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Inspection on 17/03/09 for 88 Walliscote Road

Also see our care home review for 88 Walliscote Road for more information

This inspection was carried out on 17th March 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 88 Walliscote Road 88 Walliscote Road Weston Super Mare North Somerset BS23 1EE one star adequate 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: Sandra Jones Date: 1 8 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. 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 © (20092008) 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.cqc.org.uk Internet address Information about the care home Name of care home: Address: 88 Walliscote Road 88 Walliscote Road Weston Super Mare North Somerset BS23 1EE 01934418465 01179699000 jean.southerton@brandontrust.org www.brandontrust.org The Brandon Trust care home 12 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) : Number of places (if applicable): Under 65 Over 65 12 0 learning 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 only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) A bit about the care home 88 Walliscote Road is a care home for older people with a learning disability. The residents have been resettled from long stay hospitals; some of them have communication difficulties and may exhibit challenging behaviour. The service has a flat for supported living. 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 & Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct and Management of the Home Poor Adequate Good Excellent How we did our inspection: This is what the inspector did when they were at the care home This key inspection was conducted unannounced over two days in March 2009 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 last inspection and this information was used to plan the inspection visit. This included the Annual Quality Assurance Assessment (AQAA) and notifications from the home. The home can accommodate up to t eight people and four individuals 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 homes policies and procedures were also used to confirm the findings. Face to face discussion occurred with the manager, one person and four members of staff. What the care home does well What has got better from the last inspection. What the care home could do better There are eight requirements arising from this inspection and are based on care planning with associated risk assessments, repecting the rights of people at the home and staff training. The Statement of Purpose must be updated to include the admission criteria, the range of needs that can be met and to include the Privacy and Dignity policy. This will ensure that the people wishing to live at the home can make informed decisions about moving into the home. A person centred approach where the individuals likes, dislikes and prefferred routines are incorporated into their care plans must be developed to empower people to have a say about the way their care is to be delivered. The risk assessment for individuals that have restricions imposed must be developed to specify the triggers and signs, to then implement the action plan to divert behaviours, which may require that as a last resort restrictions are imposed. For individuals that exhibit aggressive and violent behaviours, a person centred approach must be used and advice sought from health and social care professionals, so their care can be consistent and individualised. The furniture of one individual must not be placed in anothers bedroom, this respects both individuals. The manager must make arrangements to view staff files and documentation to be kept at the home must be completed to show that a robust recruitment process is followed. The manager must ensure that staff at the home attend training that meets the needs of people with autism and behaviours that challenge. This will ensure that staffs awareness is raised and increase their skills to meet the range of needs of the people accommodated at the home. The manager must ensure that two bedrooms are redecorated and remedial action is taken to repair the carpet and the seal in the downstairs toilet. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact: Sandra Jones 33 Colston 33 Colston Avenue Bristol BS1 4UA 0117 930 7110 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.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. The home has an effective process for people to make decisions about moving into the home. Evidence: The AQAA says that we provide a homely environment, assessments are completed with the service user prior to admission by staff trained to be skilled and sensitive to a persons needs, information is collected from all relevant personnel, all service users/guardians receive a contract which is open to regular reviews as circumstances change. The organisations mission statement is included in the homes Statement of Purpose, which is enabling people to live the lives they choose. The manager said that the Statement of Purpose is updated annually to ensure that people wishing to live at the home have up to date information. It was stated that the age range of people accommodated is between 43-77 years. The Privacy and Dignity policy must be included to ensure that people wishing to live at the home are aware that about the way their rights will be respected at the home. One vacancy currently exists and the admission procedure is described within the Statement of Purpose. This is to ensure that the person wishing to live at the home are compatible with the other people living at the home and that the staff have the skills to meet the needs. Introductory visits and trial periods are part of the admission process and will establish that the person is compatible with both parties and satisfies the manager that the assessed needs can be met at the home. However, the criteria for admissions are not clearly listed. Evidence: The criteria for admission must be specified so that people wishing to live at the home can be reassured about the staffs abilities to meet their identified needs. The most recent admission to the home occurred in 2004 and the social workers needs assessments and minutes of reviews confirms that before admission an assessment was conducted to determine that the staff can meet the needs of the person. 