Inspection on 02/12/08 for 77 The Street

This inspection was carried out on 2nd December 2008.

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

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

Other inspections for this house

77 The Street 05/12/06

77 The Street 21/02/06

77 The Street 21/09/05

77 The Street 13/01/05

77 The Street 27/10/04

77 The Street 25/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 77 The Street 77 The Street Kilmington Warminster Wiltshire BA12 6RW two star good service The quality rating for this care home is: 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: Roy Gregory 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. They reflect the things that people have said are important to them: 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. 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: 77 The Street 77 The Street Kilmington Warminster Wiltshire BA12 6RW 01985844800 01722716029 andynosko@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ability Associates Limited care home 2 Number of places (if applicable): Under 65 Over 65 2 0 learning disability Additional conditions: Date of last inspection 0 5 1 2 2 0 0 6 A bit about the care home 77 The Street is a residential care home registered to care for two adults with a learning disability. The property is surrounded by open countryside and has no immediate neighbours. It is situated three miles north of Mere, where there is access onto the A303 trunk road from London to the West Country. The Registered Provider is Ability Associates Ltd. The Registered Manager, Andrew Nosko, also manages another small care home within the organisation, known as Dalwood Farm. Staffing and policies and procedures are shared between the two homes. The people who live at 77 The Street spend varying amounts of time at Dalwood Farm, either socialising with staff and other service users or undertaking specific tasks or activities. 77 The Street is referred to by staff and residents of both homes, as The Cottage or Dalwood Cottage. The home provides a homely cottage environment with single room accommodation on the first floor. There is a sitting room, separate dining room, small kitchen and an upstairs bathroom. A third bedroom is used for sleeping-in staff, and doubles as an office. Owing to its somewhat isolated position, and its satellite relationship to Dalwood Farm, the company provides a car for journeys as required. Normally the home provides a single member of support staff whenever people are at home. Management and senior staff are available on call from Dalwood Farm, and they also make planned and spot monitoring visits. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home We visited 77 The Street on Tuesday 2nd December 2008 during the daytime. We met both people that live in the home. People showed us around the house. One person showed us their bedroom, where we had a long chat. We saw how people got along together. In the afternoon, people were helping get their tea ready. Andrew Nosko, the manager, was away when we visited. We talked to the member of staff who was there. A manager from the company came over to show records about staff training and recruitment. Later we were able to phone the deputy manager of the service. We looked at people’s support plans and records of care. These included risk assessments, medicine records, and details of activities people had done. We could see how people kept in touch with their friends and families. We sent out some survey questionnaires. We received answers from the people who live at the home, and from someone’s relative. Four members of staff, and a doctor, also sent surveys back. What the care home does well Surveys we received showed people received the support they needed. People thought staff listened to them. People chose what to do, how to spend their money and when to go to bed. They didn’t mind helping with the jobs that had to be done in the home, like cleaning and mowing the lawn. They had time to spend on their own, in their bedrooms or in the sitting room and dining room. People regularly played sports that they chose, and they went to clubs. They went out to local places of interest and to the cinema. Both people had holidays during 2008. They also had help to visit families. People could use the house phone whenever they wanted to. The people living at the home had set up a four-week menu. They both said they always enjoyed their meals. On Saturdays they always had a take-away meal, or went out to eat. One person said the menu had all their favourite things. But if they wanted to, they could cook something different. People always helped with cooking meals or clearing away. A doctor sent a survey back. He said people were well looked after and staff were helpful. People’s records in the home showed they got help with health matters when necessary. The home was like an ordinary house. People said they liked it. They locked their own rooms so staff only went in them if they were invited. Most members of staff have worked at the home a long time. They know the people living there very well. Most of them have got qualifications. What has got better from the last inspection A lot of the home had been redecorated. There was new flooring in the kitchen. There was better recording by staff of how they gave people medicines. What the care home could do better People’s support plans showed what help they needed to live a happy life. But they did not show what people were aiming to get better at. They could also show more of what people are already good at doing for themselves and for other people. Sometimes people get upset and do things that are difficult to cope with. Afterwards they should be helped to think about what was wrong and how everyone can help deal with things. A lot of staff were out of date in training about helping people through difficult situations. This training must be provided for them soon. When people are asked what they think of the home, they should have help to fill in forms from people like care managers or college staff. That would show that the home’s staff and managers were not affecting