Inspection on 12/03/09 for 7 Blunt Street

This inspection was carried out on 12th March 2009.

CSCI 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

7 Blunt Street 07/11/07

7 Blunt Street 14/11/06

7 Blunt Street 25/01/06

7 Blunt Street 06/09/05

7 Blunt Street 17/02/05

7 Blunt Street 22/06/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 7 Blunt Street Stanley Common Ilkeston Derbyshire DE7 6FZ     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: Anthony Barker     Date: 1 2 0 3 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 28 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 28 Information about the care home Name of care home: Address: 7 Blunt Street Stanley Common Ilkeston Derbyshire DE7 6FZ (0115)9323491 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Blunt.Street8@unitedresponse.org.uk United Response Name of registered manager (if applicable) Christine Coates Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home 7 Blunt Street is a semi-detached house in a small village development. People who live here are provided with adequate accommodation and single rooms. There is a reasonably-sized rear garden. The Service offers personal and social care to people with a severe learning disability with associated conditions that include autism, sensory disability, epilepsy and challenging behaviour. Activities are planned to meet individual needs. 3 Over 65 0 care home 3 Care Homes for Adults (18-65 years) Page 4 of 28 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 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 was unannounced and took place over one day. The last key inspection at this service was on 7th November 2007. The Commission had requested the Service to complete an Annual Quality Assurance Assessment (AQAA) before this inspection. This had been completed by the Registered Manager from another United Response service at a time when 7 Blunt Street had no registered manager. We had also received two completed survey forms from staff and two from relatives. The information provided in these documents is included in this report. The people living at the Service all had high levels of dependency and therefore were Care Homes for Adults (18-65 years) Page 5 of 28 not able to contribute directly to the inspection process, though they were observed working with and being cared for by staff. One particular persons experience of the quality of the service was focussed on, through their personal records and discussion with staff. United Responses Area Manager, the Acting Manager, Senior Support Worker with Additional Responsibilities (SSWAR) and one senior support worker were spoken with at this Inspection and records were inspected. There was also a tour of the premises. The weekly fees at the time of this inspection ranged from 1250 pounds to 1622 pounds. 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 7 of 28 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 8 of 28 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. Individual written needs assessments were in place before people were admitted to the Service so that their diverse needs were identified and planned for. Evidence: The Service Users Charter and Individual Charters had been recently updated and were individualised to the Service and the people living there. They included details of the amount of fees currently payable. This was an improvement on the last inspection. August 2004 was the last date that a person was most recently admitted to the Service. This persons file contained a range of pre-admission assessments, which were assessed at a previous inspection. Care Homes for Adults (18-65 years) Page 9 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the Service had individual plans of care which demonstrated that their health, personal and social care needs were being met. Evidence: The care plan of the person case tracked was examined. It was holistic and reasonably person centred, though work was still ongoing to bring a more person centred approach to all care plan documents. The record of this persons person centred review meeting, held on 28th August 2008, was examined. It was a positive document and included Action Plan goals. It was enhanced by an attached photograph of the person with their mother, taken at the meeting. The managers pre-inspection questionnaire stated that person centred reviews use good to great tools to enable views from everyone and involve the people we support as much as they want to be involved. The questionnaire also stated that person centred reviews are chaired by an external facilitator. This is a paid facilitator from a national organisation also used by Derbyshire County Council for their training in the person centred approach. The case Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: tracked persons Personal Planning Book was mainly completed and was found to be a potentially valuable document for staff to go through with the person concerned. However, there were no entries between November 2007 and the current date. Daily records contained a mixture of first person and third person entries and some less than meaningful entries relating to domestic routines, that happen every day, were not remarkable in any way and not related to any care plan objectives. The Acting Manager produced a document he plans that staff should use, providing guided prompts within a framework. Our overall assessment of these existing care planning documents was that there was a lack of recorded overview of the persons needs. The senior support worker spoken with gave examples of people making decisions and choices about the clothes they wear each day, for example, through making a noise or pointing to an item. She also spoke about the case tracked person particularly enjoying a previous holiday in Norfolk and how photographs of this holiday have been recently used to plan a return there this year. One member of staff, who completed our pre-inspection questionnaire, stated that the Service was good at promoting choice for the people living here. Recorded risk assessments were in place that indicated that the Service was aware of potential risks to which people were exposed and these included ways of managing these risks. The Acting Manager confirmed that these had been reviewed since the last inspection to ensure that they refer to all matters that could potentially put at risk the people who live at the Service and staff members. One risk assessment relating to the case tracked person focussed on personal hygiene and another was generic. We understood that the Service plans to make these more person centred. The senior support worker spoken with showed an understanding of the concept, and use, of responsible risk taking in order to increase peoples independence. She spoke about walking along the pavement, with