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. For individuals to achieve independent lifestyles a person centred approach must be used and advice sought for people that challenge the service so their care can be consistent and individualised. Evidence: The AQAA says regular meetings with service users and other professionals involved in their care with consent and the service users have the opportunity to put forward their views. Risks within care are noted, assessed and recorded, create opportunities for service users to increase their independence regular service user meetings where the running of the house is discussed and any suggestions taken forward. The manager said that reviews are convened by the Local Authority annually with the people at the home, their relatives where appropriate and staff at the home. From the review meeting, care plans are updated and a person centred approach is being adopted. The manager said that two staff are attended the training to develop person centred plans for those people that want this pathway to be used. We were also told Evidence: that some staff have attended person centred thinking to incorporate the individuals likes, dislikes and preferred routines into their care plan. However, person centred planning and person centred thinking have not meshed and there is little evidence that people have a say about the way their care is to be delivered. Planning for Life files are held in the upstairs office and contain review meetings, social workers needs assessment. Care plans and associated risk assessments are more accessible to staff and those individuals that regularly read their care plans. Four people were case tracked during the inspection visit and the decisions to case track these individuals was based on their diagnosis, their gender and specific needs. This included people with autism, communication need, health care need and male or female. Review minutes in place for these individuals show that their relatives and where appropriate external agencies attended the meeting. Where there are changes, the named person responsible for achieving the tasks is listed in the review minutes action plan and where it is the responsibility of the staff at the home, the homes care plan is amended. Members of staff told us that they have input into the care planning process and following review meetings, with the person they keyworker will update the care plan. One person giving feedback confirmed that they have access and can read their care plan. Care plans have a recent photograph, with a pen portrait that informs the reader about the person, their needs, preferred mode of address and their likes. Care plans are written in a simple format and large print to ensure they can be understood by the people for whom its intended. They are sectioned into daily living routines, personal care, mental health and emotional needs, with day care participation, family and friends included. The individuals needs is listed in the appropriate section of the care plan and described is the action plan to meet the need. While the care plan is dated, the signature of the person to show agreement with the plan of action is not included. The care plan of individuals with communication needs were examined and the gestures and verbal cues are used to communicate are described in the care plan. Staff are instructed to avoid anxiety provoking situations. Action plans must be more detailed about the way staff must avoid these situations. Also, for individuals to achieve independent lifestyles a person centred approach must be used and advice sought for people that challenge the service so their care can be consistent and individualised. It is evident from the care plans examined that there are restrictions placed on individuals. While the action may be appropriate, there is little evidence that the person was part of the decision-making. We were told by the staff that the restriction imposed are to modify behaviours exhibited. However, this restriction is only successful with the person and not with the property of other people. The risk assessment is in place to show that the person has some control. The risk assessment must be developed to specify the triggers and signs to then implement the action plan to divert behaviours, which may require as a last resort for restrictions to be imposed. Evidence: Risk assessments are in place for activities that may involve an element of risk. The options and effects that can be taken to reduce the levels risk identified are listed and the action plan that must be followed to ensure risks can be taken safely. Risk assessments must be reviewed to ensure that the actions to be taken do not prevent people from taking risk and for people that at times exhibit behaviours that challenge the service, staff are guided to diffuse or divert these behaviours. It is evident that there are strict framework for some individuals and advice must be sought from external agencies to ensure these measures are appropriate and follow current good practice guidelines. One person has very specific environmental needs and the actions taken by the staff to meet the need are not documented. It transpired during the tour of the property that one individuals clothing is kept in the occupied room next door to meet the need. This is unacceptable and disrespectful to both people involved. The manager must therefore undertake a risk assessment to meet the persons environmental need. The home has people that at times exhibits aggressive and violent behaviours and can self harm. Care plans in place describe the triggers and signs of agitation with an action plan to guide the staff on providing an atmosphere that will prevent an escalation of these behaviours. However, risk assessments provide little evidence that external agencies were involved. Risk assessments must support the advice sought to prevent the person harming themselves, others or property. Behaviour charts are in plans for two people that at times exhibit aggressive and violent behaviours. Reports are detailed about behaviours exhibited but the actions taken by the staff to diffuse the behaviour are not included. Members of staff must report the actions taken to support that they consistently follow the care plan and where appropriate amend the care plan to ensure potential aggressive and violent behaviours are diffused and diverted. Staff told us that there are two people that exhibit aggressive and violent behaviours and they acknowledged that they are inconsistent in their approach. It is also evident from the discussion that they are at times anxious about the level of aggression that can be exhibited when they are working on 1:1. Daily reports are completed by the staff and they include observations of the person, behaviours exhibited and outcomes of visits. 