Inspection on 14/10/08 for 6 Honister Gardens

This inspection was carried out on 14th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

6 Honister Gardens 04/11/09

6 Honister Gardens 14/08/07

6 Honister Gardens 23/05/06

6 Honister Gardens 28/02/06

6 Honister Gardens 04/11/05

6 Honister Gardens 17/03/05

6 Honister Gardens 07/09/04

6 Honister Gardens 26/02/04

6 Honister Gardens 06/01/04

Similar services:

Ashlong House

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Edenvale

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Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 13/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 6 Honister Gardens 6 Honister Gardens Stanmore Middlesex HA7 2EH     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: Andreas Schwarz     Date: 1 4 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. the things that people have said are important to them: They reflect 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: 6 Honister Gardens 6 Honister Gardens Stanmore Middlesex HA7 2EH 02089070709 02089070709 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Deborah Whittick Type of registration: Number of places registered: Striving For Independence Group Homes care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 5 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 Date of last inspection Brief description of the care home 6 Honister Gardens is a care home providing personal care and accommodation for up to five people who have a learning disability. The home is owned and run by the Striving For Independence organisation, a local private and independent care service provider. The home has 24-hour staffing. The home is located within a residential area on the edge of both Stanmore and Belmont, in the borough of Harrow. It is a few minutes from bus links, and around ten minutes walk from local shops. Parking restrictions do not apply on the road outside the home. The drive has space for two Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 5 Brief description of the care home cars. The premises are a two-storey building in keeping with other homes in the street. All bedrooms are single rooms, fully furnished, and with built-in wash-basins, both upstairs and downstairs. One bedroom has an en-suite toilet. The home has one bathroom with adapted shower facility upstairs, and a shower room downstairs. The home has a kitchen, a lounge leading into a dining area, a spacious activities room upstairs, and a garden. There is also a passenger lift. Management stated that information about the fees, and a copy of the service user guide, are available in the home on request. There were no vacancies in the home at the time of the inspection. 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: This key inspection took place in October 2008. The registered manager was available during the inspection. The registered provider joined us later. We spoke to two members of staff, one resident and the registered manager/provider. We looked at two care plan documents and other guidance in relation to two people living in the home. We looked at two staffing record. The home forwarded a well written and very informative Annual Quality Assurance Assessment, which we referred to throughout this report. Three service users surveys and one staff survey has been returned to us. We would like to thank everybody involved in this key inspection and providing us with valuable information allowing us to make a quality judgement about the home. Care Homes for Adults (18-65 years) Page 6 of 32 Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 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 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at National Minimum Standards 2 during this inspection. People are not admitted without a detailed needs assessment, ensuring the home is able to accommodate the person. Evidence: This is what you told us in your Annual Quality Assurance Assessment: Striving for Independence recognises that all service users should have the opportunity to choose a home, which suits their needs and abilities. We make possible, that choice to ensure that the residents know precisely what services we offer. Before each service user is placed in the home, an assessment is made so that the home can assess the service user and visa versa. Potential service users are fully assessed and must be given the decision to choose a home for themselves. An initial interview and visit are always carried out by the home. Potential service user is shown around the home and they are invited to stay over for Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: tea. Service users are invited to stay over overnight for the weekend. Special provisions are made for emergency placements. The home provides detailed information on the home by publishing a statement of purpose and a detailed service user guide. Professional, qualified and competent persons assess each resident before they are admitted. Where possible service users are involved in the assessment and appropriate methods of communication used otherwise an independent advocate service is advised. These details have been explained to the service users, People using the service have been provided with key documents such as Statement of Purpose and service user guide. Service users and Striving for Independence is confident that it is able to meet their required needs. We carry out a comprehensive needs assessment on all prospective service users. This what we found during this inspection: We looked at one assessment, of a person being admitted on a respite basis in June 2008. The registered manager told us that she did the assessment; the initial assessment was undertaken in March 2008. The assessment is very detailed and looks at the persons needs, likes, dislikes, wishes and choices, religious and cultural needs. Staff confirm by signing that they have read the assessment. Due to the persons ability the assessment was not signed. Information collected in the assessment is included in the persons care plan. We noted that the assessors name is not recorded in the assessment, this is recommended. Care Homes for Adults (18-65 years) Page 11 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. We looked at National Minimum Standards 6, 7 and 9 during