one person she supports, with herself on the roadside, for increased safety. Care Homes for Adults (18-65 years) Page 11 of 28 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 Service provided activities and services that were age-appropriate and valued by the people who live here, and promoted their independence. Evidence: Two people who live at the Service were being provided with a day service from Derbyshire Social Services on four days of the week with one week day based at the Service. The other person spends each day at the Service. The senior support worker spoken with gave examples of people taking part in activities that were valued by them and fulfilling. These ranged from one person enjoying swimming and taking baths -showing this enjoyment through splashes and smiles. Another person likes going for a meal in a local pub and enjoys the music there - showing this enjoyment by clapping and being positively noisy. One relative who completed our preinspection questionnaire was concerned about the lack of activities provided when the Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: Social Services day centre is closed for a week. The Acting Manager said the Service has no budget to address this closure period. The senior support worker gave examples showing that the people living at the Service have a positive involvement in the local community. This included using local shops and supermarkets, pubs, hairdressers and leisure centre pool. One person particularly enjoys a drive to the local pond and the case tracked person walks, with staff, to a bakery to buy bread. The managers pre-inspection questionnaire stated that, The people we support have regular contact with family and friends...we ensure that family and friends attend person centred reviews. The senior support worker spoken with said that family contact for one person had improved so that they now see parents weekly. One staff member who completed our pre-inspection questionnaire said, we communicate very well with the families. One relative who completed our pre-inspection questionnaire was concerned about there being insufficient staff to accompany the case tracked person on visits home, so curtailing the frequency of visits. The Acting Manager explained that this was not a staff resource issue but rather one of attitude shown by some staff towards the case tracked person. He said he would be looking at this issue and added that the relative visits the Service weekly. The senior support worker gave examples of how routines, at the Service, are flexible to meet peoples individual needs and circumstances. He described scenarios involving two people who live at the Service when routines change in the morning following a disturbed period of sleep or challenging behaviour. The senior support worker also spoke of how routines promote peoples independence. He said the case tracked person is particularly keen on loading and emptying the washing machine and dryer in the laundry room. A varied and nutritious three-week rolling menu was seen. However, this had not been reviewed since May 2005 and was not obviously person centred. Individuals food preferences had not been recorded: there was just one food entry on the case tracked persons Likes and Dislikes list. Food stocks were found to be at a satisfactory level. Care Homes for Adults (18-65 years) Page 13 of 28 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 Service was generally providing people with personal support in the way they preferred and required and was meeting their physical, emotional and health needs. Evidence: The senior support worker spoken with gave examples of how staff meet the dignity and privacy needs of people living at the Service. For example, staff encourage people living at the Service to close doors when people are going to bed or bathing. There was evidence of equipment in place that maximised peoples independence. For instance, one person has a specially shaped knife and fork for use at meal times. The Acting Manager showed his awareness of the Independent Mental Capacity Act Advocate (IMCA) service that has been involved in another United Response service he manages. One relative who completed a pre-inspection survey stated that the Service was very caring. However, another relative was concerned about some staff not always giving time to the case tracked person and not always listening to them - causing the person to get unhappy and agitated. As previously mentioned in this Report, the Acting Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: Manager said he is aware of some staff members attitudes to this person and would be looking at the issue. There was evidence of person centred communication systems within the Service. Wallets of picture cards were available for each person living at the Service: staff would use these to help explain and involve people in making choices and decisions. There were also some photographs on walls that were used as communication tools, though the Area Manager accepted that more use could be made of pictures and photographs. At the start of this Inspection we noted a lack of involvement between two staff members and two people living at the Service. The Area Manager agreed that this staff behaviour did not reflect United Responses expectation that staff use, Active Support to involve people in everyday tasks. She said there was evidence of previous lack of management...not reinforcing Active Support. Later at this Inspection the Acting Manager referred to new shift plans that will help to clarify staff roles and potentially increase proactive behaviour from staff. The managers preinspection questionnaire stated that, we are now looking at good day bad day to provide support for one person. At the Inspection, the Acting Manager explained that the Service would be trying to turn this persons bad days into good days through addressing their poor sleep patterns. Each person living at the Service had a My Health File in place that was well laid out in person centred terms. However, medical appointments were being duplicated as they were recorded on these documents as well as on peoples care plan files. Also, some recent dental appointments were not recorded at all. This meant that the health care needs of people living at the Service could not be easily monitored. There was evidence of involvement of a range of external health professionals, including optician and dentist. An Emergency Grab File was in place which provided a useful immediate source of information. Telephone numbers, a disaster plan and emergency information sheets regarding each member of staff and each person living at the service, were in this file. The Medication Administration Record (MAR) sheets of the case tracked person were examined and found to be satisfactory. There was a good system of