held at the home. It was identified at the last inspection that a quality review of the service was being undertaken to ensure that the service was being run in the best interests of those people who use the service. A copy of the findings was to be sent to us once completed, however this has not been received. The new owners need to explore how they are to promote and improve the profile of the current service along with a clear business plan and objectives, which ensure that people receive a quality service. Checks are also carried out to some of the health and safety records and checks. Up to date servicing certificates were seen for the small appliances, 5year electrics, gas, fire alarm and equipment and emergency lighting. In house checks continue to be carried out on a weekly/monthly basis with regards to health and safety. A senior member of staff has been delegated the responsibility for ensuring the necessary checks are completed. These include, general checks within the environment, vehicle checks, temperature checks and fire safety. We highlighted during our last visit irregularities in Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: the water temperatures. These were checked again during this visit and still found to vary between 35°C and 43°C. For the safety and comfort of people temperatures must be maintained at 43°C. Care Homes for Adults (18-65 years) Page 28 of 35 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 5 5 People using the service 31/12/2007 need to have an individual written contract that gives clear information about what facilities and support they can expect from the home during their stay, including specialist services. This needs to be signed by the registered manager and the person using the service and by a third party if necessary. That all members of the staff 31/12/2007 team undertake adult protection training. To ensure that people are 30/11/2007 supported by an effective staff team the registered provider must ensure that there is enough suitably qualified, experienced and skilled staff in place to meet the specialist needs of people living at the home at all times. The registered provider must inform CSCI of the date service users will cease to be provided with and outreach service from the registered home. All members of the staff team need to be provided 31/12/2007 2 23 13 3 33 18 4 35 18 Care Homes for Adults (18-65 years) Page 29 of 35 with necessary induction and basic training to ensure that it can meet the specialist needs of people using the service effectively. 5 42 13 To ensure the comfort of 30/11/2007 service users water temperatures to the baths via thermostatic mixer valves reach a water temperature that is high enough to ensure the service users are able to have a pleasant bath, safely. Care Homes for Adults (18-65 years) Page 30 of 35 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 3 18 Without the relevant knowledge, skills and experience of staff there is no assurance that people will be supported in a way, which meets the needs and aspirations. 30/01/2009 2 6 15 Person centred plans need to be completed together with each person at the home clearly showing that they are actively involved in developing the plan and their needs and wishes have been comsidered. 30/12/2008 3 13 16 Rotas must be flexible providing adequate support during the evenings and weekends so that people are not restricted in their activities both in and way from the home. 30/12/2008 Care Homes for Adults (18-65 years) Page 31 of 35 4 16 16 Consideration must be given 30/12/2008 to the staffing ratios to allow people the independent choice and freedom of movement both within and outside of the home. 5 18 13 Records must accurately reflect the monitoring of peoples health care needs ensuring there health and well-being is maintained. Information should be kept under review and amended when changes take place. 30/12/2008 6 20 13 All staff must undertake the relevant training in relation to the administration of medication ensuring practice is safe and people are not placed at risk of harm. 30/12/2008 7 22 18 Suitable arrangments must be made ensuring all issues and concerns brought to the attention of management are dealt with promptly and appropriately ensuring issues are addressed and resolved to the satisfaction of those involved. 30/12/2008 8 33 18 Sufficient staffing must be provided at all times ensuring people receive the agreed level of support and the service is not compromised. 30/12/2008 Care Homes for Adults (18-65 years) Page 32 of 35 9 34 19 New staff must not work unsupervised until a satisfactory criminal record check has been received ensuring people receiving support are protected. 30/12/2008 10 37 12 The manager must ensure that effective working relationships are maintained with the team so that they feel listened too and work together to ensure that the service delivered is in the best interests of those living at the home. 30/12/2008 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 2 1 20 The statement of purpose needs to be reviewed and amended to reflect recent changes in the service. Assessments of practice should be completed on staff with regards to medication administration ensuring they have the competence and confidence to admisiter medication safely. When agreed a finalised copy of the complaints policy and procedure needs to provided to all relevant parties including CSCI. When agreed a finalised copy of the safegaurding policy and procedure needs to shared with staff and a copy forwarded to CSCI. Rotas must accurately reflect the management and staffing hours provided at all times including arrangements to support the outreach service. All staff must receive a minimum of six supervision session per year ensuring they are provided with the relevant support ensuring their continued professional development. 3 22 4 23 5 33 6 36 Care Homes for Adults (18-65 years) Page 33 of 35 7 8 37 39 The manager of the home must submit an application to register with us without further delay. To ensure that the service is run in the best interest of people using the service a quality review must be undertaken and a copy fo the report shared with all relevant parties including CSCI. Care Homes for Adults (18-65 years) Page 34 of 35 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). 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