this inspection. The service involves individuals in the planning of care, which affects their lifestyle and quality of life. Care plans are person centred and are agreed with the individual. Plans are written in plain language, are easy to understand and look at all areas of the individuals life. Each care plan includes a comprehensive risk assessment, which is reviewed regularly. The management of risk is positive in addressing safety issues while aiming for improved outcomes for people. Evidence: This is what you told us in your Annual Quality Assurance Assessment We have a comprehensive Service User Plan, which consists of a Personal Planning Programme, Risk Assessments, Positive Behaviour Guidelines and a Personal Profile. These documents outlines service users personal goals, wants, needs and expectations also the strategies and methods to address service users needs, agreements on any Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: restrictions, strategies for managing risk and responses to changing needs and goals. Striving for Independence work with the service users, whether residents, day care and respite care, their friends and their relatives or representative in order to illustrate a written plan of care that the home aims to provide. The plan sets out the objectives for the care and how we hope to achieve these objectives, and incorporates any necessary risk assessments. At least once per month, the home reviews each service users plan together, setting whatever changes have occurred and what is needed in the future. Further assessments of the service user needs are made form time to time. This is to ensure that the standard of care, the home is providing is significant to helping the service user achieving their full potential. When it comes to making decision, staff provides information and support that will help the service user to make their own decisions. Service users are also provided with an advocacy service. If there are any restrictions imposed on service users the human rights issues and implications are fully considered. Service users are encouraged to manage in full or part of their own finances. Service users do attend monthly meetings to discuss ideas about the running of the home. The home has clear policies and procedures that support service users to take acceptable and appropriate risk. Clear policies and procedures are in place that supports service users to take appropriate risks and a comprehensive risk assessment and management plan. These policies and procedure states exactly the consequences and implications of the risk that will be taken. The policies also place emphasis on the importance of identifying and minimising all risks and hazards that threatens the safety of the persons involved. This is what we found during this inspection. We looked at two care plans during this inspection. Both documents were of very good standard and have been reviewed recently. The home is using a key worker system. Care plan goals are split into short, mid and long term goals. Goals are reviewed during the review process and achievements are recorded. Care managers undertook a placement review on one of the people, which we case tracked. Residents, key workers, families are invited and involved within the review process. The registered manager informed us that the home has purchased flash cards and symbols, which they are planning to use in the future within the care planning process. We observed staff interacting with residents, which was very respectful and choices such as if they want to go out or stay at home are given. Residents finances are managed by the home and the registered person is acting as appointee for some of the people living at the home. We viewed a range of very detailed risk assessments, all risk assessments provide staff with a risk management plan and guidance in how to minimise the risk. Risk Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: assessments have been reviewed. Two of the people living at the home have mobility problems the home has undertaken a functional ability assessment addressing areas clearly were the person needs help and what he can do independently. 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. We looked at National Minimum Standards 12, 13, 14, 15, 16 and 17 during this inspection. The service has a strong commitment to enabling residents to develop or maintain their skills. Residents are involved in meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. The menu is varied with a number of choices including a healthy option. It includes a variety of dishes that encourage individuals to try new and sometimes unfamiliar food. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. Evidence: This is what you told us in your Annual Quality Assessment: Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: Striving for Independence recognises that residents, daycare and respite care service users may need care and help in a range of aspects of their lives. In order to respond to the variety of needs and wishes of these service users the home ensures that we do the following. Provide a lifestyle for the service users which fulfill their social, cultural, religious and recreational interests and needs. Help the service users to put into action choice and control over their lives. Provide meals which is composed of an appealing and balanced diet which pleases the surroundings and the convenience of the service users. Service users have the ability to broaden their education. Support is made available for the service users to take advantage of these opportunities. Service users are encouraged to take part in community activities. Service users use the local transport on a regular basis by going shopping or out sightseeing. We aim to make it possible for our service users to live their lives fully. Residents are given help when possible to maintain contacts they wish to preserve with their families and friends outside the home. They also have the choice to choose whom they see, when and where. If there are any events which are taking place relating to SFI, invitations are sent out to friends and relatives. These events could include, the annual summer BBQ, birthday or Christmas parties. Arrangements are made for residents to have any visits in private. Service users are offered