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Inspection on 12/02/09 for 2a & 2b Mayfair

Also see our care home review for 2a & 2b Mayfair for more information

This inspection was carried out on 12th February 2009.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 2a & 2b Mayfair 2a & 2b Mayfair Tilehurst Reading Berkshire RG30 4QY     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: Kerry Kingston     Date: 1 2 0 2 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: 2a & 2b Mayfair 2a & 2b Mayfair Tilehurst Reading Berkshire RG30 4QY 01189453744 01189453743 nick_debourg@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Milbury Care Services Ltd Name of registered manager (if applicable) Mrs Lynda Anne Coy 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 10. 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 Mayfair provides twenty-four hour care to ten adults, of both sexes, with learning and associated behaviour and /or physical dificulties, though at present there are eight male residents. The home is operated by Milbury Care Services Limited. The home consists of two properties, joined internally via a linking corridor and has bedroom accommodation on the ground and first floors. Care Homes for Adults (18-65 years) Page 4 of 32 care home 10 Over 65 0 10 Brief description of the care home The home is in a suburb of Reading approximately fifteen minutes from the town centre. Local shops and facilities are available within walking distance of the home. The home has its own transport and public transport is readily available. 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: The last Key Inspection of this service took place on the 26th April 2007. The current fees are 1,214 pounds to 1,526 pounds per week. This is a report for the key inspection, which included a routine unannounced site visit to the service. This took place between 10.30 and and 6.30 pm on the the 12th February 2009. The information was collected from an Annual Quality Assurance Assessment, a document sent to the service from the Commission for Social Care Inspection and completed by the service manager. Discussions with the manager and two members of staff took place. Some people who use the service have difficulty communicating with people who do not know them so observation of people and their interactions with staff took place Care Homes for Adults (18-65 years) Page 6 of 32 during the visit to the home, two people who use the service were communicated with. Any information collected by the Commission for Social care Inspection, since the last inspection has also been included in this report. What the care home does well: What has improved since the last inspection? What they could do better: The home should make sure that people can do even more than they do now so that they do not get bored or fed up with their lives. Staff should write down what people do and if they enjoy it, so that they know what things people might like to do in the future. The home should make sure that staff are taught things so that they know how to give the best care to people. Care Homes for Adults (18-65 years) Page 8 of 32 The home must make sure that staff who know alot help those who need to know more, so that they can all give good support to people who live in the home. The home should make sure that staff are helped to write things down properly so that everyone can see things like what activities people do and what the Doctor says when they go to see them. The home should carry on looking at what needs to get better and making sure that it does, so that people who live there can be as happy as possible. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home makes sure that peoples needs are fully assessed and that it is able to meet those needs. Peoples needs are reviewed regularly to ensure the home can continue to meet their needs. Evidence: The Statement of Purpose and Service User Guide are produced with pictures, symbols and words. People who use the service may not be able to understand the content clearly but with staff help it gives them the best opportunity to understand as much as possible. Both documents have been reviewed and are up-to-date. Admissions and assessment policies are available in the home and are included in the Statement of Purpose.It is a very detailed policy, which is supported by the transition policy and procedures, that is, how people are introduced to a new service. The last person to be admitted was in the July of 2008, they have a full assessment completed by Social services (Community Residential/Nursing assessment) and a full Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: pre-admission assessment completed by the Services Manager. A care plan and transition plan is developed dependant on the needs of the individual. One person has pictorial, aswell as written records of their visits and stays during the transitional period to limit any emotional distress, they may feel at leaving their old home. The home ensure people can keep in contact with peers of the same age and background, even if there is a distance issue. The home complete a three month and six month review at which any changes are made to the care plan. One person indicated that they were happy with their home and their behaviour since admission supports this. The manager is able to refuse any admissions if she believes the home is unable to meet peoples needs. 