what people said. The water in the hot taps was very hot, which was dangerous when people ran their baths. Staff should be checking how hot the water is, so if it turns too hot or too cool, it can be put right. If you want to read the full report of our inspection please ask the person in charge of the care home Mr Andrew Nosko If you want to speak to the inspector please contact Roy Gregory CSCI Regional Office 4th Floor, Colston 33 33 Colston Ave., BRISTOL BS1 4UA 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 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 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 . Based on previous evidence, the organisation has a detailed admission procedure that involves consultation with existing service users. Evidence: The home provides long-term care for two people, so assessment for vacant places is a rare occurrence. The people currently living there have done so since 2002. We have been satisfied from previous inspections of 77 The Street, and Dalwood Farm, that the organisation has a detailed admission procedure. This involves receipt of a care managers assessment and a full assessment by Andrew Nosko of the prospective residents current needs, together with details of any previous placement. The process provides for consultation with the person with whom the new resident would be sharing the home. Admission would be followed by an early review, to check the appropriateness of the placement and to finalise agreement of support plans. 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 . Peoples assessed needs are reflected in support plans, which are reviewed and changed as necessary. People are supported in making decisions about their everyday lives and being involved in the life of the home. Risks are identified, and assessed in such a way as to encourage safe participation in a range of lifestyle choices. Evidence: There were support plans in place for each person living in the home. These were kept in the office, but there was evidence that they were well known to the people they concerned. Plans included support guidelines, counter-signed by the people being supported and their external care managers. These showed how to meet individual needs. However, there was little acknowledgement of peoples strengths and abilities, and thus how to build on those. The plans would benefit from developing agreed goals with people, in such a way as to allow for evaluation of how successfully personal issues have been addressed and supported. This in turn would give focus to annual reviews, and to key workers monthly reports. These gave a good overview of the lives people were living, but unrelated to clear person-centred aims. A person living in the home told us of many things they felt they had achieved as a result of the support they got from the service. However, these achievements were not well documented, and the person saw their future planning as more to do with their care manager than the home. A further issue to consider is how support plans are presented. The same person had pointed out to their care manager that, although they had signed their support plan when it was drawn up, they were not actually able to read it. However, they told us they felt involved in their care plan and the related recording. They described their key workers role as someone who ensured things run Evidence: smoothly and get done. The key workers monthly reports were sent to the persons family, by agreement. Within the home, we saw, and people told us, that people living there could use facilities as they chose. For example, the kitchen was available all day and people had a bath when they chose. One person liked using the shared sitting room, whereas the other preferred the privacy of their bedroom most of the time. They valued it as my space. People chose what to do, how to spend their money and when to go to bed. People were at ease with the need to participate in basic routines, such as meal preparation and clearing away, since most of the time there were just the two people living in the home together with one member of staff. However, this small-scale nature of the service also meant that people had to accept doing some activities either together, or not at all, so that each could be supported by the member of staff on duty. There was also some compromise of self-determination because of the satellite nature of the home, in relation to Dalwood Farm. Day activities were centred on Dalwood Farm, and staff began and finished their working shifts there, which meant people had to travel to and from there with staff to enable staff handovers to take place. It might not always be a persons choice to make the journey, for example if unwell or in severe weather. One person said that after work, they could find themselves hanging around at Dalwood Farm when they just wanted to get home. People had several opportunities to take risks in their daily living, for example making hot drinks, cooking and using garden machinery. A number of risk assessments demonstrated how risk-taking was encouraged safely. One persons placement at the home was related in part to management of a preferred activity, which had potential for self-harm. The related risk assessment was comprehensive, well known to staff, and reviewed regularly. Whilst the person concerned experienced the control aspects as restrictive, it was clear they and their care manager were fully involved in how and why these were in place. Surveys we received from people and their supporters showed people considered they received the support they needed and staff listened to them. 