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. Support systems in place ensure individuals can maintain appropriate and fulfilling lives in and out the home. Evidence: The Annual Quality Assurance Assessment completed by the manager says that people lifestyles are met by promoting individual rights to live a purposeful life and treating all service users as individuals in a respectful and dignified manner. All assistance given is discrete and sensitive. Cultural needs are catered for and service users are given choices. The individuals involvement in day care service, employment and activities form part of their care plan. Each person has an activity log where staff record the type of activity and the level of enjoyment which is signed by the person facilitating the activity. Records show that people attend day care centres, go on outings, shopping, visit family and undertake in-house activities. One person giving feedback explained their community based activities and stated that some individuals are able to leave the property without staff support. Four staff on duty agreed to give feedback about the support they provide for people to undertake meaningful activities. We were told that the staff team is planning to provide arts and crafts and music sessions. Arometherapy will be provided two weekly with additional entertainment from external entertainers. Evidence: Feedback from staff was also sought about the way people are supported to be part of the community. It was stated that staff are assisting people to use public transport independently and local shops are used so that people living at the home can be recognised in the local community. The people at the home celebrate festivals and invite neighbours and people that live in Trust homes within the vicinity to their BBQ and parties. On the day of the inspection, the staff were preparing for a BBQ and people said that BBQ and parties were common and people comments from people was that these events are well attended. The Service User Guide and Statement of Purpose specify the arrangements for visiting at the home. The procedures in place show that the staff, recognise the importance of maintaining links with family and friends. For this reason visiting is open and can take place in bedrooms for additional privacy. The Privacy and Dignity policy is not currently appended onto the Statement of Purpose. The policy must be included to inform people wishing to live at the home about the way their rights will be respected. It is stated in the Service User Guide that accommodation is single and lockable with separate lockable space, which the person can personalise. Rules about smoking exist, a shelter is provided in the garden for people that smoke. Feedback about the way staff respect them was sought from one person. This person said that staff provide discreet personal care, they knock on the door before entering and they are addressed by their preferred mode. Staff were consulted about the way people at the home are respected as individuals. Staff said that 1:1 time and giving people the opportunity to make choices ensures people are respected. The manager told us that ancillary staff, are employed and where people participate in independent living skills training, the expectation is that people put the training into practice. Each person has a designated day each week for independence living skills, which are known as home days. People on home days generally tidy their bedrooms, do their laundry, vacuum and shop for personal toiletries. The manager also said that one person is more independent and the expectation is that this person undertakes household chores. Comments were sought from staff about the arrangements for meals. A member of staff said that menus are accessible in picture format and in future the daily menu will be on display to ensure that the people for whom its intended can understand them. It was also stated that during residents meeting, menus were prepared by the people at the home. Meals form part of the care plan and stated is the preferred size of meals, their dislikes. Evidence: The menus in place show that people have a continental style breakfast, cooked lunch and a light tea and the range of fresh, frozen and tinned food confirms that people have a varied diet. A record of meals not included in the menus and cooked meats is kept. The Environmental Health Agency visited and awarded the home Two Star. 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 can expect sensitive and prompt support for their health care needs. However, personal care is not always provided in private. Medication systems are safe. Evidence: The Annual Quality Assurance Assessment completed by the manager says that the Statement of Purpose sets out the competences and specialist service the home offers and delivers through skilled staff. Individual care plans record service users personal and healthcare needs and detail how they will be delivered. Staff are sensitive to given situations when delivering care which is conducted in private and at a time and pace directed by the service user. The individuals ability with personal care and the support needed from the staff to meet the identified need. Daily routines included specify the preferred times for personal care along with the times for rising and retiring. It transpired during consultation with the staff that bathroom doors are left open for some individuals that have epilepsy. This practice is not appropriate and risk assessments must be completed to ensure that the level of risk demands this action. Initial health assessments are in place for people at the home and include their personal details, medical history and medication. Personal health profiles are also in place and relate to past medical history, medical support and health checks. It is evident that people at the home have access to NHS facilities and, regular visits are arranged for people to visit the dentist, optician and chiropodist. Evidence: Documentation from health care professionals show that people have input from physiotherapists and psychologists through the Community Learning Disabilities Team (CLDT), are registered with a GP. One person told us that staff accompany people on health care appointments. Outcome of