separate blister packs containing tablets used by people who live at the Service for use when they attend day services. There was a record of staff signatures/initials to ensure that signatures can be cross-referenced against staff names. Medicines were securely stored in personal medicine cabinets in peoples bedrooms. A copy of the Services Medicines Policy was being kept in each of these cabinets. No controlled drugs were prescribed. Most staff had received training in the safe use of medicines within the past two years. Care Homes for Adults (18-65 years) Page 15 of 28 Care Homes for Adults (18-65 years) Page 16 of 28 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. Procedures for handling complaints and abuse were in place to ensure that people were fully protected, though safeguarding practices could be more robust. Evidence: United Response had a robust procedure for dealing with complaints. The Services complaints procedure had been updated since the last inspection and now makes reference to the Commission for Social Care Inspection. A copy of the procedure was displayed. It made appropriate use of symbols so that people who live at the Service could better understand it. The managers pre-inspection questionnaire stated that plans were being made to ensure verbal concerns (from people who live at the service) are recorded. The Acting Manager spoke of plans to make the complaints process more person centred by addressing the question Is this my way of complaining? when analysing incident records. Also, he said individual communication guides will, in future, include reference to How I communicate when Im sad/happy and When Im sad/happy/in pain I will do this. The managers pre-inspection questionnaire indicated that no complaints had been received during the 12 months previous to this Inspection. The Service had a written policy and procedure on prevention of abuse linked to the statutory procedures and prepared by United Response. The senior support worker spoken with showed good awareness of these procedures and the Services whistle Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: blowing policy. She was asked if she felt safe working at the Service. She replied that there were times when she felt vulnerable in the presence of the case tracked person that is when she was the sole staff member on duty and the person concerned was showing intimidating behaviour. She also felt that the case tracked person can target one other person living at the Service, as well as staff. The staff training matrix showed that most care staff had been provided with training, on the subject of Safeguarding Adults, within the past three years. The case tracked persons personal money record was examined. This was satisfactory and included recorded evidence of the regular checks made by management - an improvement from the last inspection. The Acting Manager spoke about the breakthrough with one bank that has agreed to providing individual bank accounts, for each person living at the Service, accessed through their own signature or mark. Care Homes for Adults (18-65 years) Page 18 of 28 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. People were living in a comfortable and safe environment that was clean and hygienic. Evidence: The premises were well decorated and furnished. New carpets had been laid in the hall, stairway and lounge and new vinyl floor covering on the landing. The maintenance issues, raised at the previous Inspection, had been dealt with although the wall beside one bedroom door frame was, again, in need of redecoration. Bedrooms were equipped with visual stimuli according to the individuals needs and one bedroom was particularly comfortable and personalised. All people living at the Service had a 4-foot bed to provide more comfort and safety in the event of a seizure. Each of the bedroom doors had a suitable lock although none of the people living at the Service would be able to hold their own door key, the Acting Manager confirmed. People had been assessed as not understanding the need for locked space in their bedrooms and the reason for not providing this facility had been recorded in the current Service Plan. From the tour of the premises there was evidence of satisfactory standards of cleanliness and hygiene, with no unpleasant odours. However, there was no soap or towel in the first floor toilet. No communal rooms have to be passed through by staff Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: between bedrooms and the laundry room. The senior support worker spoken with described good practice regarding the transportation of soiled articles of clothing and bedding within the premises. The managers pre-inspection questionnaire referred to all staff having completed Infection Control training. The Acting Manager said that the Department of Healths Infection Control Guidance for Care Homes and its Essential Steps to safe, clean care had been incorporated into United Responses policy and procedures on Infection Control. Care Homes for Adults (18-65 years) Page 20 of 28 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 Service had well-trained and well-recruited staff which generally ensured that people living here were safe and their needs were met. Evidence: The managers pre-inspection questionnaire stated that five of the nine care staff had achieved a National Vocational Qualification (NVQ) in Care to level 2 or above. This met the National Minimum Standard to maintain a staff group with at least 50 qualified staff. The Acting Manager said that two of these five staff members have an NVQ in Care at level 3 and the SSWAR is currently undertaking this. The staff member who completed the pre-inspection survey stated that there were usually enough staff to meet the individual needs of all the people who use the Service. However, the senior support worker spoken with at this Inspection, when asked about staffing levels, described two 4.5 hour periods each Saturday and Sunday evenings when only one member of staff was on duty. This was later confirmed by examining the staffing rota. The senior support workers opinion was that people living at the Service, may not get the attention they deserve at these times. She added that she finds it very stressful being on duty at these times and has shared her feelings with the SSWAR and other colleagues. She was otherwise very positive about Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: working in this staff team. The United Response risk assessment that addresses lone working, and the actions necessary to control associated risks, states that, Staff to only work on their own when they feel confident and competent to do so. It also states that on-call staff can arrive within 10 minutes of a telephone call and, if immediate support is needed, staff from one of the adjoining services