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Inspection on 02/12/08 for 71 Coriander Close

Also see our care home review for 71 Coriander Close for more information

This inspection was carried out on 2nd December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

The home has consistently demonstrated that it offers the people living there a good service. The people living in the home had extensive care plans that detailed their needs and how these were to be met. These were updated when there were any changes to the needs of the people living in the home. There were numerous risk assessments in place for the individuals in the home for such things as accessing areas of the home and any activities they took part in. There were also detailed behavioural guidelines in place. The guidelines included the early warning signs of any behaviours, what may be the triggers and how staff were to respond. The people living in the home had access to a good range of activities both in the home and in the community. There were good systems in place to enable staff to communicate with the people living in the home. The personal and health care needs of the people living in the home were met in ways that suited them. The medication system was well managed and ensured people received their medication at the prescribed times. The care plans for the people living in the home detailed their abilities in relation to raising concerns. There was also detail of how staff would know if any of the people living in the home were unhappy. Staff were well trained and available in adequate numbers to ensure that the needs of the people living in the home could be met. The home is a small domestic dwelling and as such provides the people living there with a very homely atmosphere. The quality monitoring system that was in place ensured the service was run in the best interests of the people living in the home and that it was continuously improved.

What has improved since the last inspection?

Only two requirements were made following the last key inspection and the manager of the home at the time addressed these very promptly. One of the requirements was in relation to the management of medicines and not carrying balances forward at the end of the 28 day cycle and ensuring paracetamol was detailed on the MAR charts. The other requirement was in relation to risk assessments. At the time of this inspection there were numerous risk assessments and management plans in place for the people living in the home to ensure they were safeguarded.The care planning system in the home had changed. Staff had had person centred planning training and the people living in the home had had person centred plans drawn up which detailed their dreams and aspirations. One was sampled during this inspection and staff are commended for the comprehensive details that were included in the plans. The sensory room had been further developed since the last inspection and included further items and exploration objects. One of the bedrooms had had new flooring and some new furniture since the last inspection.

What the care home could do better:

Only one requirement was made following this inspection. This was in relation to fire drills which must be carried out every six months so that staff know what to do should a fire occur to ensure the people living in the home were kept safe. Some recommendations were made following the inspection and these are detailed below. The fire alarms in the home needed to be checked on a weekly basis and records of the checks retained. This will ensure people are safeguarded should a fire occur. It was recommended that when the new supply of medication is received into the home only that amount is entered onto the new medication administration record (MAR) and then if any balances remained in the home when the new MAR charts started they were carried forward at that point to ensure medication could be easily audited. The suite in the lounge and some of the drawer fronts on the kitchen units were wearing and should be replaced. This will ensure the accommodation is kept to an acceptable standard. The stair carpet was beginning to fray and should be replaced before it becomes a tripping hazard.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 71 Coriander Close 71 Coriander Close Northfield Birmingham West Midlands B45 0PB     The quality rating for this care home is:   three star excellent 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: Brenda ONeill     Date: 0 2 1 2 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 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.csci.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: 71 Coriander Close 71 Coriander Close Northfield Birmingham West Midlands B45 0PB 01214601846 01214578355 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Sense, The National Deafblind and Rubella Association Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability sensory impairment Additional conditions: The maximum number of service users who can be accommodated is: 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 (LD) 3 Sensory impairment (SI) 3 Date of last inspection Brief description of the care home 71 Coriander Close is a three bed roomed terraced house, situated in the middle of a housing estate in Northfield, Birmingham. It is registered for three people with learning disabilities and sensory impairment. Trident Housing owns the premises, and Sense in the Midlands are the care providers. The home consists of a downstairs toilet, kitchen with combined area for dining, lounge and sensory room. The laundry facilities are Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 3 3 Brief description of the care home housed within the klitchen area. On the first floor there are three bedrooms for the people living in the home, a bathroom and toilet and a small staff office. To the front of the house there is off road parking. There is a garden to the rear of the house. The home is not accessible to people who may use a wheelchair as there is no lift to access the first floor or aids and adaptations to assist people with impaired mobility. The service user guide did not include the range of fees charged at the home but did include a statement stating that due to the needs of the deaf blind being very complex fees were negotiated on an individual basis. 