a choice from a suitable menu and have their dietary needs catered for. This is what we found during this inspection: Residents may attend the organizations day service that is held in a specificallyadapted building at the back of another homes garden. Records and feedback found that the majority of residents including the respite residents were currently following this option. The registered manager told us that one of the people admitted recently, used to access Strathcona Day Centre five days a week. The day service has stopped due to deterioration in the persons health. The registered manager is currently in the process of discusing day service options with Strathcona. The manager informed us that one resident is accessing a local college regularly, this was only possible due to a reduction in challenging behaviour. The home played a major part in this and has introduced a reward system for the person. This system has helped to reduce challenging behaviour and therefore opened more opportunities for the person. During the day of this inspection two residents went for a walk to a local park supported by two members of staff. The home is organising every Wednesday outings, these outings could be locally or further afield such as Brighton, Hastings, etc. All but two residents were on holiday in Hastings during the week of this key inspection, the registered manager told us that she will join service users and staff for Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: the weekend. The registered manager told us that families are involved in residents life and care plan review minutes showed their attendance. One of the residents spoken to told us that she sees her relative regularly. Residents can make or maintain contact with people at Gateway Club, regular organised parties and seasonal celebrations such as Christmas, Diwali, Summer BBQ, etc. Residents can access all areas of their home. The manager was confident, from visits and phone calls, that residents are engaged at all times. Records and feedback found that some residents have keys to the front door and their rooms. Risks prevent others from holding such keys. We observed staff interacting with both residents throughout this inspection. Residents take part in housekeeping depending on their ability and disability. The home is providing a choice of two cooked meals for lunch and dinner time. During the day of this inspection residents could choose between chicken and fish. Peoples dietary needs are recorded on the weekly menu. The home is providing healthy, nutritious and culturally appropriate meals for residents. Drinks and snacks are available throughout the day. The home invited us to sample lunch, which was nicely presented and very tasty. 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. We looked at National Minimum Standards 18, 19 and 20 during this inspection. People receive personal and health care support using a person centred approach. Personal health care needs including specialist health, nursing and dietary requirements are clearly recorded.Residents have access to health care and remedial services. Residents have the aids and equipment they need and these are well maintained to support them and staff in daily living. Medication records are fully completed, contain required entries, and are signed by appropriate staff. Medication systems do not always follow good practise or safe practise guidelines and has needed action. Evidence: This is what you told us in your Annual Quality Assurance Assessment: Service user remain in control of the personal care they receive, their needs and wishes are acknowledged, listened and responded to. Service users are encouraged to choose their clothing and personal effects. Our staff communicate effectively with each Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: service user and recognise the boundaries and limitations influencing choice and autonomy, and communicate these to service users. All service users have designated key workers. Service users who have responsibilities duties are keen to participate.We provide service users with up to date information about relevant health care issues that concern them. Key workers work with service users to ensure that they receive the health care services to which they are entitled. Service users are enabled to control their own medication where possible. All decisions on medication are recorded on Mediation Administration Records and Health Appointment sheets. Staff monitor service users who are on medication and report any concerns. This is what we found during this inspection: We viewed detailed personal care guidance in care plans during this inspection.A functional capability assessment has been undertaken on service users, this assessment provides clear information of help and support required by residents. The home is currently providing 2:1 support for two service users, this funding has yet not been agreed by the funding authority. The home can access specialist support such as physiotherapy, occupational therapy if residents needs cannot be fully met by the home. For example one resident has been assessed by occupational therapy for technical aids, which have been provided to the home by the local Primary Care Trust. We viewed guidance around assisting people using the service to eat. The guidance was of good standard, but referred to feeding, we feel that this term should be removed and be replaced with assisting to eat. We viewed detailed health records in peoples care plans, records document the outcome and any further actions to be taken following the visit. All residents are registered with a local GP, who will visit the home if required. The home has good links with the district nursing team, who provided care and support to the home and one resident who developed pressure sores during his time in hospital The sores have now fully healed. The Medication Administration Sheet had no gaps. Allergies are not recorded on the Medication Administration Sheet. The home has a detailed medicines policy in place, which is compliant with National Minimum Standards. A signatory list of staff competent in the administration of medication is in the medication file. Staff confirmed of having received medication training. The medication key is kept in a separate lockable cabinet. This