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. The home make sure that people know their assessed and changing needs which are reflected in their care plans. People are encouraged to make as many decisions and choices, as possible. Individual risk assessments, to help people to be as independent as possible, whatever their disability, are in place. Evidence: Care plans for four people were seen, they include goals , peoples cultural, physical, emotional and religious needs. Care plans are individual so meet any diversity and equality needs such as finding different ways of meeting someones religious preferences if they do not wish to attend church and finding ways of ensuring people can make clear their decisions and choices, if they do not have conventional methods of communicating. Support plans for each area of life such as physical health, community presence, mobility, finances,relationships,activities/holidays and living skills are included in the Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: care plans. They detail what people do on a day to day basis, their preferences, likes and dislikes and how staff support them to live as they choose. All care plans seen have been formally reviewed every year or more often if needed, triggered by people expressing different or changing needs by their behaviour or by other means, they are updated after a review has taken place. The home is currently transferring to the corporate care plan model but existing care plans are detailed and contain good quality information. The home has monthly house meetings which staff and the people who live there attend. They are used to remind people of everything about the home and what is going on in the home, aswell as organisational issues. An advocate is used by one person, anothers advocate has not been heard from for sometime, all but one person have contact with families who also act as advocates. How people make decisions and choices is part of the care plans and staff are guided on how to listen and interpret their communication systems. People have a communication passport to help in this process. The people who use the service have comprehensive risk assessments which encourage independence in as safe a way as possible. Each individual has risk assessments , appropriate to their individual needs such as community presence, travelling in vehicles, and performing household tasks. Those seen were up-to-date and amended as necessary, when any behaviour changes occurred or needs changed. 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. The home enable people to be involved in activities that include being part of the community. They are encouraged to keep in contact with family and friends and maintain any special relationships. The home provide a healthy diet and people are helped with eating their meals, according to their needs. Evidence: The newly registered manager is still developing this area of work, there is an overall daily and an individual activity plan for the people who use the service. Individuals specific communication needs are taken into account to ensure people have the best opportunity to understand what they are doing that day, such as display boards in peoples bedrooms and in communal areas. There are a variety of activities in the Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: community such as bowling, swimming, attending the working mans club to play darts and snooker, going out for meals and people attending college courses. In house activities include artwork, computer type games and a music man who comes to the home sings and plays guitar. A letter from the music man congratulated the home for their participation in his sessions and noted how much the people who live there enjoy it. Younger people are encouraged to continue to do activities that they were involved in at school such as computer work and playing on X-box games. The provision of I.T equipment that can be used by staff and people who use the service should be considered and may be very beneficial to all parties. The manager is in the process of completing a new activity plan.Staff reported that people have been to the cinema, have been supplied with bus passes ,so that they can use public transport and one person is getting a season ticket to the local football club, one has been to a game at Manchester United and tickets are booked for three people to go to a pop concert. Additional staffing are provided if people, because of their diverse needs such as behavioural or physical, need additional support to access the community. Only one person was able to go on holiday in 2008 because of changes in management and a shortage of staff due to staff turnover, others went on day trips to places of interest such as the Sealife Centre. Trips and outings are noted in the diary but they are not always recorded in peoples daily notes, there is often no record of activities participated in or peoples reaction to them. Two residents indicated that they had enough to do and one staff member articulated her commitment to improving opportunities for people to access the community and have a better range of activities to choose from. All but one person has contact with family and friends. The manager and care manager are attempting to re-establish contact with that persons family. The home support people to make telephone contact with family and friends and will help them with transport to enable them to visit parents or friends. The home is very sensitive to the needs of families, such as one parent getting elderly and frail. Staff support visits which have been reduced to one a fortnight rather than one a week. One person is positively supported to keep in contact with someone with whom he has a special relationship, even though the distance to their home is quite prohibitive. Menus are well balanced and nutritious, although they do not include much variety.People help choose menus at the house meetings and assist in making meals, where possible. Staff said that people who live in the home prefer plain British meals. Details of how people can assist with meal preparation and how they can be offered choices is included in care plans. People are also encouraged to choose things they like ad hoc when they help with the house shopping with staff at the local supermarket. One person indicated that he liked the food. Pictorial menus are displayed on dining room walls. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: Risk assessments are developed so that people who use the service can safely assist staff in the kitchens, whenever appropriate. Any special diets are adhered too and the home ensures it has the correct equipment to keep people safe and comfortable when eating, such as special chairs or cutlery. Weight charts are completed where necessary and appropriate. The home use the services of a dietitian and referrals are made to speech and language therapy and occupational therapy as necessary. Care Homes for Adults (18-65 years) Page 17 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 home meets the needs of people in the way they they prefer. Peoples emotional and physical needs are effectively met and medication is administered safely. Record keeping needs to be improved in some areas. Evidence: Four care plans were seen, they include a detailed list of likes and dislikes, interests and hobbies and how staff ensure people can make decisions and choices for themselves. One person confirmed (by indication) that he has been completing his new care plan with his key worker, recently. The personal support guidelines note how people like to be treated and what their preferred daily routines are. It is also clear what gender people like their carers to be and there is a cross gender care policy in operation. The people who live in the house are all male but there are a large proportion of female carers, dignity, safety and privacy issues are noted on care plans. Part of the new care planning system includes a personal Planning Book which notes things such as things I like, things I would like to do, things I dont like, things I need help with, my best weekend and my hopes and dreams. Key workers are in Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: the process of completing these. Each individual has a Health Care Plan, although these are not all fully completed. This includes a health action plan which is very detailed and descriptive, it notes feelings and emotional well being aswell as physical needs. It also describes how people indicate that they are in pain. The records of health care appointments are not consistently completed, the diary shows when people have been to health appointments and people are assisted to have regular check ups but staff do not always complete the records to detail the results of the consultation. One person has been to the pain clinic, had a physiotherapist appointment, a dental appointment, seen the dietitian, the speech and language therapist, the psychologist and the G.P. The manager is aware that there are some recording deficits and is currently working on this area with some staff. People have behavioural guidelines for behaviours that they or others may find distressing.These are completed by the in-house psychologist but these could be developed into more staff friendly tools to assist them to deal with people consistently, on a daily basis. Some guidelines and other documentation are not dated so it is difficult to know if they are still current and being used. The home staff are trained to use physical restraint but its use has not been necessary for over a year. There has been only one recorded incident relating to a difficult behaviour by a person who uses the service, this indicates that people are generally happy and their emotional needs are being met. Another professional (reviewing officer from West Berkshire Social Services Department) held a review on the day of the inspection visit, she said she was very pleased with the placement and her client seemed happy and his behaviour had improved. All eight people who live in the home are receiving medication, none are able to selfmedicate. The home uses the BOOTS Monitored Dosage System to ensure safe administration. Only staff who have received medication administration training give medication, a medication giver is always rotad on duty at each shift. Staffs competence to administer medication is assessed annually by senior staff members. Medication records seen on the day of inspection were accurate, medication is properly stored. The home use medication prescribed to be taken when necessary for epilepsy control, they have protocols for its use but individual guidelines could be more detailed, to ensure its consistent and safe use. Care Homes for Adults (18-65 years) Page 19 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. The home ensures that peoples views are listened to and acted upon and they are protected from all forms of abuse. Evidence: The home has recorded one complaint since the last inspection, the manager confirmed that only one complaint had been received. The complaint was dealt with swiftly and appropriately, the complainant was happy with the outcome. Four compliments have been received recently, some were about men being well presented. The complaints procedure is presented in a pictorial format, as simply as possible. The manager confirmed that there have been no safeguarding concerns about the home since the last inspection. The safeguarding procedure is also produced in a simple format and a keeping me safe what to do if you dont like something document is included in peoples care plans. Staff training records showed that staff have received safeguarding (Protection of Vulnerable Adults ), some training records were not upto-date but the manager confirmed that all staff have Safeguarding training during their induction period. The Commission for Social Care Inspection have received no information with regard to complaints or safeguarding issues in relation to this home. The home use physical restraint as a last resort and staff are fully trained in its application, however it has not been used since the last inspection in 2006. There are guidelines developed by the psychologist to instruct staff when and how they should Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: be used for individuals, these could be more detailed and developed into a more staff friendly format. One file was seen to contain physical restraint guidelines that had not been reviewed by the stated review date. It was discussed with the manager to consider how long