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection at the home was carried out on December 28th 2006. Following this an Annual Service Review was done on December 7th 2007 when we sent some satisfaction surveys to the families of the people living in the home and the home sent us some information in the Annual Quality Assurance Assessment. From the information we received we decided the home had continued to provide a good service to the people living there and that we did not need to bring forward the next inspection. This key inspection was carried out by one inspector over one day in December 2008. During the course of the inspection the care for one of the people living in the home was tracked. This involved looking at the care plan, risk assessments and daily records Care Homes for Adults (18-65 years) Page 6 of 30 for the individual and observing the person in the home. We also looked at medication management, one staff file, training records, staff rotas and some health and safety documentation. A tour of the home was also undertaken. During the course of the inspection we spoke with the area manager and two staff. Prior to the inspection the area manager had completed and returned to us the Annual Quality Assurance Assessment (AQAA) for the home which gave us some further information and is referred to in this report. No complaints or adult protection issues had been raised with us about the home since the last key inspection and none had been lodged directly with the home. What the care home does well: What has improved since the last inspection? Only two requirements were made following the last key inspection and the manager of the home at the time addressed these very promptly. One of the requirements was in relation to the management of medicines and not carrying balances forward at the end of the 28 day cycle and ensuring paracetamol was detailed on the MAR charts. The other requirement was in relation to risk assessments. At the time of this inspection there were numerous risk assessments and management plans in place for the people living in the home to ensure they were safeguarded. Care Homes for Adults (18-65 years) Page 8 of 30 The care planning system in the home had changed. Staff had had person centred planning training and the people living in the home had had person centred plans drawn up which detailed their dreams and aspirations. One was sampled during this inspection and staff are commended for the comprehensive details that were included in the plans. The sensory room had been further developed since the last inspection and included further items and exploration objects. One of the bedrooms had had new flooring and some new furniture 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 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems in the home ensured that the individual aspirations and needs of the people living in the home were assessed on an ongoing basis to ensure they could be met by the home. Evidence: There was a service user guide for the home which was available in different formats, for example, on disc. The document included all the necessary information to enable people moving into the home or their representatives to decide if the home would be able to meet the needs of the individual concerned. Each of the people living in the home had a personalised copy of the service user guide on their files. No new people had been admitted to the home for a number of years. Records in the home showed that the goals and aspirations of the people living in the home were regularly reviewed, for example, statutory placement reviews and on an ongoing basis in monthly core meetings. The people living in the home had extensive care plans that detailed their needs and how these were to be met. These were updated when there Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: were any changes to the needs of the people living in the home. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home had comprehensive person centred care plans and risk assessments that detailed how all their needs were to be met and how any identified risks were to be minimised by staff. Evidence: The AQAA stated under what the home does well Person Centred Care Plans that contain an array of information to reflect the support needs and preferred lifestyle choices of individuals. The information is updated regularly by the manager, practice development worker and staff members. The information in each persons care plan is very informative and enables a consistent approach to the support given. The person centred plans had been drawn up since the last key inspection and one was sampled during this inspection. Staff are commended for the comprehensive details that are included in the plans. The Person Centred Plan (PCP) looked at had been drawn up in consultation with the Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: staff and managers of the home, the organisations family liaison manager and the mother of the person concerned. The input by the individual concerned was very limited due to their complex needs. The file sampled included a full life history of the individual, their likes, dislikes, abilities, preferred activities and daily routines. The PCP included details of the individuals goals and aspirations, what was possible and what was a dream. A lot of the PCP was in colour picture format making it easy to understand and follow. An action plan was drawn up to identify how staff would help the individual realise their goals with time scales included. The PCP included comprehensive details of how staff were to communicate with the individual and what symbols were to be used. For example, wooden triangle means home, wooden spoon cooking, plastic beaker cold drink, safety scissors hairdresser, seat belt mini bus. Every task or activity was detailed as to how staff were to involve the individual, for example, making toast and hot drinks. Progress on the PCP was monitored via monthly core meetings which also included what has been done during that period and the general well being of the individual. There were also regular reviews being held. There were numerous risk assessments in place for the individuals in the home for such things as accessing areas of the home and any activities they took part in. There were also detailed behavioural guidelines in place. These detailed that the individual may become anxious at times and aggressive to others. The guidelines included the early warning signs of any behaviours and what may be the triggers and how staff were to respond. Daily records clearly documented any presenting behaviours and how these had been managed by staff. To enable the people living in the home to make some decisions about their daily lives staff had developed effective ways of communicating with them, for example, calendar boards with symbols that told them what was planned for that day and hand over hand communication. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home were encouraged and enabled to have an independent lifestyle as far as was possible. Their rights and responsibilities were recognised by staff in their everyday lives. The catering arrangements at the home met the needs of the people living there. Evidence: Detailed information is located in care plans as to what the people living in the home enjoy and dont enjoy being involved with. Individual choices are respected and catered for on a daily basis allowing and enabling activities both within the home and within the community. There was a weekly activity plan in place for the person whose care was being tracked. This indicated that the individual took part in activities both in the home and the wider Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: community. Activities detailed on this included, snoozalem, swimming, horse riding, walking machine, aromatherapy. There were numerous pictures around the home and on care files showing people taking part in their planned activities. It was also evident that staff tried new activities, for example, a hot tub had been hired for the use of the people living in the home and we were told they enjoyed this very much. Daily records included details of the activities taken part in and how people reacted to these. Staff were able to tell us how they knew if any of the individuals did not want to take part in any of the planned activities. This was not seen as an issue unless it went on for any length of time. Contact with families was enabled and encouraged by the staff in the home. Records showed that the person whose care was being tracked went to visit her mother with staff quite regularly. Care files included information of when staff were to send birthday cards and so on to family members. All contact with families was detailed on personal files. Families were able to visit the home when they wished. All the food served to the people living in the home was detailed on their daily records. There were menus on display in the kitchen and these showed that the food was varied and nutritious. One of the people living in the home had specific dietary needs and had a separate menu. This detailed that meat needed to be blended and only brown bread was to be served without crusts. We spoke to one of the staff on duty and she was able to say what people liked and disliked and that one of the people living in the home did not aways eat lunch but ate well at breakfast and tea. The likes and dislikes of the people living in the home in relation to food were clearly detailed in their care files. 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. The personal and health care needs of the people living in the home were met in ways that suited them. The medication system was well managed and ensured people received their medication as prescribed. Evidence: The people living in the home needed considerable support to meet their personal care needs. The care plan for the individual being case tracked was very detailed in relation to personal care. There were detailed morning and evening routines that showed what the individual could do for themselves and what staff needed to assist with. It detailed such things as to what extent the person could assist when in the bath and how long they could be safely left for, to what extent they could participate in dressing and how to ensure good oral hygiene. There were details to be followed for when the individual was going to the hairdressers and what preparations were needed. Clearly gender sensitive care had been considered and there was a statement on the file in relation to this. It was also pleasing to note that one of the people living in the home had their hair done in a style to meet their cultural needs. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: The people living in the home had health action plans in place. The one sampled during the inspection included a lot of information about the health care needs of the individual including many pictures. It gave details of ongoing health concerns and also covered areas such as communication, vision, mobility, weight and healthy eating with detail of how often and when checks with health care professionals were undertaken. Records showed the individual had appointments with the G.P., hospital appointments were kept, medication was regularly reviewed and eye health checks, dental checks and chiropody were carried out as detailed in the health action plan. The individuals weight was being monitored and eating and drinking screenings were undertaken and any particular needs in relation to diet were detailed. The records of the visits by health care professionals were well documented and included the outcome of the visit. The medication in the home was well managed. Only staff who had been appropriately trained were allowed to administer medication. The requirements made at the last inspection in relation to PRN (as and when medication), carrying the balances of medication and having a complete audit trail had been met. However it was noted that when the new supply of medication was received into the home, which was generally a few days before the new MAR (medication administration records) started, the total balance of the medication held in the home at that time was entered on the new MAR. Consequently the amounts on the MAR charts at the beginning of the 28 day cycle were not actually the amounts held in the home at that time. It was recommended that when the new supply of medication was received into the home only that amount was entered onto the new MAR chart and then if any balances remained in the home when the new MAR charts started they were carried forward at that point to ensure medication could be easily audited. We were told there was no controlled medication being administered in the home at the time of the inspection. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The policies and procedures in the home along with the training staff received ensured the people living in the home were safeguarded. Evidence: There have been no complaints or adult protection issues lodged with us or directly with the home since the last key inspection. The complaints procedure for the home was not viewed at this inspection. Previous inspections have shown us that the procedure is appropriate and that it is available in different formats, for example, pictures and compact disc. The AQAA indicated that the procedure remains the same and that the organisation has a number of ways in which complaints can be raised. The care plans for the people living in the home detail their abilities in relation to raising concerns. There was also detail of how staff would know if any of the people living in the home were unhappy. One of the staff spoken with told us how she knew if people were unhappy by the way they reacted to the symbols they were given to indicate a particular task or by their gestures. The organisation had clear guidelines in place in relation to challenging behaviours to ensure the people living in the home were safeguarded. The AQAA detailed the training Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: staff had in relation to managing challenging behaviours where they learnt safe and non harmful control and restraint techniques. If restraint had to be used it was as a last resort and for the minimum duration. The staff at the home also had the support of a behaviour management team that advised them on how to manage any presenting behaviours. The home notify us when physical intervention has been necessary with a full explanation of why and the technique used. The systems in place for the safekeeping of money on behalf of the people living in the home were robust. All had bank accounts that there personal and mobility allowances are paid into. Withdrawals from the accounts are only allowed by managers and all were clearly documented and cross referenced to bank statements. Small amounts of cash were accessible to the staff in the home for use on behalf of the people living in the home. All expenditure was documented and signed for with receipts available. The cash balance checked at the time of the inspection was correct. The training matrix for the home indicated that all staff had training in adult protection issues. The AQAA indicated that this was also followed up with them in supervision and that they were given protection questionnaires to refresh their knowledge and understanding of the subject if formal training was not due. 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. The home provided the people living there with a comfortable, safe and homely environment in which to live. Evidence: The home is a small domestic dwelling and as such provides the people living there with a very homely atmosphere. Communal space consists of a lounge, dining kitchen and a sensory room. These were generally well maintained and adequately decorated. It was noted that the suite in the lounge was wearing and in need of replacement. The sensory room had been further developed since the last inspection and included further items and exploration objects. One of the people living in the home particularly enjoyed time in this room listening to music. The home has a large well maintained garden with furniture and a hammock available for the use of the people living in the home. The were symbols, calendar boards and communication boxes around the home enabling individuals to access objects of reference easily. The people living in the Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: home were able to find their way around the home either independently or with some guidance from staff. It was noted that the stair carpet was beginning to fray and although not dangerous will need to be replaced in the near future. The kitchen was clean and tidy. All opened foods in the fridge had been dated on opening. Some of the fronts on the kitchen units were wearing and in need of replacing. Laundry facilities were located in the kitchen but due to the layout of the home there was no alternative space for this. All bedrooms are located on the first floor and of single occupancy. All were appropriately personalised to reflect the personalities of the occupants. Two of the bedroom had double beds as this was preferred by the occupants. One of the bedrooms had had new flooring and some new furniture since the last inspection. The home has one bathroom and toilet located on the first floor with a shower over the bath. This gave the people living in the home the choice of either having a bath or shower. There was also an additional toilet on the ground floor. 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. Appropriate staffing levels were being maintained by a well trained staff team that could meet the needs of the people living in the home. The recruitment procedures were robust and ensured the people living in the home were safeguarded. Evidence: The AQAA indicated only one staff member had left the home over the last year. We were told during the course of the inspection that another member of staff had left recently and this post was vacant. Vacant posts were covered by existing staff working extra shifts, bank staff or on occasions agency staff. Due to the complex needs of the people living in the home it was important they had continuity of staff that knew them well therefore if agency staff were used the home insisted on the same people. The rotas for the home indicated that the minimum staffing levels were two throughout the waking day and one waking night care assistant. However