Inspection on 07/05/08 for Adams House

This inspection was carried out on 7th May 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Adams House Willowbridge Lane Sutton in Ashfield Nottinghamshire NG17 1DS Lead Inspector Jayne Hilton Unannounced Inspection 7th May 2008 11:30 Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Adams House Address Willowbridge Lane Sutton in Ashfield Nottinghamshire NG17 1DS 01623 559009 01623 443709 clare.lawrence@qualitycare-em.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Quality Care (EM) Ltd Clare Louise Lawrence Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home fall within the following category: Learning Disability - Code LD The maximum number of service users who can be accommodated is: 10 This is a new service 2. Date of last inspection Brief Description of the Service: Adams House is a detached building providing three units of accommodation for ten people aged between 18 and 65 years with an Autism Spectrum Disorder, Learning Disability or associated Challenging Behaviour. Rufford has 5 bedrooms Clumber has 3 bedrooms and Sherwood 2 bedrooms. There is a passenger lift for people with mobility difficulties to access the first floor. Placements are offered on a 3 – 5 year basis during which time individual needs are continually assessed in conjunction with an integrated programme of learning, designed to encourage the development of life skills and coping strategies for day-to-day living. Further support solutions for individuals are offered at the end of the placement. The home is situated close to Sutton town centre, bus routes and local shops and public facilities. The home may admit Young People aged 16-17 years in certain circumstances. There are no persons under the age of 18 years currently residing in the home. At the time of this inspection five service users are in residence. Fees charged at a basic rate of between £ 1,350-£ 1,400 a week Additional one to one staffing hours are charged in addition which ranges between £10-£15 and hour depending on the contract arrangements. Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people living in the home and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This inspection took place over 6 daytime hours and was conducted unannounced. The main method of inspection used was called ‘case tracking.’ This involves selecting two people and looking at the quality of the care they receive by talking to them, examining their care files and discussing how support is offered to them by staff members. Many of the people who live at this home have a very limited ability to understand and communicate. Therefore many judgements in this report are from observation and reading individuals’ records and documents. The people who were “case tracked” were not able to help by giving an opinion about the care provided. One person who could express an opinion was interviewed and others were communicated with throughout the inspection process. Relatives were observed visiting the home and they were spoken with to gain their opinion about the service also. Four members of staff and the manager were spoken with as part of this inspection, documents were read and medication inspected to form an opinion about the quality of the care provided to residents. Prior to completing this visit the inspector assessed the homes service history including complaints and adult protection referrals, and an Annual Quality Assurance Assessment questionnaire completed by the registered manager. No completed residents satisfaction questionnaires were received prior to this inspection, however three staff surveys and one relatives survey were received prior to the completion of the report. All were very positive about the service provided. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 6 What the service does well: Qualified and experienced staff that will have direct daily responsibility for the person carries out full assessments. The assessment is only carried out when a placement is identified by initial assessment from the Provider. A full transitions programme is designed to meet the needs of the individual. Central to the home’s aims and objectives is the promotion of the individual’s right to live an ordinary and meaningful life, appropriate to their peer group, in both the home and the community, and to enjoy all the rights and responsibilities of citizenship. People who live in the home are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. The home has sought the views of the residents and considered their varied interests when planning the routines of daily living and arranging activities both in the home and the community. Routines are very flexible and residents can make choices in major areas of their life. People receive personal and healthcare support using a person centred approach with support provided based upon the rights of dignity, equality, fairness, autonomy and respect. Personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each person centred plan. The service assesses and records the preferred communication style of the individual, and uses new and innovative methods that enable the person to fully participate. This includes communication charts, information about communication styles (sometimes called communication passports), relationship circles, intensive interaction, objects of reference, photographs, visual timetables, drawing and signing or symbols. The aims and objectives of the home reinforce the importance of treating individuals with respect and dignity. People living in the home and their relatives told us that privacy and dignity is always respected. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, and are protected from abuse, and have their rights protected. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. People have confidence in the staff that care for them. Rotas show well thought out and creative ways of making sure that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the people who use the service. Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 7 There are consistently enough staff available to meet the needs of the people using the service, with more staff being available at peak times of activity. The staffing structure is based around delivering outcomes for people in the home and is not led by staff requirements. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a competent manager. What has improved since the last inspection? What they could do better: Three requirements have been made: Ensure the systems for medication management are safe. This will ensure people living in the home are fully safeguarded from harm and receive their medication as prescribed. Ensure notifications are made to CSCI as Required by Regulation 37. This will ensure people living in the home are safeguarded and CSCI can monitor any event in the home. The manager must seek to undertake the Registered Managers Award without delay to ensure she meets with the requirements of Regulation 9 Six good practice recommendations have also been made to further improve the service. Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. Further development of the information in different formats will make the information more accessible for people. EVIDENCE: The home provides an up to date statement of purpose, philosophy of care and service users guide for the home, however these are not yet provided in accessible formats for people who live in the home. The manager has told us that they are working on this currently but could not provide a timescale for completion. Qualified and experienced staff that will have direct daily responsibility for the person carries out full assessments. The assessment is only carried out when a placement is identified by initial assessment from the Provider. A full transitions programme is designed to meet the needs of the individual. These were viewed on individual files. The Manager stated in the AQAA [Annual Quality Assurance Assessment] ‘We positively encourage overnight stay during introductory visits Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 11 All Service users have their own Person Centred Care Plan & Programme tailored to their individual needs We work with Parents/Relatives/Guardians/Social Workers where it has been identified that the Service User cannot make their own informed choice as stated in the Mental Capacity Act 2007. We will be identifying the needs of the Parents/Relatives/Guardians and the support they require from the service and will be encouraging their input into the care of their Son/Daughter. We have set up a yearly forum and six monthly questionnaires We support and encourage Social Worker review of residents after 72 hours and 3 months and then 6 monthly followed by 12 monthly reviews’. A relative spoken with confirmed this process and praised the service highly. Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Individuals are involved in decisions about their lives, and play an active role in planning the care and support they receive. EVIDENCE: The key principle of the home is that people using the service are in control of their lives and they direct the service. Staff are fully committed in supporting individuals to lead purposeful and fulfilling lives as independently as possible. People using the service make their own informed decisions and have the right to take risks in their daily lives. The care plan is developed with, and owned by the person using the service. It is based on a full and up to date holistic assessment. It includes reference to equality and diversity and clearly addresses any needs identified in the six strands of diversity, which are: gender (including gender identity), age, sexual orientation, race, religion or belief, and disability. The plan is person centred and focuses on the individual’s strengths and personal preferences. The Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 13 support plan is as far as possible written with the individual, or their representative, and includes a range of information that is important to them. For example, who and what is important to them, how they keep safe, their goals and aspirations, their skills and abilities, and how they make choices in their life. It also includes information about their health; but could be improved by incorporating an ‘health action plan’ and medication profile. The plans viewed celebrate the individual, their life experiences and sets out in detail how their current requirements and aspirations are to be met through positive individualised support. Plans are all different and highly individualised and they include evidence that the service values improving outcomes for people using the service. A variety of different and creative methods are used to help people who use the service to contribute to the development of their care plan and the ongoing review process. Staff have the specialised training and skills to support, engage and encourage the individual to be fully involved. Key workers actively provide one to one support, keep the care plan up to date and make sure that other staff always know the person’s current needs and wishes. The service assesses and records the preferred communication style of the individual, and will uses new and innovative methods that enable the person to fully participate. This includes communication charts, information about communication styles (sometimes called communication passports), relationship circles, intensive interaction, objects of reference, photographs, visual timetables, drawing and signing or symbols. The plan is an up to date working tool used by the individual and all involved staff. The care plan can be, easily used by people who are not familiar with the individual to deliver a personalised and consistent person centred service. Plans were reviewed regularly, and as the individual’s needs change. The care plan includes a comprehensive risk assessment, which is regularly reviewed. The service has a ‘can do’ attitude and risks are managed positively to help people using the service lead the life they want. Any limitations on freedom, choice or facilities are always in the person’s best interests. The individual understands and agrees any limitations; they are fully documented and reviewed regularly. People using the service know, and are able to see, the records the home holds about them. Individuals know their rights and advocacy services are encouraged to promote these. The service works creatively and actively with other services and organisations to ensure that the person’s whole life needs are met, and goals addressed. The Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 14 service recognises its own limitations and when to seek support from others to meet the individual needs of people. People living in the home are continually consulted on how the service runs and are able to influence key decisions in the home whatever their communication style. The home acts upon the results of consultation with people living in the home and their representatives. The home makes sure that good practice is modelled and developed throughout. Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use services are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities meet individual’s expectations. EVIDENCE: Central to the home’s aims and objectives is the promotion of the individual’s right to live an ordinary and meaningful life, appropriate to their peer group, in both the home and the community, and to enjoy all the rights and responsibilities of citizenship. The home understands the importance of enabling younger adults to achieve their goals, follow their interests and be integrated into community life and leisure activities in a way that is directed by the person using the service. The service understands and actively promotes the importance of respecting the human rights of people using the service, with fairness, equality, dignity, Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 16 respect and autonomy all being seen as central to the care and support being provided. People who live in the home are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. The home has sought the views of the residents and considered their varied interests when planning the routines of daily living and arranging activities both in the home and the community. Routines are very flexible and residents can make choices in major areas of their life. The routines, activities and plans are person centred, individualised and reflect diverse needs. They are regularly reviewed, and are very responsive to individuals changing needs, choices and wishes. The service actively encourages and provides imaginative and varied opportunities for people using the service to develop and maintain social, emotional, communication and independent living skills where appropriate. The service has very strong and highly effective methods, which focus on involving residents in all areas of their life, and actively promotes the rights of individuals to make informed choices, providing links to specialist support when needed. This includes developing and maintaining family and personal relationships. Outcomes for people are positive, and there is evidence that they are enjoying the life opportunities that they experience. The service actively supports people to be independent and involved in all areas of daily living in the home. This includes where appropriate, taking responsibility for shopping, planning meals, and meal preparation. Meals are very well balanced and highly nutritional and cater for varying cultural and dietary needs of residents. For those individuals who need support during mealtimes, including those who have difficulty swallowing or chewing, staff give assistance. They are discrete and sensitive to the feelings of both the person they are helping and also to others present. Mealtimes are flexible and relaxed, staff are patient and helpful, and allow individuals the time they needed to finish their meal comfortably. Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice, however medication procedures, were not always being followed by some staff, which means that the health, safety and welfare of people living in the home may be compromised. EVIDENCE: People receive personal and healthcare support using a person centred approach with support provided based upon the rights of dignity, equality, fairness, autonomy and respect. Personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each person centred plan. They give a comprehensive overview of their health needs and act as an indicator of change in health requirements. Attention is needed however to ensure follow-ups for blood tests and medical appointments are cross-referenced and up to date. Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 18 Personal support is responsive to the varied and individual needs and preferences. The delivery of personal care is individual and is flexible, consistent, reliable, and person centred. Staff respect privacy and dignity and are sensitive to changing needs. A Relative confirmed the service listens and responds to individuals’ choices and decisions about who delivers their personal care. People are supported and helped to be independent and can take responsibility for their personal care needs. Staff listen and take account of what is important to them. People have access to healthcare and remedial services. Staff make sure that those who are fit and well enough are encouraged to be independent, have regular appointments and visit local health care services. The health care needs of residents unable to leave the home are managed by visits from local health care services. Residents have the aids and equipment they need and these are well maintained to support them and staff in daily living. The aims and objectives of the home reinforce the importance of treating individuals with respect and dignity. People living in the home and their relatives told us that privacy and dignity is always respected. The home has a medication policy which is accessible to staff. There are no people currently administering their own medication. Medication records are generally up to date for each resident and medicines received, administered and disposed of are mostly recorded. The home understands the need to comply with the administration, safekeeping and disposal of controlled drugs, but medication systems do not always follow good practice or safe practice guidelines and needs action to ensure that people living in the home are not placed at risk of harm from not receiving their medication properly. Homely remedies purchased for one person on 11/4/08 had not entered onto the Medication Record sheets. Gaps were noted on the medication records for one person 26/4/08. Examination of the medication dispenser indicated that the medication had been administered but not signed for. There were several other gaps noted on another persons medication records for Lactulose liquid, supplement drinks, an eye ointment treatment and a dental gel and therefore it was difficult to ascertain if the medication had been administered. Handwritten Prescriptions had no signature of the author or any witness checks. Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 19 A pharmacist audit undertaken on 25/2/08 had already identified to the home the need for handwritten prescriptions on Medication records to have 2 signatures and this clearly was not being complied with. This indicates that people may not be receiving their medication as prescribed and this may compromise their health, safety and wellbeing. Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, and are protected from abuse, and have their rights protected. Further work is needed to ensure all staff are fully aware of the Nottinghamshire Safeguarding Policy and Procedures. EVIDENCE: The home has an open culture that allows residents to express their views and concerns in a safe and understanding environment. Residents and others involved with the service say that they are happy with the service provided, feel safe and well supported by an organisation that has their protection and safety as a priority. The service has a complaints procedure that is clearly written and easy to understand. It is available on request in a number of formats (including other languages, large print, audio etc) to help anyone living at, or involved with, the service to complain or make suggestions for improvement. The complaints procedure is supplied to everyone living at the home and is displayed in a number of areas within the service. Residents and others involved with the home understand how to make a complaint and are clear about what will happen if a complaint is made. There have been no complaints made to the home. Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 21 The home has the Nottinghamshire policies and procedures for safeguarding adults. Their own policy and procedures were also viewed but these did not match with the Nottinghamshire protocols and may give conflicting or confusing guidance to those using them. Training of staff in safeguarding is regularly arranged by the Home. Staff working at the service generally know when incidents need external input and who to refer the incident to, but further training for staff should be provided to ensure that all staff are clear about their responsibilities. It was established that an incident between two people living in the home should have been notified to CSCI. It is also recommended that the manager and her deputy seek training in referral procedures and cascades the Nottinghamshire protocols to all staff. There is a clear system for staff to report concerns about colleagues and managers. Staff that ‘blow the whistle’ on bad practice are supported by the service. Challenging behaviour is monitored but there was some inconsistency noted in Behaviour charts, incident reports and reviews so the system for recording events needs to be reviewed to ensure records are always accurate and up to date. Training around dealing with physical and verbal aggression is being made available to staff in May 08, however due to the complex needs of some people who live in the home this training should have been provided at the commencement of the service and staff employment to ensure staff have the necessary skills and knowledge to meet individual needs of people living in the home. The system in place for resident’s finances was examined and although there was initially concern because the monies are pooled into one joint bank account through discussion with the home and the bank it was established that clear audit trails are in place and people are allocated any interest they are entitled to and that the system is robust. There is no policy in place in respect of informing staff that it is illegal under The Financial Services and Markets Act 2000 for staff to use their own bonus point cards when making transactions/purchases on behalf of people living in the home and this must be actioned promptly. Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: The provider and manager have ensured that the physical environment of the home provides for the individual requirements of the people who use the service who live there. The living environment is appropriate for the particular lifestyle and needs of the residents and is homely, clean, safe and comfortable, well maintained and reflects the individuality of the people using the service. Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 23 The environment reflects the differing needs of residents under the six strands of diversity: gender (including gender identity), age, sexual orientation, race, religion or belief, and disability. Residents are encouraged to see the home as their own. It is a very well maintained, attractive home and has very good access to community facilities and services. It has a wider range of up to date specialist equipment and adaptations to meet the individual needs of people who use the service. The environment is fully able to meet the changing needs of people, along with their cultural and specialist care needs. It is fully accessible throughout to people with physical disabilities, adaptations and specialist equipment are designed to fit within the homely environment. Residents are fully involved in decisions about the décor and any changes in their communal and personal accommodation. The service is creative in how it involves people in decision-making and positively encourages people with a limited capacity to be as fully involved as possible. The home has single rooms available for all people who wish to have one. Residents say that they had real choice of the room they use. The rooms are above-average size, very well designed with most having en-suite facilities. The fixtures and fittings are of high quality, well maintained and adapted to meet the wishes of the present occupant. Individuals personalise their rooms and can use their own furniture if they wish. There is a selection of communal areas both inside and outside of the home, this means that people using the service have a choice of place to sit quietly, meet with family and friends or be actively engaged with other people who use the service. The kitchen and laundry are designed to enable and promote the involvement of people in domestic tasks and as part of developing or maintaining independence. Where there are concerns about the health and safety of anyone using the kitchen and laundry arrangements are fully risk assessed with the involvement of the person. Access is only limited when the completed assessment indicates such a need. The bathrooms are homely and include aids and adaptations to meet the needs of the people using the service. There are sufficient toilets to enable immediate access. Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. EVIDENCE: People have confidence in the staff that care for them. Rotas show well thought out and creative ways of making sure that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the people who use the service. There are consistently enough staff available to meet the needs of the people using the service, with more staff being available at peak times of activity. The staffing structure is based around delivering outcomes for residents and is not led by staff requirements. All staff receive relevant training that is focussed on delivering improved outcomes for residents. The home puts a high level of importance on training and staff report that they are supported through training to meet the individual needs of people in a person centred way. Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 25 There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the home recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. Staff recruited confirm that the home was clear about what was involved at all stages and was robust in following its procedure. There are clear contingency plans for cover for vacancies and sickness and there is little use of any agency or temporary staff. Staff meetings take place regularly. Supervision sessions are regular and staff find them helpful with a focus on improving outcomes for people using the service. Notes and action points are taken of meetings and sessions, and progress is regularly reviewing. Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 41, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a competent manager. EVIDENCE: The manager is a qualified nurse who has the experience and is competent to run the home, however she has yet to undertake the Registered Managers Award. The manager has a clear understanding of the key principles and focus of the service, based on organisational values and priorities. They work to continuously improve services. They provide an increased quality of life for residents with a strong focus on equality and diversity issues and promoting human rights, especially in the areas of dignity, respect and fairness. There is Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 27 also a focus on person centred thinking, with residents shaping service delivery. There is a strong ethos of being open and transparent in all areas of running of the home. The manager leads and supports a strong staff team who have been recruited and trained to a high standard. The manager is aware of current developments both nationally and by CSCI [Commission for Social Care Inspection] and plans the service accordingly. As the service is relatively new the AQAA [Annual Quality Assurance Assessment] contains clear, relevant information that is supported by a brief range of evidence. The data section of the AQAA is accurately and fully completed. The manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. The home works to a clear health and safety policy. All staff are fully aware of the policy and are trained to put theory into practice. Regular random checks take place to ensure they are working to it. The home has a good record of meeting relevant health and safety requirements and legislation, and closely monitoring its own practice. There is also evidence of organisational monitoring by corporate providers. Record keeping in respect of medication, follow ups to medical appointments, blood tests and incidents require attention to ensure records are of a good standard, are routinely completed and are fully up to date. Notifications have not been made as required by Regulation 37 and a requirement is set in respect of this. The manager ensures risk assessments involve the residents in their production and that they are fully completed and taken into account in planning the care and routines of the home. A sample of service records were viewed including the ‘Electrical Circuit Certificate’ and ‘Gas safety certificate’ and maintenance records, which were satisfactory. Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 4 25 X 26 4 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 3 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 3 X 2 3 X Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 29 N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13[2] Requirement Ensure the systems for medication management are safe. This will ensure people living in the home are fully safeguarded from harm and receive their medication as prescribed. Ensure notifications are made to CSCI as Required by Regulation 37. Timescale for action 12/06/08 2 YA23 YA41 37 12/06/08 3 YA37 9 This will ensure people living in the home are safeguarded and CSCI can monitor any event in the home. The manager must seek to 12/10/08 undertake the Registered Managers Award without delay to ensure she meets with the requirements of Regulation 9 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 30 No. 1 2 3 4 5 6 Refer to Standard YA1 YA6 YA19 YA20 YA19 YA41 YA23 YA23 YA41 YA23 Good Practice Recommendations Further development of the Statement of Purpose and Service user Guide information in different formats will make the information more accessible for people. Include within support plans sections for Health Action Plans and Medication Profiles. Attention is needed to ensure follow-ups for blood tests and medical appointments are cross-referenced and up to date. The manager and deputy should seek training in Safeguarding Referral and ensure all staff are aware of the Nottinghamshire Safeguarding procedures Review the system in place for recording and evaluating Challenging Behaviour to ensure records are accurate and up to date. Provide a policy for staff on handling peoples monies, which, informs staff that it is illegal to use their own bonus cards when making purchases on individual’s behalf. Adams House DS0000071162.V363964.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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