Inspection on 30/04/09 for 38 Sandgate

This inspection was carried out on 30th April 2009.

CQC found this care home to be providing an Adequate service.

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

Other inspections for this house

38 Sandgate 14/04/08

38 Sandgate 09/08/07

38 Sandgate 09/08/06

38 Sandgate 09/03/06

38 Sandgate 11/12/05

38 Sandgate 14/02/05

38 Sandgate 05/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 38 Sandgate 38 Sandgate Kendal Cumbria LA9 6HT     The quality rating for this care home is:   one star adequate 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: Ray Mowat     Date: 3 0 0 4 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 30 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: 38 Sandgate 38 Sandgate Kendal Cumbria LA9 6HT 01539733465 01539773073 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Cumbria Care care home 3 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 3 The registered person may provide the following category of service only: Care home only - Code 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 - Code LD The maximum number of service users who can be accommodated is: 3 Date of last inspection Brief description of the care home 38 Sandgate is a registered care home for up to three people with learning disabilities. The home is owned by Impact Housing Association and operated and managed by Cumbria Care, an independent business unit within Cumbria County Council contract services group. There were two people living in the home at the time of this key inspection visit. This is due to one of the people living there having a high level of assessed need requiring an additional sleep-in staff, who is using the third bedroom. The home is in a quiet residential area on the outskirts of Kendal town, it is close to a bus route and local amenities. The home is a semi-detached property with a small front garden and a paved patio area to the rear. Care Homes for Adults (18-65 years) Page 4 of 30 Brief description of the care home All the rooms are single occupancy with the bathroom and communal areas of the home being shared, although the downstairs bedroom has a fully accessible en-suite bathroom with a high low bath and toilet. The fees charged are agreed individually according to a persons assessed needs. Information about the service is supplied to new and prospective residents in the service user guide, which is produced in an easy read format. Inspection reports are made available to people and or their representatives on request and are also displayed in the home. Care Homes for Adults (18-65 years) Page 5 of 30 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support peterchart Concerns, complaints and protection Environment Staffing Conduct and management of the home Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use the service experience adequate quality outcomes. During the visit we (The Commission for Social Care Inspection) met with people living in the home and spent time with the manager. We also met with care staff individually and talked to them as they went about their duties. The manager completed a self assessment questionnaire called an Annual Quality Assurance Assessment (AQAA) and sent it to us before the inspection visit. This provided us with information about how the home is run and the managers views on what the home does well, where they have improved and plans for the future. There is also information about the people who live in the home and the staff working there. Care Homes for Adults (18-65 years) Page 6 of 30 Surveys were sent out as part of this inspection to people living in the home, staff and other professionals with their views being used to formulate the judgements in this report. We also examined records relating to the running of the home that are required by legisalation, which included care plan files that guide staff in supporting people to achieve their goals and lead independent lives. We examined staff files and records relating to the maintenance and safety of the home. What the care home does well: What has improved since the last inspection? The information supplied to people living in the home has been reviewed and updated to ensure it is accurate, including the statement of purpose and service user guide. An up to date contract explaining the terms and conditions for the provision of services and facilities by the provider to the service users, has been agreed with the people living in the home or their representative. The manager has developed a training and development programme for the home that will ensure staff receive suitable levels of training in line with the requirements of the Care Homes for Adults (18-65 years) Page 8 of 30 Care Home Regulations and NMS. Supervision and appraisals are taking place at the required intervals ensuring staff receive the support and guidance they require and training and development needs are identified. Guidance sheets have been developed for all as and when required (PRN) medication so that it is administered safely and appropriately at all times. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good systems are in place to ensure peoples needs are fully assessed and make sure the home is suitable for them. Up to date information is supplied to them to help them make informed choices about moving in to the home. Evidence: The manager has made sure the statement of purpose and service user guide are up to date and accurate and reflect what is happening in the home including any changes to the service or staffing. A list of amendments and when they were made is maintained enabling people to see recent developments and changes. They provide relevant information for prospective new residents. There have been no new admissions to the home since the last inspection, however clear policies and procedures are in place to guide staff through the process ensuring a persons needs are fully assessed and they are provided with information and an opportunity to experience life in the home before making a decision about moving in. Peoples needs are assessed on an ongoing basis with the home staff working closely with other agencies and professionals to ake sure peoples individual needs are being Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: met. There is an ongoing programme of training that is developed annually to meet the training needs of staff making sure they have the skills and knowledge to support people to lead an independent and fulfilling lifestyle. Both service users have been issued with a tenancy agreement in conjunction with a contract of terms and conditions of residency. These documents ensure people or their representatives are aware of their rights and the terms and conditions of their stay. The terms and conditions of residency has been written to ensure that the people living in the home have the protection of the care home regulations despite having a tenancy agreement with a social housing provider. Care Homes for Adults (18-65 years) Page 12 of 30 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. Detailed person centred care plans help staff to provide a personalised