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 . Varied activities give people opportunities to maintain leisure interests, to develop skills and to access the community. Relationships with families and friends are encouraged. People participate in everyday tasks and their rights are respected. A healthy diet is offered, and mealtimes are conducted as people wish. Evidence: Things in the home generally, and in peoples bedrooms, reflected the age, gender and interests of the people living there. Allowing for the transport between the home and Dalwood Farm, the organisation of every day life provided a good balance between household routines, personal enjoyment of time, special events and accessing the community. People regularly played sports of their choice and they attended two social clubs. A person told us they liked the amount they went out to planned and spontaneous places. People living at the home confirmed their direct involvement in setting up a four-week menu, which incorporated advice about healthy eating. Both indicated in survey returns that they always enjoyed their meals. The menu showed a wide range of substantial and nutritious meals, albeit with reliance on the freezer. People took it in turns to help prepare meals, and they were involved in trips for food shopping. On Saturdays they always had a take-away meal, or went out to eat. One person said the menu included all their favourite things, and additionally they could cook an alternative to the menu anyway. Evidence: One of the people living at the home had four days of work per week with two employers. The other attended a college course, and was otherwise occupied at home or at Dalwood Farm, where they had established relationships with residents and staff. One day a week tended to be a rest and catching-up day at home, whilst at weekends there were opportunities to go out and about with staff support. Records showed people went to local places of interest and used various leisure resources. A member of staff said that as far as possible, essential journeys to Dalwood Farm were tied in with getting people to where else they needed to go for their activity and community access needs. Sometimes one person would join activities at Dalwood Farm, which enabled the other to benefit from one-to-one staff support elsewhere. A member of staff commented that whenever one person was away from the home, there were definite advantages for the other in having one-to-one staff support always available. For holidays, arrangements were made for people to stay at holiday centres. One person preferred to go with others from Dalwood Farm, whereas the other benefited from going away just with one member of staff. Both residents had holidays during 2008. People also had practical support to visit or go away with families. They were able to maintain telephone contact with family members and community resources, including care managers, as they wished, taking the house telephone into their rooms for privacy. Records showed how one person had been supported to maintain a girlfriend relationship. Privacy of bedrooms was given a high priority in the home. People locked their rooms and staff entered only by invitation. Whilst staff prompted conversation and activity, the emphasis was on people directing their own time and choosing how to use resources, including staff availability. Daily records and conversation with one person in the home confirmed that people lived a full and active life. The home provided a car, which was essential because of the homes isolated location. 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 home provides personal and health support in line with peoples preferences and needs. People are protected by the homes policies and procedures for the safe handling of medication. Evidence: People currently living at the home did not require direct support to personal care. Health care needs were described appropriately in support plans, and appointments were tracked and monitored. One person had some long-term medical conditions, which they preferred to manage on their own. This meant staff were reliant on the persons feedback about doctor and nurse appointments they had attended, although the person had agreed to staff accompaniment at one such appointment. Useful information about the persons conditions was readily available to staff in the office. It was disturbing to note from records, however, that a member of staff had helped the person to obtain cigarettes at a time when they were attempting to avoid smoking, for medical reasons. The deputy manager confirmed this poor judgement had been taken up with the staff member concerned. This provided an example of a care need, where an agreed goal-oriented support plan could have been a powerful and positive tool in guiding both the person supported, and the staff. There was good evidence of liaison between the home and health professionals, such as GPs and a continence nurse. In our survey, both people living in the home indicated that they always receive the care and support and medical support they needed. A GP expressed satisfaction with the overall care provided to people and added, Staff are always helpful and respectful of the residents. Guidance in support plans included advice on responding to undesirable behaviours. Staff were required to detail in writing, exactly how any incidents arose, how they Evidence: responded and how the incident was resolved. Care managers had assisted in devising agreed intervention plans. We made a requirement at the previous inspection that following any incident of challenging behaviour, discussion must take place with the staff team regarding their actions, so that behaviours that challenge are not exacerbated. There had been few such incidents within the home since that time. Staff spoke of contact with senior staff at the end of a shift for the purpose of debriefing, or at any stage by telephone if a situation was seen as urgent. In all instances, it would seem desirable to also offer a debrief to the person who has presented the behaviour, in order to enhance understanding of how incidents arise and what works to resolve and learn from them. An addition to the incident recording form could show how management of any incident has been completed in this way. A person living in the home thought management tended to take the staff side in how events were looked at. Such a view underlines the need for the service to be able to show how the people being cared for are involved in understanding and addressing any difficulties they present to others. There was not a great deal of medication use in the home. There were good arrangements for storing and administering medications, which the supplying pharmacy provided in a monitored dosage system. Support workers received training in working with that system, whilst the deputy manager was trained to a higher level in handling medication. Records of administration of medicines were good, indicating that the service had met our requirement from the previous inspection that the recording of administration of medicines needed to be improved. There was written GP approval for a list of homely medicines that might be used, for example, cold treatments. The possibilities of self-medication had been assessed for each of the people living in the home. 