can arrive within 2 minutes. The Acting Manager said that staff have been given a cordless telephone to use in an emergency. At this Inspection, the Acting Manager said there had been no new members of staff recruited since the last inspection. United Response has generally followed good practice regarding recruitment practices. The senior support worker spoken with said she had received a good induction when she started working at the Service. She said she had received training in Basic Food Hygiene, First Aid and Timian - a system of managing challenging behaviours through focussing on early non-physical intervention - within the past 12 months. Training records showed that all staff had been provided with mandatory training in Basic Food Hygiene, First Aid and Moving & Handling, within the past three years, except for one staff without recent training in First Aid. All staff except three had been provided with external Fire Safety training within the past 12 months. There had been no in-house fire safety training recently provided to the two waking night staff, the Acting Manager confirmed. Care Homes for Adults (18-65 years) Page 22 of 28 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 welfare of people who live at the Service, and those of staff, were being compromised by the management systems in place. Evidence: At the time of this Inspection the Service had had four managers within the previous eight months, including the current Acting Manager. He had 17 years experience of working with people with learning disabilities and had an NVQ in Care and Management at level 4. He had been in this post for six months before this Inspection. He planned to make application to us to become the Registered Manager. The Area Manager described recent training for Senior Support Workers with Additional Responsibilities (SSWARS) on their role as Practice Leaders. She described this training as inspirational and how it enabled cross fertilisation over local United Response services. Monthly independent audit visits to the Service, on behalf of the Registered Provider, as required by Regulation 26, were now taking place - an improvement from the last Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: inspection. The Services current annual Service Plan was in place and included target dates. Quality assurance questionnaires were being sent to staff, but not to relatives or external professionals, for their views on the quality of service provided. However, the Area Manager said that a meeting was planned between relatives and herself, together with the Regional Director, to discuss person centred plans for the people who live at the service. Good food hygiene practices were noted. The safe storage of cleaning materials was observed, along with the product data sheets required by the Control Of Substances Hazardous to Health (COSHH) Regulations. The managers pre-inspection questionnaire indicated that equipment at the Service was being maintained and good Health and Safety practices followed. However, although the electrical wiring at the premises had been checked in 2006, according to the Acting Manager, the Certificate confirming this was not available at this inspection. Incident records were examined. One record described how, in November 2008, the case tracked person, was alleged to have pushed a member of staff downstairs, and how she then, locked herself in the office. We saw a record of discussion of this persons behaviour at a staff meeting and reference to the need to revise the persons Behaviour Support Plan. However, we noted that the case tracked persons Behaviour Support Plan was last reviewed in October 2008 and so there was no evidence it had been reviewed again after this incident. The Acting Manager said that some staff are apprehensive over this person and accepted the need for staff training and support. There was no record of any one to one supervision of this staff member since August 2008 and therefore no evidence of how the Service had supported her. Evidence gained at this Inspection, recorded above and in the Lifestyle and the Concerns, Complaints and Protection sections of this report, indicates an unsatisfactory management of the interplay between the needs of the case tracked person and of the staff group. Care Homes for Adults (18-65 years) Page 24 of 28 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 25 of 28 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 23 13 13(6) The Service must take 01/05/2009 action to prevent people who live at the Service, or staff members, from being unsafe because of any behaviour exhibited by a person living at the Service. This will ensure the safety of people living at the Service and of staff. 2 42 12 12(1)(a),(5)(b) Staff must 01/05/2009 be encouraged and assisted to maintain good personal and professional relationships with the people who live at the Service. This will promote peoples health and welfare. 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 Care Homes for Adults (18-65 years) Page 26 of 28 1 2 3 6 6 15 Continue efforts to bring a more person centred approach to all care plan documents. Staff recording practices should be improved on daily records. People living at the Service should be enabled to maintain contact with relatives home at a frequency determined by their individual choice. The menu should be reviewed to take account of peoples preferences and seasonal factors. An associated food preferences list should be recorded for each person living at the Service. Staff should be more actively involving people who live at the Service in their everyday activities and domestic tasks. More use should be made of pictures and photographs to involve people in making choices and decisions. A review should be made of the way medical appointments are recorded. The action taken to prevent people who live at the Service, or staff members, from being unsafe should be person centred to ensure that the welfare and needs of all people who live at the Service are being met. The Acting Manager should ensure that the people who live at the service are safe and have their needs met during times when staff are working on their own. The Acting Manager should maintain clear communication with individual staff, and the whole staff group, over their experiences of lone working to ensure that stress levels are minimised. Staff who work night shifts should be provided with fire training twice a year. The views of the families of people who live at the Service, and of external professionals, should be formally sought. The Acting Manager should obtain the Certificate confirming that the Services Electrical Wiring was checked in 2006. 4 17 5 6 7 8 18 18 19 23 9 33 10 33 11 12 13 35 42 42 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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