service that supports people to achieve their goals and lead an independent lifestyle of their choice. Evidence: The manager and staff have worked closely with each person and their families or representatives to develop a person centred care plan. The plans are very detailed making sure the reader gets a real understanding about the person and what is important to them in their day to day lives. At the start of each plan is an informative pen picture that gives an insight to how the person will communicate their needs and preferences, important relationships in their lives and their basic likes and dislikes. These are also recorded in more detail in the relevant sections of the plan giving stff the guidance and support they need to help people achieve their personal goals and promote choice, dignity and independence in their lives. The care plans are supported by a good range of risk assessments that make sure both the individual and the staff supporting them are safe at all times both in the Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: home and when in the community. Specialist needs are well documented making sure staff provide a consistent service in response to peoples sometimes complex and challenging needs. Specific strategies have been developed with input from other professionals that guide staff in line with current good practice guidelines. How people make choices in their lives is recorded in detail including how people will make their needs known. This is particularly important for one person who has very limited verbal communication who uses different utterances and gestures to get his message across. Under the guidance of a speech and language therapist staff have developed a good understanding with this person and the meaning of their gestures, words and utterances are recorded. This involved staff monitoring when particular noises were made and what they related to and through a process of elimination the staff now have a list of commonly used words and gestures with their possible meaning. Judging by the reduction in challenging incidients this has proved effective in improving communication and how staff respond to him. Daily care notes and diary recordings make sure there is an accurate record of the care and support provided and significant events and activities. This ensures a good continuity of care among the staff team and keeps people up to date with any changes. People have a lot of autonomy in their lives and can make decisions and choices about about everyday events such as what time to get up, what to wear, what to eat and how they spend their day as well as being involved in decisions about the home and life choices. During this visit we observed staff offering people choices and taking on an enabling role when supporting them. There are both formal and informal systems in place that make sure people are consulted about all aspects of their lives, with evidence recorded of what people have said and how the staff have responded to their comments and requests. A good example of this is a forthcoming foreign holiday which one person is planning with support from staff. The home has clear policies and procedures in relation to maintaining confidentiality when handling personal information. Information is made abvailable to people in the service user guide and staement of purpose about the homes procedures. All information is securley stored in locked cabinets or password protected on the computer and is only shared on a need to know basis. Care Homes for Adults (18-65 years) Page 14 of 30 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. People are enjoying a fulfilling lifestyle both in the home environment and in the local community. Evidence: Both people living in the home attend different local day centres during the week, which provides them with a good range of social and educational opportunities and a chance to socialise with their peer group. Based on my discussions and observations during this visit they value this day service support and it is beneficial to them in providing meaningful activities and friendships in their lives. Staff support people to pursue their hobbies and interests both at home and in the local community. One person participates in a number of evening and weekend social clubs enjoying sailing, football matches, bowling and trips to the pub. In addition they also enjoy relaxing at home with more sedentry activities such as watching television Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: and DVDs, listening to music, computer activities. Staff help them to identify local events of interest to them as well as participating in regualr community activities such as shopping, going out for walks, visiting friends and family or just going to the local park or a cafe for a drink. One person particularly enjoys going on holiday and is eagerly awaiting a foreign holiday which staff have supported him to organise. In addition two shorter holiday breaks are also planned based on his personal interests. The other person does not enjoy the disruption to their routine that is associated with going on a holiday so staff are working with them to plan a number of different day trips that will be suitable for them. This will include a trip to a Zoo and another trip to a multi sensory activity centre, which they have enjoyed previously. People are involved with all aspects of home life with staff encouraging and supporting them to take part in household chores suitable to their capabilities, including cooking, cleaning, laundry and shopping. Staff work closely with peoples families and representatives to enable them to lead fulfilling lifestyles. Families and friends are welcomed in to the home and staff support people to visit them. They can meet with their visitors in the privacy of their own rooms or in one of the communal areas of the home. The daily routines of the home are based on the needs and preferences of the people living there with people being consulted on all aspects of home life. Staff have a good awareness of their role in promoting independence and choice in peooples lives and the need to take on an enabling role. The choice of meals and mealtimes is very flexible due to the small scale of the home. One person is very actively involved in choosing, shopping for and cooking their meals, with staff advising with reguard to maintaining healthy eating and a balanced and nutritious diet. Staff have worked closely with the other individual and their family and representatives to understand how they make their choices, enabling them to make sure they respond to knwown likes and dislikes whilst providing a balanced and healthy diet. Care Homes for Adults (18-65 years) Page 16 of 30 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. Personal and healthcare needs are well documented making sure people receive appropriate support and have access to relevant services they may require. Evidence: Based on the comprehensive needs assessments which are completed on admission to the home personal and healthcare needs are clearly recorded in the person centred plan. These are kept under review to ensure changing