health care appointments along with the purpose of the visit and advice given is recorded. Staff told us that handovers, communication book and health care notes ensure that medical advice is followed at the home. Medications are administered through a monitored dosage system and with the exception of one, the staff administer medication to the people at the home. The records of administration were signed after medications are administered and codes are used to record the reasons for not administering the medication. Protocols are in place for people that have when required medications which describe the purpose of the medication and side effect. We were told by the manager and support workers that CLDT review the guidelines to ensure the staff administer medications consistently. A record of medications no longer required is maintained and signed by the pharmacist to indicate receipt of the medication for disposal. Homely remedies are not kept at 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. The home responds to complaints and ensures people at the home safeguarded from abuse Evidence: The Annual Quality Assurance Assessment completed by the manager says that service users are made aware of complaints procedure, policies and procedures are reviewed and update all service users are given a copy of the complaints procedure. The Complaints procedure is described in the Statement of Purpose and Service User Guide and copies held in the individuals Person Centred file. The manager said that copies were originally held in bedrooms but they got lost so they are now kept in their files. For people to have access to the procedure, they must be more available. The most recent recorded complaint was from a relative about the appearance of their family member living at the home. While the relative was given an explanation, the level of satisfaction was not recorded. The level of complaint will show that the procedure is followed for complainants with unresolved complaints. One person giving feedback said that the manager would be approached with complaints and felt safe at the home. The manager said that during induction staff attend Safeguarding Adults training and to maintain staffs awareness of the factors of abuse, refresher training is being provided. Staff will be attending Mental Capacity Act and Deprivation of Liberty, Equalities and Diversity. There are no Safeguarding Adults referrals pending. Members of staff confirmed that they had attended Safeguarding Adults training and were clear about the factors of abuse and the actions to be taken. 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. For people to benefit from living in a homely enviroment, remedial action is necessary. Evidence: The AQAA says provide a home that is homely, clean, tidy, safe, comfortable well maintained. The home is situated in a residential area and blends well with its local environment, it is close to shops and bus routes. Arranged over three floors, with single bedrooms on all floors and communal space on the ground floors. Communal space consists of two large lounges and a spacious dining room for the people at the home to undertake shared activities or for private use. A tour of the homes premises took place during the inspection and the home is accessible for people to move around independently. The premises were generally bright and cheerful and free from offensive odours throughout. However, two bedrooms are in need of redecoration, the carpet in the foyer is rippled and requires attention. There is some damp in the dining room and the seal in a downstairs toilet needs attention. The premises were sufficiently warm and had a reasonable access to heat, light and ventilation. The bedrooms are single and lockable with the fixtures and fittings that meet National Minimum Standards. There is a self contained flat on the third floor for one person that is more independant and provides a bedroom, bathroom and sitting room. While bedrooms are generally pleasant, two rooms are in need of redecoration. 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. It is not clear that staff employed at the home are suitable to work with vulnerable adults. People at the home do not benefit from staff that are skilled to meet their changing needs. Evidence: The Annual Quality Assurance Assessment prepared by the manager says that a rota that meets the needs of the home and service users is prepared, follow policies and procedures for recruitment i.e. interviewing is based on identified criteria, clearly defined job descriptions and specifications only filling posts with the right people and interviews involve the service users. Panel aware of equality and diversity. Diverse staff team utilizing various skills knowledge and experience while understanding the needs of individuals. Delivering effective personal care. Training is ongoing both internal and external all staff support each other sharing skills and knowledge. Equality and diversity training is also a statutory requirement within the organisation. Members of staff personnel records are held at the Brandon Trust office, and employment record sheets to support recruitment details kept at the home. These record sheets are used to evidence that the manager saw Criminal Records Bureau (CRB) checks and references. While personal details were listed in the employment record sheets, there was no evidence for eight staff that the manager had seen their CRB disclosures or references. The manager must make arrangements to view staff files and documentation in place must be completed to show that a robust recruitment process is in place. The manager said that since the last inspection staff have attended Assistive Technology, Person Centred thinking, Understanding Autism, Equalities and Diversity, Mental Health and Learning Disabilities training. We were also told that there is a programme of mandatory training that includes Moving and Handling, First Aid, Safeguarding Adults, Food Hygiene and Fire Safety. In terms of ensuring that staff put Evidence: into practice training, which then ensures that current good practices is followed, the manager said that at house meeting staff discuss training attended. The training records of the staff were examined and it is evident that staff are encouraged to undertake vocational qualifications. Eight staff have NVQ level 2 and above. However, not all staff have attended specific training that meets the needs of the people at the home. While it is acknowledged that staff are encouraged to undertake vocational qualifications and attend mandatory training, specific training for staff to meet the needs of the people at the home is not provided. For example there are people that exhibit aggressive and violent behaviours and have a diagnosis of Autism. The records examined show that two staff have attended Understanding Autism and training to equip the staff with the skills to meet behaviours that challenge the service has not been provided. Members of staff explained the new TRENT system where staff have access to the Brandon Trust training website. We were told that staff can then select the appropriate training independently. Regarding supervision staff said that supervision is individual and occurs regularly. One person giving feedback about the staff said I get on well with the staff. 