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 . There are appropriate procedures, including staff training, to protect people from harm, and to receive and act on complaints, but not all incidents have been notified to the Commission. Evidence: There was a complaints book in the office, but it was unused and the member of staff said it was only there for show really. More useful were complaints forms kept in residents files, which could be asked for at any time and completed in order to bring a complaint within the scope of the company complaints procedure. Information for people in the service, and their supporters, included details of how to contact CSCI. There was evidence that contact between people and their care managers was facilitated, and that people were given opportunities to meet privately with any external professionals of their choice. No complaints had been received since the previous inspection. A person resident at the home said they felt staff supported them through any difficulties they encountered. They found it easy to gain access to Andrew Nosko, and to their care manager. Staff received abuse awareness training from Andrew Nosko. The No Secrets abbreviated guide to local inter-agency safeguarding procedures was kept to hand in the office. A person in the home told us they felt safe living there. A very few incidents had been recorded during the preceding year. One of these concerned a person who went missing for a while, and the police were involved. An action decided on to prevent recurrence was to refer the person for psychological inputs. However, there were no records to evaluate progress of the homes action plan. We verified with the psychologist that a referral had been made, but it resulted only in placement on a waiting list. The deputy manager subsequently said there would be a fuller record of events, at Dalwood Farm. However, staff on duty at 77 The Street, and visitors there, need to have full information available. There was clear recording of all staff involvement with residents monies, including regular checks on actual balances held. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People have a sense of ownership of their home environment. It is homely, well maintained and kept clean to a good standard. Evidence: The accommodation presented extremely well. There had been considerable redecoration over the preceding year, including replacing the kitchen floor, as recommended at the previous inspection. Furnishings and soft furnishings were homely in character and suited the current residents. Maintenance records showed that when staff reported any environmental shortfalls, they were attended to promptly. The people living at the home were involved in cleaning shared and private rooms, with staff support as necessary, on an as needed basis, rather than with any fixed rota. Manager visits incorporated monitoring of environmental standards. As staff shared the bathroom and kitchen facilities with residents, it was in everyones interests to uphold good standards of cleaning. There was evidence that people enjoyed playing their part in household and garden maintenance tasks. People chose to keep their bedrooms locked when they were not in them. One person preferred not to show their personal room. The other person showed they had personalised their room as they wished, to create a very individual bed-sitting room, with audio-visual equipment that they made full use of. They had decorated their room ready for Christmas, and said they planned to decorate the sitting room the following weekend. People said they liked the house. 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 . People are supported by competent whose work is regularly supervised. Recruitment practices ensure people are protected from being cared for by unsuitable staff. Staff training is mostly well provided for, but there are shortfalls in training for staff to work with people whose behaviours may present challenges. Evidence: The ten residential staff employed by the company spend duty time at both this home, and Dalwood Farm. Two members of staff are respectively key workers to each of the people resident at the home, and they tend to spend a greater proportion of their working time at 77 The Street, which aids continuity of care. The staff team includes a deputy manager and a senior support worker, who work opposite shifts in order to maximise availability of senior staff to each shift. A shift includes one member of staff working at 77 The Street. Staff cover there includes sleep-in cover at night. In the absence of a senior member of staff on a shift, one person is designated a shift leader. Staff at 77 The Street keep in contact with their shift by telephone, and by staff handovers at the beginning and end of a shift, hence the necessity to drive to and from Dalwood Farm with the people who live in the home, at those times. People living at the home are familiar with the entire staff group, and so they experience consistent relationships with them, whether at Dalwood Farm or at home. The company benefits from a very stable staff group. It was decided that an additional part-time support worker would enable greater flexibility to the staff rota. Recruitment records for that person showed that all necessary checks were undertaken before confirming appointment. People using the service were not directly involved in the recruitment or selection process, but opportunities were created to observe