cabinet was not locked during this inspection. Residents take liquid medication, but bottles were not signed after opening. The registered manager informed us that she will send a detailed report to the Commission for Social Care Inspection stipulating how the home is planning to deal with this. Medication is checked regularly during each hand over. Care Homes for Adults (18-65 years) Page 19 of 32 Care Homes for Adults (18-65 years) Page 20 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. We looked at National Minimum Standards 22 and 23 during this inspection. The home has suitable procedures for ensuring that residents are protected from abuse and feel safe in the home, both in respect of injury and looked-after money. Evidence: This is what you told us in your Annual Quality Assurance Assessment: SFI Group Homes have a clear and accessible complaints procedure, which includes all the stages and timescales through which complaints may be taken, the emphasis being on prompt and effective action. The complaints procedure enables service users to make complaints over any aspect of the service provided and know how to make a complaint and how it will be acted upon. Residents have the access to advocacy.All service users receive copies of the complaints procedure in user friendly formats. We have not had any complaints so far. Staff have had all the necessary checks to determine their fitness to work with vulnerable adults. Staff have been trained how to respond and take action when abuse is suspected. Our staff know the policy on receiving gifts from service users. This is what we found during this inspection: Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: The home did not receive any complaints since the last key inspection. The complaints procedure is available in pictorial form and compliant with National Minimum Standards. Previous complaints have been recorded and dealt with appropriately. Staff spoken to demonstrated understanding of what they would do if they receive a complaint. The home has a safeguarding adults procedure in place. Staff has received safeguarding adults training provided by Brent Social Service. Previous safeguarding adults allegations have been referred and dealt with appropriately. Staff spoken to feels comfortable of reporting allegations of abuse. Care Homes for Adults (18-65 years) Page 22 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. We looked at National Minimum Standards 24 and 30 during this inspection. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The well-maintained environment provides specialist aids and equipment to meet their needs. Evidence: This is what you told us in your Annual Quality Assurance Assessment: The physical environment of the home and day care and respite care facilities is constructed for the convenience and comfort of the service users. The buildings and grounds are maintained to ensure that they are in safe conditions. Toilet, washing and bathing facilities are suitable for the service users. We ensure service users live in a warm, comfortable and safe environment, which complies with regulations for fire safety, health & safety and environmental health. Service users bedrooms meet their needs and lifestyles. Service users do keep their rooms secure with staff only having access when needed.Service users are encouraged to personalised their rooms. We provide service users with toilets and bathrooms that have privacy and are lockable. Staff are advised not to override lock unless in an emergency or as indicated on a Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: service users risk assessment. Service users have a range of comfortable, safe accessible shared spaces such as the downstairs lounge, garden and the workshop. Service users have access via ramps and grab rails in the toilet and bathroom. The laundry facilities is sited away from the kitchen, hand washing facilities are present where infected material and clinical waste are handled. Systems are also in place to control the spread of any infection, in accordance with relevant legislation and published professional guidance and the purpose of the home. SFI ensures that we comply with required standards for cleanliness and hygiene. This is what we found during this inspection: The home is spacious, on the ground floor is a lounge and dinning area. The garden can be accessed through the lounge. Ramps are available for people with mobility problems. Residents did not invite us to see their room, but one resident told us that she is happy at the home. The registered manager told us that the home has been recarpeted and lino flooring was laid in the dinning area. The home is nicely decorated. The registered manager told us that the home is doing ongoing refurbishment work. During the day of this key inspection the home was clean and free of any offensive odours. Staff told us that the receive infection control training. The laundry room is located in the hallway and a washing machine and a clothes dryer is provided. Care Homes for Adults (18-65 years) Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We assessd National Minimum Standard 32, 34, 35 and 36 during this inspection. Staff members undertake external qualifications beyond the basic requirements. The staffing structure is based around delivering outcomes for residents and is not led by staff requirements. All staff receive relevant training that is focused on delivering improved outcomes for residents. Supervision sessions are regular and staff find them helpful with a focus on improving outcomes for people using the service. Evidence: This is what you told us in your Annual Quality Assurance Assessment: All staff have clearly defined job descriptions that are linked to achieving service users goals. Staff have received training on their roles and responsibilities and staff are aware of the GSCC code of conduct. We encourage all of our staff to do NVQ training and offer sponsorship. Staffing levels are consistent with service users assessed needs and are reviewed regularly. We work in partnership with specialist services (OT, physiotherapy etc..) to meet identified needs. Staff meetings take place on a monthly basis (In-house meeting) and six monthly basis (General meeting) and staff receive bimonthly supervision. Induction training is provided