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 care delivered to the people at the home is inconsistent and they cannot be reassured that the staffing levels will allow the standards of care to improve. Evidence: The Annual Quality Assurance Assessment completed by the manager says that the management of the home is achieved through awareness of policies and procedures understanding current legislation, leading by example and demonstrating good practises, is imaginative giving regular effective support, follows organisational strategic and financial planning, demonstrates effective budgeting utilises quality audit and addresss issues. The manager explained that as a result of the Trusts re-structuring, senior support staff will be taking on the day to day running of the home, with a locality manager having control over a number of care homes. From discussion with the staff there is little clarity with the expectations of their new roles. Staff giving feedback acknowledged that there are inconsistencies in the way they work, accept that there must be changes and look forward to more consistent ways of working. The Trust operates their own Quality Assurance system. However, an action plan has not been developed because of the impending changes with restructuring. Facilities for the safekeeping of cash and valuable exist and the sample records checked and show safehandling of the individuals finances. Records were consistent with the balances held and receipts support purchases made on behalf of the people at the home. Evidence: A Fire Authority visit took place in August 2008 and the report draws attention to the Trust significant findings. Fire risk assessments are in place. The boiler was replaced and we were told is under guarantee. A contractor last checked portable electrical equipment in October 2008. The rota in place shows that between three to four staff are rostered in the morning and in the afternoon the staffing levels are between three and two staff. At night there is one member of staff awake and one asleep in the premises. Ancillary staff for cooking and cleaning are employed at the home. There will be 150 hours to be covered which raises concern about the way consistency will be provided at the home. 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 1 24 23 2 b The inspector requires the Brandon Trust make good the damage to the fabric of the ceiling in the dinning area adjacent to the pillar. 30/09/2007 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 1 6 The Statement of Purpose must be kept under review. This ensure that people at the home have up to date information. 16/06/2009 The Statement of Purpose must be updated to include the admission criteria, the range of needs that can be met and to include the Privacy and Dignity policy 2 6 12 16/07/2009 The registered manager must ensure that the wishes and feelings of the people at the home are taken into account. A person centred approach where the individuals likes, dislikes and prefferred routines are incorporated into their care plans must be developed to empower people to have a say about 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 the way their care is to be delivered. 3 7 17 The manager must develop a 16/07/2009 record of the individuals communication needs with the way the person makes decisions. For individuals to achieve independent lifestyles a person centred approach must be used and advice sought for people that challenge the service so their care can be consistent and individualised. 4 9 12 The manager must ensure that the privacy and dignity of people at the home is respected. 24/04/2009 The furniture of one individual must not be placed in anothers bedroom. 5 9 13 Risk assessments must be developed for people that at times exhibit aggressive, violent and inappropriate behaviours. 27/05/2009 For individuals that exhibit aggressive and violent behaviours, a person centred approach must be used and advice sought from health and social care professionals, so their care can be 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 consistent and individualised. 6 9 17 The manager must ensure that a record of any limitations imposed is maintained which must be agreed by the person. 15/05/2009 The risk assessment for individuals that have restricions imposed must be developed to specify the triggers and signs, to then implement the action plan to divert behaviours, which may require that as a last resort restrictions are imposed. 7 24 23 The registered manager must ensure the home is kept in a good state of repair. 16/06/2009 The manager must ensure that two bedrooms are redecorated and remedial action is taken to repair the carpet and the seal in the downstairs toilet. 8 34 19 The manager must ensure that the staff employed at the home are suitable to work with vulnerable adults. 16/05/2009 The manager must make arrangements to view staff files and documentation in place must be completed to show that a robust 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 recruitment process is followed. 9 35 18 The manager must ensure that the staff employed at the home are trained to the work they are to perform. 16/08/2009 The manager must ensure that staff at the home attend training that meets the needs of people with autism and behaviours that challenge. This will ensure that staffs awareness is raised and increase their skills to meet the range of needs of the people accommodated at the home. 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 22 The people at the home should have meaningful access to the complaints procedure. 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