Inspection on 26/11/08 for 76-78 Hampstead Road

This inspection was carried out on 26th November 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

76-78 Hampstead Road 04/06/08

76-78 Hampstead Road 05/06/07

76-78 Hampstead Road 06/07/06

76-78 Hampstead Road 15/11/05

76-78 Hampstead Road 13/07/05

76-78 Hampstead Road 13/01/05

76-78 Hampstead Road 18/06/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 76-78 Hampstead Road 76-78 Hampstead Road 76-78 Hampstead Road Brislington Bristol BS4 3HN     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: Sandra Jones     Date: 2 7 1 1 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: 76-78 Hampstead Road 76-78 Hampstead Road 76-78 Hampstead Road Brislington Bristol BS4 3HN 01179728513 01179699000 judi.lorentz@brandontrust.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) The Brandon Trust Type of registration: Number of places registered: care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is 12. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability- Code LD Physical disability- Code PD Date of last inspection Brief description of the care home The Brandon Trust operates 76/78 Hampstead Road and their philosophy is supporting and enabling people to live the lives they choose. The care home is registered to provide accommodation and personal care to twelve younger adults with learning and/or physical disabilities. The property was purpose built to accommodate people with physical impairments. As the property is purpose built to accommodate people with physical impairments, there is level access and wide corridors. It blends well with Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 12 12 Brief description of the care home its local residential environment and close to shops, park and bus routes. There are three staff rostered in each house throughout the day, with ancillary staff to maintain the home clean. At night there are two staff awake and one sleeping-in. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support 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 conducted unannounced in over two days in November 2008 and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined and feedback was sought from individuals and staff. Prior to the visit some time was spent examining documentation accumulated since the previous inspection and this information was used to plan the inspection visit. The Annual Quality Assurance Assessment (AQAA) was sent to the home and the manager failed to return the AQAA within the timescale given. Care Homes for Adults (18-65 years) Page 6 of 30 Have your say surveys were sent to people who use the service and health care professionals. One survey from an individual at the home was returned to the Commission. There are twelve individuals currently living at the home and four people were case tracked. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people using the service and other related documents. The home’s policies and procedures were also used to confirm the findings. 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 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 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals wishing to live at the home are provided with clear and up to date information. There is an effective admission process, which ensures that the needs of the people wishing to live at the home can be met by the skills of the staff. Evidence: The Brandon Trusts Mission Statement is ‘Supporting and enabling people to live the lives they choose. The Statement of Purpose and Service User Guide was reviewed in August 2008, the information provided is up to date and accurate for people wishing to live at the home, their relatives and agencies making placements at the home. People wishing to live at the home will have more up to date information about the facilities and services at the home. The arrangements for admission at the home is briefly outlined in the Statement of Purpose. It states that outside professionals will conduct needs assessments to ensure Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: the needs of the people wishing to live at the home can be met by the skills of the staff. This procedure is supplemented by a local protocol and the manager said it would be appended onto the Statement of Purpose. To establish that the person can make decisions about moving into the home introductory visits are welcome and trial periods are offered. There are no vacancies at the home. Care Homes for Adults (18-65 years) Page 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning processes need to be more consistent and the approach must be more person centred. This will ensure people receive individualised care and are empowered to make decisions. Evidence: The manager said that following from the social workers care reviews; homes support plans and associated risk assessments are reviewed and interlink with each other. The manager said review meetings are currently undertaken by the placing agency and the intention is for the keyworker to organise the review meeting, provide reports in advance of the care review and amend the care plan following the review. Care reviews were undertaken for ten people by the placing agency and the minutes for three people are outstanding. Support plans were checked against the care plan review minutes to determine if the plans matched the social workers care review. Overall support plans were devised for each assessed need and routines and intimate Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: care plans supplement support plans for physical tasks. However, a more consistent and person centred approach is needed. The manager recognises that support plans require further development in term of making the action plans more meaningful. Staff were asked to describe their responsibilities towards care planning. It was stated that the placing authority is reviewing the care needs of the people at the home. However, the member of staff said that its taking longer to develop support plans because social workers are not providing the minutes of the meeting promptly. The people living at the home have communication needs and there is a section for communication in the individuals Planning for Life Packs. While communications plans describe the behaviours