to new staff we also provide Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: Moving & Handling and Food Hygiene training. External training sessions in the following areas; Fire Safety, Infection Control, Challenging Behaviour, Medication Training, Epilepsy, Dementia, Diabetes, Learning Disability and First Aid. This is what we found during this inspection: We looked at the homes rota, currently there are two staff on shift during the morning and two staff during the afternoon and evening. staffing levels change when residents have specific activities such as Gateway club, college, etc. Eight out of nine permanent members of staff have or work towards achieving their National Vocational Qualifications in Care. The home does not employ staff under the age of 18. We looked at two staffing files during this inspection, all files contained the necessary documentation such as Criminal Records Checks, references, application forms, birth certificate, visa status, contract, etc. Staff spoken to confirmed that they had an interview and feel that recruitment was done fairly. Staff have detailed training records on file and have attended First Aid, Food Hygiene, challenging behaviour, Mental Health, Equality and Diversity, Adult protection training, etc. Induction is in stages and staff have to do tests to demonstrate their competence before moving up one stage. Staff confirmed that they have an induction and are happy with the training provided. Staff informed us that the home has regular team meetings, records of these have been viewed by us during this inspection. Staffing records and staff confirmed that regular supervisions and annual appraisals are provided by the management team. 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. We assessed National Minimum Standards 37, 39 and 42 during this inspection. The manager has the required qualifications and experience and is competent to run the home. The manager has a clear understanding of the key principles and focus of the service, based on organizational values and priorities. The AQAA contains clear, relevant information that is supported by a wide range of evidence. Evidence: This is what you told us in your Annual Quality Assurance Assessment: The Home has a formal quality system and there is evidence of continuous self monitoring and assessment. The views of residents and stake holders are obtained. The Policy and Procedures are reviewed on a regular basis, staff have access to policies and procedures and they receive supervision and training in order to understand and implement them. Staff are consulted on the development and revising of policies and procedures. Records in accordance with Schedule 3 regulation are Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: maintained, updated and accurate. Service users have access to their records and information. There are written policies and procedures on all safe working practices issues: Moving and Handling, Fire Safety, Food Hygiene, First Aid and Infection Control. Risk assessments are carried out every year, managers and staff carry out regular checks on all aspects of health and safety. New and inexperienced staff receive training on safe working practices and existing staff have ongoing supervision and training. This is what we found during this inspection: The manager has managed this home since it opened about four years ago. She is finishing an appropriate NVQ level 4 qualification, and she has a degree in management in another field. The manager showed good awareness of individual needs of residents, and could describe how the service has changed at key stages since the last key inspection. She also showed willingness to adapt the service to better meet residents needs. The home has undertaken stakeholder surveys and produced an annual development plan, which is of excellent quality. The annual development plan is based on the National Minimum Standards outcome groups and areas such as diversity, sexuality, activities, and management are addressed. The annual development plan is currently in draft format. The home is holding regular residents meetings, staff meetings and general staff meetings, to discuss individual as well as collective issues regarding the home, support, training, etc. The home has forwarded an Annual Quality Assurance Assessment, which was very informative. Information and evidence from the Annual Quality Assurance Assessment has been used throughout this report. Families and relatives are invited regularly to parties and celebrations allowing them to comment about the service. Fire records are of good standards and an up to date fire risk assessment is in place. Fire drill are done monthly, the fire alarm and fire equipment is tested fortnightly. The fire alarm has been serviced in July 2008. The home is undertaking monthly Health and Safety checks and all Health and Safety test certificates are up to date. The home has a passenger lift, which has been serviced, we noted however that the call bell was not working. 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 20 13 The responsible person must 01/12/2008 ensure that the key for the medication cupboard is allways locked away safely This is to ensure residnets are protected from medication wrongly administered to them 2 20 13 The responsible person must 01/12/2008 send an action plan to the Commission for Social Care Inspection stipulating how the are planning to deal with liquid medication bottles not being signed once opened. This is to ensure residents are administered medication within the expiry date. 3 20 13 The responsible person must 01/12/2008 ensure allergies are recorded on the Medication Administration Record. This is to ensure only appropriate medication is prescribed and administered Care Homes for Adults (18-65 years) Page 30 of 32 4 42 13 The responsible person must 01/12/2008 ensure that the call bell in the passenger lift is working. This is to ensure people can safely use the lift. 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 2 19 The registered person should ensure that the assessors name is recorded on the assessment. The responsible person should change some of the wording used in guidance around assisting people to eat. 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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