candidates with people using the service at Dalwood Farm. A benefit of low turnover of staff is that most staff have attained National Vocational Qualifications (NVQ) level 2 in care, which is regarded by the company as the absolute Evidence: minimum expected; people are encouraged to go on to level 3. Staff maintain skills and awareness by revisiting mandatory and other training. Train to Gain was used as a training resource. A training spreadsheet showed there was ongoing availability of training, which several staff mentioned in surveys as a particular strength of the service. However, we identified that a number of staff were out of date in their training in working with behaviours that may challenge. Some staff had not updated this aspect of their training since 2003, so this must be a priority.Staff received visits from the manager and deputy manager at the home, for monitoring and supervision. The member of staff on duty told us they valued supervision, which they received formally every two months. 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 . Management provides leadership and direction so people benefit from a well run home. Quality assurance systems include obtaining the views of people living in the home, and their supporters, to monitor and improve the service. There are systems in place to identify and promote the health and safety needs of residents and staff, but these have not been used sufficiently to ensure safety of provision of hot water. Evidence: Andrew Nosko is the Registered Manager of both 77 The Street and Dalwood Farm. He has obtained the NVQ in care to level 4, as has the deputy manager, and also the Registered Managers Award. Mr Nosko supplied a detailed AQAA (Annual Quality Assurance Assessment) when asked to do so. The office in the home, which doubles as a sleep-in room, was well organised and had clear guidance to staff about routine duties and responses to events. Staff meetings took place approximately three-monthly, at Dalwood Farm. A member of staff commented in a survey questionnaire that they would like more staff meetings, but that they are difficult to organise due to the high levels of support and different activities carried out with residents. Given the isolated nature of work at 77 The Street, it would be helpful for staff to have copies of the latest team meeting minutes there. For quality assurance, the registered manager and deputy made unannounced visits to the home for monitoring purposes. Feedback forms were used to obtain the views of relatives and professionals involved with people living in the home. There was also a client validation form, for people being supported to give formalised feedback. Most people benefit from support to complete such forms. Therefore it would be preferable Evidence: that such assistance was obtained from outside the organisation, for example, from care managers, tutors or employers, to show they were completed independently of the provider company. A member of staff said house meetings had been tried with the people living in the home, but had been unproductive. Such a format would seem cumbersome, given the small-scale nature of provision and daily exchange of opinion and ideas at meal times and generally. Visiting senior staff, including Mr Nosko, make a point of interacting with the people in the home. Health and safety of residents and staff were well provided for by way of reviewed risk assessments. However, monitoring of hot water temperatures, as recommended at the previous inspection, had ceased. It appeared at this inspection that the outlet temperature was excessive. This was significant, as both people currently living at the home were accustomed to running their own baths unsupported. The member of staff on duty located the immersion heater thermostat and reduced the setting from 60 to 50 degrees C. The deputy manager has undertaken to ensure written monitoring is restarted, so that management can keep the safety of hot water provision under review. We are making this action a legal requirement. Are there any outstanding requirements from the last inspection? Yes  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 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 Description 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 Description Timescale for action 1 35 18 The registered person must make arrangements to ensure support staff receive training appropriate to the work they perform. 31/03/2009 Support staff are required to work with people whose behaviours can pose challenges. They must receive current, validated training related to this aspect of their work, to provide for transparency and safety in how they address incidents that arise. This training must be maintained by regular updating. 2 42 13 The registered person must ensure that unnecessary risks to peoples health and safety are identified and as far as possible eliminated. 30/01/2009 There is provision in the home for monitoring hot water outlet temperatures, as previously recommended. This process must be adhered to, so that unsafe temperatures can be identified and addressed, to avoid the risk of scald injuries. 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 6 Make sure personal plans show a balance of peoples abilities and needs. Aims should be set that lend themselves to evaluation, and recognition of achievements. Extend the documentation of behaviour management incidents to show how the person presenting the behaviour has been enabled to contribute to understanding its origins and meaning. Use this process to assist staff to consider the efffectiveness of their interventions. Full details of incidents, how they have been handled, and follow-up actions, should be kept in the home so that people supported, staff and visiting professionals can refer to accurate information as needed. Identify people outside the service who can support individuals living in the home to give feedback to the company, and to the inspection process, by way of questionnaires or other means. 2 18 3 23 4 39 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. 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