needs are recognised and responded to with appropriate referrals made to other agencies and professionals when required. Within the care plan, support plans and specific strategies are in place for significant and routine healthcare needs and interventions by health professionals. People are registered with a local GP of their choice as well staff as liaising with other relevant community health services or specialised services on an ongoing basis to make sure support is appropriate. This has recently included the community nurse team, speech and language therapist and the local hospital. They have provided advice and guidance to the staff, developed specific strategies to support people or provided aids and adaptations to support and promote independence. This has been particularly effective for one person with regard to their communication, with the development of Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: strategies and guidance to help staff communicate more effectively with them. Health action plans have been comleted and are incorporated in to peoples care plans, which has reduced duplication of information and clearly records peoples healthcare needs and outcomes. The majority of the medication held in the home and administered by staff is managed through a monitored dosage system. Medication outside of this system is also securly stored and clear records maintained making sure it is safely managed and administered. We examined medication records and the contents of the medication cabinet and on the whole these were well maintained ensuring people were being given appropriate support and guidance with their medication. There is a record of all medication entering or leaving the home and the contents of the cabinet are checked and signed by two staff each shift. MAR charts were up to date and signed. It is recommended that the content of the medication record file be reviewed as there were some old PRN records that should either be reviewed and updated or removed if they are no longer relevant. All staff have recently had their competence checked by the manager with a record of the observation recorded signed and dated. The manager is now aware of monitoring peoples competence on a regular basis and making sure training is provided when required. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home and their family or representatives are confident their views and concerns are listened to and they are safegurded by the homes policy and practice. Evidence: The organisation has a clear complaints policy and procedure in place, which is produced in an easy read format. It is included in the service user guide making sure people are aware of their rights, how to raise a concern and how the organisation will handle it. The manager described how she deals promptly with any concerns or queries therefore preventing them escalating to a formal complaint. There was evidence on peoples personal files of issues being addressed as they arise ensuring peoples views and concerns are responded to. Again the organisation has clear policies and procedures in place relating to safeguarding concerns and how they must be handled. These are in line with current legislation and local good practice guidelines. Staff receive safeguarding training through the induction process and refresher training is planned to make sure staff are confident in identifying and reporting abuse or mistreatment. Staff also receive training in physical intervetion specific to one person who does sometimes need to be protected from self harming.There have been no safeguarding concerns reported since the last inspection. Care Homes for Adults (18-65 years) Page 19 of 30 Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some aspects of the decoration and maintenance of the home are poor and must be addressed to make sure the home is kept in a good state of repair. Evidence: Although the repainting of the outside of the home has been planned for some time it still has not been completed. The home now looks unsightly and unkempt and is not in keeping with the neighbouring properties, which are well cared for. This must now be a prority to complete this outstanding work. The upstairs bathroom is also in need of attention as the tiles are discoloured, one tile has been replaced with a totally different colour tile and the sanitry ware and decoration are looking tired and in need of replacement. Refurbishment of this bathroom should now be planned in the near future. Inside the home a number of improvements have been made with the installation of a new central heating boiler and radiators unfortunately this work took place after decorating had been completed so further redecoration is now required to repair the damage done by this installation. The manager has a planned programme of maintenance that is agreed with the landlord. However some of the planned work has not taken place as agreed, which the manager is pursuing with them. In addition staff have supported one person to make a formal complaint to the landlord about these Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: issues, which is being processed. A new larger screen television has been purchased which is beneficial to the people living there as they have visual impairments. New soft furnishings and furniture has also been purchased making sure the home remains homely and comfortable. The manager and staff have been working with other agencies to make sure suitable aids and adaptations are in place to support an independent lifestyle. One person has received a new wheelchair to help them access the community more easily. As a result of occupational therapy assessments a high/low bath has been installed and other adaptations to promote independence with personal care. One person has had a computer provided and maintained by the low vision service which they particularly enjoy using. Infection control policies and procedures are in line with good practice and staff have received or have planned relevant training in relation to food hygiene, infection control and health and safety. Staff have access to appropriate protective equipment and cleaning materials and are aware of procedures relating to handling soiled linen and removing clinical waste safely. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home enjoys the benefits of a well trained and experienced staff team who have developed a good relationship and understanding of individuals needs and preferences about how they like to live their lives. Evidence: The organisation has developed clear pathways to ensure all staff have access to relevant training and qualifications in line with their role and responsibilities. In addition the manager will arrange more specialist training specific to the needs of the people living in the home. All permanent staff have completed their NVQ 2 qualification and two of them have also completed their level 3 award with another two registered on it this year. The home enjoys the benefits of having an experienced and knowledgeable staff team who have a good unnderstanding about individuals needs and how best to support them to achieve their goals. Approrpiate staffing levels have been maintained with permamnent and relief staff, who are familiar with the routines of the home and the people living there, used to cover absences when they arise. This helps to maintain a good continuity of care for people. Recruitment policies and procedures are in line with current good practice guidelines and are effective in making sure staff are safe and suitable for their role.The manager had developed a training programme for the staff Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: team, which identifies individual staff training and development needs and how they will be met. Training activity is monitored by the manager on individual training records making sure staff receive the relevant training they require. Based on examination of staff training records a good range of training has been provided to staff covering core subjects and specialist areas such as epilepsy management and physical intervention training. Refresher training is also planned to make sure staff skilss and knowledge is current and in line with good practice. We examined staff personnel files including a record of formal supervision. Meetings were taking place on a frequent basis with the discussion and outcomes recorded, signed and dated, which is good practice. It was evident from these recordings that staff were getting good support and guidance when required and their training and development needs were being assessed and responded to. Feedback from staff surveys and discussions confirmed that the manager is supportive and understanding and that she is accessible and approachable, always listening to and acting on their concerns and suggestions. Annual appraisals have also been completed, which have helped to inform both individual and team training needs. Regular team meetings are also used to share relevant information about individuals, practice issues and check staff understanding of policies and procedures. Care Homes for Adults (18-65 years) Page 24 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The committment of the manager and staff team is ensuring people living in the home enjoy a good quality of life. The low allocation of management and supervisory hours for the home is putting unacceptable pressure on the manager and staff. Evidence: The registered manager for the home Mrs Lesley Watson has about twelve years management experience in social care settings. She has made good progress since her appointment ensuring people in the home are safe and well cared for and receive appropriate levels of support to lead independent and fulfilling lifestyles. There is no doubt since her arrival the people living in the home are benefitting from consistent support and guidance from an organised and well trained staff team. As a result of the last inspection a requirement was made relating to an increase in management or supervisory hours in the home. This was intially responded to with Mrs Watson working approximately 22 hours a week. This enabled her to get new systems in place and make sure records were up to date and staff had the support and guidance they required. However the additional ten hours were only temporary and she is again Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: reduced to her substantive twelve hour post with no additional supervisory hours in the home. This situation gives us serious concerns about who is leading shifts when she is not there and the general management and administration of the home in her absence. The organisation is putting an unrealistic expectation on the manager and staff to safely manage the home with only twelve supervisory/management hours allocated to the home each week. They are relying on the good will and committment of the manager and staff to regularly work over and above their contracted hours to maintain the quality of the service . In reality, taking out time spent at a monthly managers meeting and the formal supervision of seven staff, it leaves the manager approximately thirty four hours a month to manage the home. Although there are only two people living there the management responsibilities and administrative tasks are not greatly reduced compared to a larger home. This situation must now be addressed by the organisation to make sure there are adequate supervisory/management hours to effectively run the home in the best interests of the people living there. The organisations decision not to support the home with sufficient management/supervisory hours is directly impacting on the homes quality rating remaining adequate. The manager is making sure people living in the home, their relatives and representatives and other interestsed parties are regularly consulted about the quality of the service provided. We looked at records of discussions and consultation that had taken place and how the manager had responded to the comments and suggestions made, making sure the home is being run in the best interests of the people living there. Staff are receiving training in relation to all aspects of health and safety relevant to their role and showed a good awareness of their individual and collective responsibilities. They have received training in emergency action, food hygiene, infection control, physical intervention and manual handling. Staff practice and their understanding of relevant policies, procedures and legisaltion are checked out at supervision and appraisals and suitable training programmes are arranged. Routine servicing and maintenance of equipment is taking place with records maintained of all relevant routine health and safety checks. The manager has developed a cleaning schedule for staff to follow to make sure all areas of the home are clean and hygienic. The staff communication book is used each shift to share important information to maintain a good continuity of care and make sure the home and the people living there are safe. Care Homes for Adults (18-65 years) Page 26 of 30 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 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 23 The outside of the home must be repainted to make sure it is kept in a good state of repair. The outside decoration of the home looks unkempt with peeling paint making the homes exterior unsightly and not in keeping with the neighbouring properties. 01/08/2009 2 37 18 The number of management 01/08/2009 or supervisory hours must be permanently increased to ensure the home is managed effectively. Currently the manager only has twelve hours to effectively manage the home and there are no supervisory or senior care staff to support her and mange the home in her absence. Care Homes for Adults (18-65 years) Page 28 of 30 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 20 The content of the medication record file should be reviewed as there were some old records that should either be reviewed and updated or removed if they are no longer relevant as this can cause confusion. The upstairs bathroom is in need of refurbishment as the tiles are looking discoloured and the sanitry ware and decoration is looking tired and in need of replacement. 2 27 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!