there were often more staff in the home depending on the planned activities for the people living in the home. At the time of the inspection there were three staff on duty. Two were very established staff who knew the needs of the people living in the home well. The other was a fairly Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: new staff member who was shadowing the other staff and getting to know the people living in the home and watching how other staff interacted with them. This was seen as a very important part of the induction process due to the complex needs of the people living in the home and their lack of ability to communicate their needs verbally. If staff did not interact appropriately with them it was very distressing for them. The longer standing staff were able to tell us about the people living in the home, for example, their likes and dislikes and how they reacted when they did not want to do something. New staff also had a lot of training off site during their induction period and this was completed within the time scales down laid by Skills for Care. Topics covered during induction were detailed in the AQAA as including manual handling, food hygiene, medication awareness, infection control, deaf blind awareness and managing challenging behaviour. Once new staff had completed their probationary period and all the required training during that period they were given the opportunity to start NVQ training. The training matrix for the home indicated staff had undertaken training in numerous topics including manual handling, health and safety, first aid, food hygiene, care of medicines, infection control, protection and fire safety. Refresher dates were indicated and the few that were overdue were highlighted to ensure they were addressed. Staff also undertook training in topics specifically related to the people they were caring for such things as communication, challenging behaviour and working with deaf blind people. Four of the seven staff employed at the home had NVQ level 3 which is a little above the required fifty percent. The recruitment documentation for the new employee was sampled. All the required documentation was on site and this showed that all the appropriate checks had been undertaken before the person had started work at the home. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was running smoothly. The quality monitoring system that was place ensured the service was run in the best interests of the people living in the home and that it was continuously improved. Evidence: The registered manager had left the home during the year however there had been an unregistered care manager until recently who was being supported by the area manager. She had recently gone on maternity leave. The area manager was present throughout the course of the inspection and was spending quite a lot of time at the home to ensure staff were being supported as necessary. He told us that he had interviewed and appointed a new manager but the person had refused the post at the last minute so he was now having to advertise again. The home was running smoothly and the staff were confident in their roles and were able to answer any questions asked of them. Staff were very aware of the needs of the people living in the home and ensured the home was run in their best interests with as Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: few routines as possible. As at the last inspection there was a quality monitoring system in place at the home. The manager of the home undertook a comprehensive audit of the home on an annual basis. This included feed back from staff, the relatives of the people living in the home and any professionals involved in their care. The outcome of the audit resulted in an action plan being drawn up to further the improve the service offered at the home. The outcome of the annual audits and the action plan were overseen and agreed with senior management. The area manager undertook regular unannounced visits to the home to oversee the conduct of the home. The health and safety of the people living in the home and the staff were well managed. Staff received training in safe working practices and the home was safe and well maintained. The AQAA indicated that the servicing of the equipment in the home was up to date. The in house records for the checks on the fire system were sampled. These were generally up to date however it was noticed that there was the odd occasion when the fire alarm had not been tested weekly. The area manager was aware of this and had brought it to the attention of the staff. It was also noted that the last recorded fire drill was in January 2008. These should be undertaken every six months. The area manager told us he thought they had had another fire drill since then but the records could not be found. The home continue to notify us appropriately of any incidents or accidents in the home. 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 42 23 Fire drills must be undertaken every six months. This will ensure staff know what to do should a fire occur and ensure the people living in the home are safeguarded. 31/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 20 It is recommended that when the new supply of medication is received into the home only that amount is entered onto the new MAR chart and then if any balances remain in the home when the new MAR charts start they are carried forward at that point to ensure medication can be easily audited. The stair carpet is beginning to fray and should be replaced before it becomes a tripping hazard. The fronts of the kitchen units that are wearing should be replaced to ensure the accommodation is kept to an acceptable standard. The suite in the lounge is wearing and should be replaced. This will ensure the accommodation is kept to an Page 28 of 30 2 3 28 28 4 28 Care Homes for Adults (18-65 years) acceptable standard. 5 42 The fire alarms in the home must be checked on a weekly basis and records of the checks retained. This will ensure people are safeguarded should a fire occur. Care Homes for Adults (18-65 years) Page 29 of 30 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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