exhibited, the interpretation and assistance needed by the staff; there is little evidence that the information is used by the staff. The manager explained that Speech and Language therapists would provide training for staff to communicate with objects of reference. The manager confirmed that Mental Capacity Act ‘best interest’ decisions currently focus on medication. Feedback from staff about the way individuals at the home are empowered to make decision. Staff said that understanding the way people make decisions because of their complex needs they are not made in the same way as other non-disabled people. It was acknowledged that for some people choices are new and through the care planning process, observation of behaviours and making suggestions on behalf the person people will empower people. Members of staff record daily events, individual’s social activities and physical care provided is recorded. The information recorded shows improvement and provides some evidence that people are making choices. Risk assessments are completed for activities that may involve an element of risk. They consider the options to reduce the risk to then develop an action plan, which is reviewed. These include money management, using transport and summoning assistance from staff. Care Homes for Adults (18-65 years) Page 13 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The introduction of support systems will ensure that people at the home lead active and interesting lifestyles and are recognised in the community. Evidence: The manager said that at present staff make daily decisions about the activities to be undertaken by the individual. In future activities will become part of the care planning process and risk assessments will be completed for any activity that may involve an element of risks. Ten people have 1:1 day care services provided by the Trust with one person attending a day care centre four full days per week. In addition to the day care service, home staff must support people with activities. The activity chart of daily activities demonstrates that people have more opportunities for activities in and out Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: the home. Staff record activities undertaken, the length of each session along with comments about the session. The people at the home go on walks with the staff have talking books, snoozelum sessions and listen to music. The manager said that from December keyworkers would be expected to prepare plans of a day’s activity with the person they keywork. The purpose is to ensure that people have 1:1 with their keyworker and the activity is varied. There are two people who currently have spiritual needs and are supported by the staff to visit places of worship. It was also stated that the people would be going to see the local pantomime, and visit local shops to ensure they are recognised in the local community. Staff were consulted about the way individuals are supported to participate in meaningful activities. A senior on duty said that ensuring keyworkers were given an opportunity to have 1:1 time with individuals, adequate staffing levels and through person centred planning people can share positive experiences. The arrangements for visiting the home is included in the Statement of Purpose and recognises the importance of maintaining links with family and friends. Visiting at the home is open and where possible staff support individuals to visit their family and friends. The preference is for visits to take place in personal space although communal areas are available with consent from people at the home. The Privacy and Dignity policy is appended onto the Statement of Purpose. The manager was consulted about the procedures in place that ensure people are respected as individuals. It was stated that staff attend training to ensure they are aware of people rights, Safeguarding Adults training and the principles of care as part of their induction. Ensuring staff know what is acceptable and making the two houses more individual will respect the people at the home. The manager also described the ways that staff involve people with the running of the home. Since the last inspection, staff are more involved with daily tasks, for example, tidying bedrooms with the persons. Staff prepare meals with people present in the kitchen, individuals have their own linen baskets and each person will be involved with taking their washing to the laundry and their washing will then be done separately. The manager explained the ‘Getting there project’ which is about involving people about how their home is managed and their local community that build on individuals network. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: It was explained by the staff that the existing menu would change in the future. A good range of fresh, fruit and vegetables are held in both houses, which shows that people have varied menus. This is an improvement from the last inspection. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home are supported with their personal and health care by the staff. Evidence: It was explained by the manager that the people at the home require assistance with personal care from the staff. For some people their daily routines include eating and drinking, these are person centred and instruct staff on the way personal care is to be provided. The people at the home have mobility needs and support plans are in place for these individuals. Risk assessments for people with moving and handling needs supplement their support plans. The manager said that the people at the home have open appointments with physiotherapists and will be visiting to assess the input and frequency of visits needed by the people at the home. This will ensure that people with mobility needs are regularly assessed and their physiotherapy programmes are regularly updated. Aids and equipment is used for safe handling, hoists, walking belts, bath support, Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: wheelchairs and easy chairs for posture are used. The manger confirmed that the people with a history of pressure areas have pressure-relieving equipment in their beds and wheelchairs. Each person has a personal care file and individual profiles that state the persons abilities with communications, mobility, hygiene, continence and