guidelines should stay in place if they are not used. Financial procedures are robust families or the providers are appointees for the people who use the service. The manager and her deputy are the only people in the home who are able to sign for peoples money ,that is to access it on behalf of the resident. If the providers are the appointees, benefits are paid directly into peoples bank accounts. The manager has a breakdown of benefit entitlements and expenditure and has a good knowledge of peoples overall finances. It was discussed that she could clarify which activities individuals pay for and why and what their individual contribution to the transport of the home is. Cash records and bank records seen were accurate and all receipts are kept. Care Homes for Adults (18-65 years) Page 21 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. The home ensure that they provide an environment that meets the needs of individuals and the group. It is kept clean and hygienic. Evidence: A short tour of the building, included looking at one residents bedroom, with their permission, other rooms were occupied or people were out so permission could not be sought. The bedroom seen was very personalised, football memorabilia and an activity programme described in a pictorial format decorated some of the wall space. Family photographs were displayed. The room had any necessary equipment to meet the individuals specific needs. The house was, generally, in a good state or repair and was reasonably well kept. One of the bathrooms needs some redecoration and the skirting board needed cleaning but baths and toilets were clean and hygienic.One of the downstairs toilets would benefit from a de-scaling treatment. The home is spacious with reasonable quality furniture and fittings. The kitchens and laundry were clean and tidy and the laundry space is well away from food preparation and serving areas. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: Care Homes for Adults (18-65 years) Page 23 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. The home have a competent staff team who are able to meet the complex and diverse needs of the people who live there, interaction and communication between some staff and people who use the service could be more positive. The homes recruitment policy is robust to ensure that staff are safe to work with the people who use the service, but how and where recruitment and selection records are to be kept must be clarified. Evidence: The home has a minimum of five staff on duty to cover both of the units in the home. There are two resident vacancies in one house the staffing is therefore reduced by one per shift, when vacancies are filled staffing will revert to six per shift. The manager is not part of the care rota and is, generally, in the home during the week. There are a total of 18 staff , 12 people have 35 hour contracts, 2 have 30 hour contracts and four have 20 hour contracts. Staff cover shortfalls by doing overtime, the manager said that she monitors how many hours people are working and ensures performance does not suffer. However, it was noted that some staff had worked 84 hours overtime in a month , there was a reference in one persons supervision notes of the manager instructing her to ensure she had at least one day off per week. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: The home has a check list of evidence attained prior to the employment of staff, these are verified and signed by the manager. The manager advised that she sees all the necessary information including application forms during the selection process, however all information is not available on site as the manager sends them to the personnel department for processing and confidential filing. There was a discussion with the manager about clarifying if the organisation has an agreement with the Commission to keep recruitment files at head office or if she should have them on the premises for perusal. Some files had interview records, the manager confirmed that all necessary checks had been made, pre-employment and application forms are fully completed with no gaps of employment noted. The home has staff vacancies as eight staff have left over the past year, a much lower percentage of staff are part time, four of 18, which has benefits to people who use the service as staff are able to access more training and offer a more consistent service. Only four of the 18 staff have an NV.Q. 2 or above qualification as many are new to the service. The manager advised that Voyager(Milbury) have recently appointed a training officer to deal with the qualification issues and to ensure that more staff receive N.V.Q. training. The home has a core training record but because it does not have access to any I.T or word processing systems it was not entirely up to date, written records of training are kept in individual files. The list showed that staff have completed Health and Safety, induction, food hygiene, 1st Aid, fire drills, fire training, manual handling, people moving people, hoist training, infection control, Protection of Vulnerable Adults, Challenging Behaviour and medication training. The manager confirmed that all the core training is completed and people are up-dated as necessary. The organisation has a central training department which support the house staff with their training needs. The performance of staff observed throughout the inspection visit was variable, some staff appeared to interact only nominally with people whilst others had an obviously positive and enabling relationship with those who use the service. Communication between some staff (two of the five staff observed working)and people was very limited. Two people, who use the service, spent most of their time in the office interacting with the manager, rather than the staff team. The manager is aware of the issues of staff engaging with people and some remaining cultural issues from the past, she said that she is positively addressing these with the help of her senior staff team and service manager. Some supervision notes were not available and some of those seen were out of date, the manager suggested that some were in the personal files of senior supervisory staff. The manager suggested that this was another issue caused by lack of access to a word processing system. Some of the supervision notes that were seen were poor quality and not clear enough when relating to staff performance, administration and record keeping. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: One staff member confirmed that there are good staff training opportunities, had completed all core training and had been assessed by senior staff on her knowledge. Staff use a computer based training system for some of the induction and core training,their knowledge and understanding is then tested by written questions and assessed by senior staff. The staff member did not recognise that they had received any formal supervision but said that they could approach senior staff at any time and had many discussions with senior staff on an ongoing and daily basis. The staff member felt supported and valued by management and was very aware of the needs of people who use the service. Care Homes for Adults (18-65 years) Page 26 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. The home is well run, it focuses on the needs of the people who live there. It has developed in some areas and is aware of the need for further development work to take place. People are kept as safe as possible by adherence to Health and Safety Policy and procedures. Evidence: The manager is recently registered by the Commission on the 30th January 2009. She has been in post since July of 2008 and was the deputy manager for approximately six months. She had previously been a deputy manager in another home run by the organisation for approximately two years. She is currently undertaking her Registered Managers Award which should be completed this year , that is during 2009. The home is developing under her management but there are still some vital areas that need further development such as, the variability of staffs interaction and relationship with the people who live in the service. Some staff are very enthusiastic about their work and some staff have difficulties with areas of work such as report writing , Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: communication with people who use the service and supporting people to access activities. There are still staff shortages, eight people have left in the last year, possibly because of culture changes within the home. The Quality Assurance process includes regular regulation 26 visits, reports are provided to the home which specifically note some of the areas for development completed and to address. The home complete an annual service review, the last one was completed in 2008, a development plan was produced as a result of this. The review report includes a summary of the views of people who use the service and the service managers perception of the quality of care. Other professionals involved include external professionals, purchasers, other managers and staff from the home. The development plan noted that 50 of the staff team must be pursuing N.V.Q.2 by April 2009. If the action dates on the development plan are not met , the manager has to explain to the service manager why and adjust dates with senior managers. The manager is currently unable to up-date records quickly as there is no access to I.T. equipment. The company use computer based recording systems, access to it would greatly enhance the managers ability to improve records and keep things up-to-date such as training, development monitoring, peoples care plans and supervision notes. She does use her own lap top for some work but is aware of the need to take care not to compromise data protection or confidentiality and she is unable to access the providers on -line systems. The manager confirmed that all necessary Health and Safety maintenance checks are completed in a timely way and that the home has a full set of all policy and procedural documents (as noted on the AQAA.) The home keep detailed accident and incident records, the manager audits these to ensure any necessary action is taken, promptly, to minimise the risk of recurrence. Only one accident was recorded for the year, this was caused by a seizure which resulted in a visit to the Accident and Emergency Department of the local hospital. Two incidents which were not serious were also recorded. The home has recorded no physical interventions during the previous year and the manager confirmed that there had been no necessity to use any physical intervention techniques. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 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 36 18 That all staff are properly and regularly formally supervised with a written record of supervision completed. To ensure that staff are able to offer good quality care to people who use the service and areas where they need help to perform their role are identified and the shortfalls addressed. 01/05/2009 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 12 To continue with the development programme of activities within the home and the community so that people have as many opportunities as possible to experience activities that they enjoy to enhance their lifestyle. To improve the recording of activities and outings into the community so that they can be used to further develop individual programmes to enable them to access the things they like to do. Page 30 of 32 2 13 Care Homes for Adults (18-65 years) 3 32 To ensure that the home adhere to the training plan as presented in the 2008 development plan, that is 50 of staff to be enrolled on N.V.Q training by April 2009. To clarify where recruitment records are to be held and how to clearly demonstrate that all the necessary paperwork is in place. 4 34 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). 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