medical care. The documentation in files supports that people at the home have input from the Community Learning Disabilities Team (CLDT) and access other health care professionals including NHS facilities. People at the home visit the dentist, optician and audiologist. The manager said that health care action plans are to be introduced once staff are able to set up the system. It was explained that once staff attend training they would be leading the introduction of the system into the home. At the time of the inspection a Best Interest meeting was taking place for one person. The purpose of the meeting was to ensure external agencies agree that a medical procedure is necessary for one person that is unable to consent to treatment. A visual camera is in use for one person at risk of SUDEP and a clear protocol is in place to ensure privacy and dignity is maintained when using intrusive devises. A community nurse that specialises in epilepsy care will be providing training for the staff. For people on Boccal Midazolam protocols were developed and signed by the community nurse, the prescriber and epilepsy specialist ensuring that the staff are given guidance to administer medications correctly. Members of staff then record the seizures, their time and behaviours both before and after the seizure as required by the protocol. Requests for GPs and other health care visits are recorded in the medical reports by the staff. The reason for contacting the health care professional, the diagnosis, advice and treatment, with any further action or appointments are recorded. Overall staff sign records of administration when they have administered the medications or use codes to record the reasons for not administering the medication. Each person has a profile with their photograph, medical details and information about administering the medication. In house 1 there is a medication file, which contains the purpose and the side effects of medications, prescribed to each person in the house. Members of staff giving feedback about personal and health care said that systems that ensure medical advise is followed include handovers when shift changes occur, diarys and documentation. Staff told us that people at the home are unable to make Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: obvious decisions about their care. Best interest decisions are now done through a circle of professional that include the individual, family and professional bodies. People at the home are supported on health care visits by the staff. Care Homes for Adults (18-65 years) Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems in place ensure that complaints can be raised on behalf of the people at the home. Individuals at the home are protected from abuse. Evidence: The Complaints procedure is included in the home’s Statement of Purpose, it is symbolised with pictures and words. There were no Complaints received at the home since the last inspection. Corporate procedures that safeguard people from abuse include Whistle Blowing, Safeguarding Adults and Dignity, Respect and Diversity procedures. It is confirmed through the Whistle Blowing procedure that staff concerns will be taken seriously, they will not be put under pressure or suffer from adverse consequences. Also made clear through the procedure is that staff have a duty to report poor practise. Where there are allegations of abuse the Safeguarding Adults procedure is used to ensure that the actions taken by the staff safeguard people at the home from abuse. The factors of abuse are detailed within the procedure, with the actions to be taken by staff and line managers to ensure the safety of the people at the home. The Trust commitment towards developing an open and transparent culture is specified within the Dignity, Respect & Diversity. A Safeguarding referral was made at the last inspection about possible institutional Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: abuse. Since the referral the home has attended strategy review meetings and developed improvement plans to safeguard people from abuse. Staff were asked about the way people are supported to make complaints. Staff said they would advocate for people or use independent advocates to raise concerns on behalf of the person. The member of staff consulted about their responsibilities towards safeguarding people from abuse described the factors of abuse and the actions to be taken. Care Homes for Adults (18-65 years) Page 21 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. Improvements continue to be made to provide a homely and comfortable environment for people that live at the home Evidence: Hampstead Road was purpose built to accommodate people with physical and sensory impairments that have learning disabilities. The accommodation is arranged into two separate dwellings, which is linked by shared space. There are six single rooms, lounge, conservatory and kitchen/dinner in each house. Other shared space consists of a laundry and Snoozelem. It is located close to shops, places of worship, amenities and bus routes. The home is clean and free from offensive smells. A tour of the premises was conducted during the site visit and it is evident that some action was taken to maintain a comfortable and homely environment for the people that live at the home. Since the last inspection the current manager moved the office downstairs, this ensures that people at the home have more contact with the manager and their visitors. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: Aids and equipment were moved from the conservatories in each house to create a more social space and people were observed using the space. In each house there is a bathroom, shower room and toilet with six bedrooms arranged into a circle. It was noted during the tour of the premises that bathrooms are also used to store equipment and cannot be a pleasant experience for people using these facilities. Other areas that require attention include the kitchen in house 2 and the lounge carpet in house 1. While it’s acknowledged that the lounge carpet in house 1 is regularly cleaned, at the time of the inspection it was dirty. People that use their knees and hands to move around the house independently are then expected to move around in a dirty environment. This disrespects the people that move around the home in this way. We were told that the kitchen in house 2 is to be refurbished in the near future. Bedrooms are single and members of staff ensure rooms are decorated to their perception of the individual. Bedrooms have furniture and fittings that reflect their lifestyle and needs. There is a lounge in each house and there is sufficient seating for the residents in the house to sit together. The laundry is away from the kitchens and shared by both houses. The walls are painted and there is vinyl flooring for easy cleaning. There are two small washing machines with specific programmes for sluicing and tumble dryers. Care Homes for Adults (18-65 years) Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A competent staff team that have a better understanding of their roles support people at the home. Evidence: Staffs personnel records are held at the Brandon Trust office, and employment record sheets are kept at the home. Employment record sheets are held at the home and used to evidence that the manager saw Criminal Records Bureau (CRB) checks and references. A recently employed member of staff was consulted about the recruitment process. It was confirmed that an interview took place before their appointment; checks were conducted that included CRB checks and two written references. For people already employed by the Trust but seeking employment at the home undertake house induction that involves working supernumerary with existing staff. Feedback from the staff was sought about their roles and responsibilities. One member of staff said that previously duties and responsibilities were unclear I did it on a whim, I believe in good quality care. I have learnt so much since and feel I am fulfilling my Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: role. Another said that the changes are positive which are due but it was felt that the seniors are less confident and support workers are delegated more tasks. This comment was discussed with the manager who will be investigating this remark. A third support worker said that the additional responsibilities gave them greater opportunities to learn new tasks. Members of staff have attended Mental Health awareness, Food Hygiene, First Aid, Safeguarding Adults, Fire and Mental Capacity Act training. Not all staff have attended medication and Midazolam training. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager must be registered with CSCI to operate Hampstead Rd. Individuals live in a safe environment and must be re-assured that standards will be the subject of ongoing monitoring. Evidence: It is clear that the manager is experienced and qualified to manage Hampstead Rd. However, the manager is not registered. The manager was consulted about the management styles used to raise standards of care. The manager said that the Reg 26 visits from peers and external managers are used to determine the progress on the standards of care. Reg 26 visits occur monthly and the report on the conduct of the home show that standards at the home are improving. Feedback was then sought from the manager about changes necessary to improve outcomes for people at the home. The manager said that supporting staff and making Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: changes to improve the outcomes for the people at the home had been necessary. Ensuring through training that staff have the skills to meet the needs of the people at the home is a priority. Undertaking staff appraisals and separating the two houses will ensure a person centred approach is adopted and changing the focus from staff to the people living at the home will improve outcomes for the people at the home. Members of staff said that the successful split of the houses has created more stability for the people at the home, which is seen by their appetite and participation in more in-house and community activities. Another senior member of staff made positive comments about the split of both houses that has created smaller teams and enabled more contact with people. Other staff said that the changes included a strong emphasis on changing the culture of the home and improving consistency. It was stated that staff meetings were taking place regularly, support plans were being reviewed, communication was better and staff were clearer about their roles. A senior member of staff said that there has been a vast improvement from where we were to where we are. The separation of the two houses and balance between both houses has raised standards and stated ‘ I can now prove I can do my job.’ Quality Assurance was discussed with the manager, it was stated that the assessments is based on the NMS, relatives questionnaires will be sent to relatives on a quarterly basis, the questionnaires will be rolled out to include external agencies and professionals that have input into the home. From the information gathered the manager said an action plan would then be developed. The duty rota in place illustrates that the manager undertakes hands on shifts, there are two seniors and have designated houses to manage shifts in each house with ten support workers in each house. The ratio of staff is three staff in each house throughout the day. Fire risk assessments in place focus on the sources of ignition; the checks and practises that must be undertaken to reduce the potential of fire in the home. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 6 14 (2) (a) Care plans must be kept under review 30/08/2008 2 7 12 (1) (a) Records must be clear about 30/07/2008 best interest decisions made on behalf of the people at the home Attend to repairs to the property (Partially Met) 30/03/2009 3 24 23(2)(b) Care Homes for Adults (18-65 years) Page 28 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 6 13 The registered person shall, for the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practicable ascertain and take into account their wishes and feelings. Support plans must include the individuals likes, dislikes and preferred routines 30/03/2009 2 37 8 The registered provider shall 30/03/2009 appoint an individual to manage the care home where (a) there is no registered manager in respect of the care home The currnet manager must register with CSCI 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 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!