Inspection on 07/10/08 for Alder House Cheshire Home

This inspection was carried out on 7th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Alder House Cheshire Home 31/10/06

Alder House Cheshire Home 03/03/06

Alder House Cheshire Home 09/06/05

Alder House Cheshire Home 13/01/05

Alder House Cheshire Home 27/05/04

Similar services:

Claremont House

Sun Court Nursing Home

Bramley Avenue (73)

15 Bramble Close

Dolphin Court

Fen Road

Wakes Hall

165 Putnoe Lane

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Alder House Cheshire Home Lambourne Road Chigwell Essex IG7 6HH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Diana Green     Date: 0 7 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Alder House Cheshire Home Lambourne Road Chigwell Essex IG7 6HH 02085008491 02085004660 dilip.mahadeo@LCDisability.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Leonard Cheshire Disability Name of registered manager (if applicable) Mr Dilip Kumar Mahadeo Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: On completion of the final phases of development a building regulation certificate must be sent to the Commission Persons of either sex, under the age of 65 years, who require care by reason of physical disability (not to exceed 19 persons) Date of last inspection Brief description of the care home Alder House is a care home registered to provide care and accommodation to nineteen people with physical and sensory disabilities. The home is part of the Leonard Cheshire Foundation and Mr Dilep Mahadeo is the Registered Manager. Alder House is a purpose built single storey building set in spacious gardens incorporating a large lake, situated in a semi rural area of Chigwell, Essex on the border of London. All bedrooms are for single occupancy and adapted for wheelchair users and have en-suite toilet and bathroom facilities. The grounds are private, well maintained and accessible to wheelchair users. Each room opens out onto its own individual garden and patio area with garden seating A bus route provides access to the home, although the bus stop is Care Homes for Adults (18-65 years) Page 4 of 31 care home 19 Over 65 0 19 Brief description of the care home approximately 10 minutes away by foot. There is a local train station and Woodford station is approximately 30 minutes away. Car parking facilities are available at the front of the house. As at 31st October 2006, the manager advised that the fees for accommodation ranged from #830.00 to #1600.00 per week. Items considered to be extra to the fees include private chiropody, hairdressing, toiletries and newspapers. CSCI inspection reports are available from the home and the CSCI website. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place on 7th October 2008. All of the Key National Minimum Standards were inspected (NMS) for Younger Adults, and the intended outcomes were assessed in relation to this service during the inspection. The report has been written using accumulated evidence gathered prior to and during the site visit, including the homes Annual Quality Assurance Assessment (AQAA). The Annual Quality Assurance Assessment, a self assessment that focuses how well outcomes are being met for people using the service, was completed by the home and returned to us prior to the visit to the home. Information received in the self assessment provided us with some detail in understanding how the Registered Persons understand the services strengths and weaknesses and how they will address these. Care Homes for Adults (18-65 years) Page 6 of 31 The inspection process included reviewing documents required under the Care Home Regulations 2001. A number of records were looked at in relation to residents, staff recruitment and training, staff rotas and policies and procedures. Time spent talking to the staff and the manager. Surveys were sent to service users and their representatives, health and social care professionals and staff. The manager and staff were welcoming and helpful throughout the inspection. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 8 of 31 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 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. People planning to live at Alder House can expect to have an opportunity to visit the home and to have their needs fully assessed prior to admission to ensure they can be met. Evidence: The home had a statement of purpose and service user guide that had been reviewed since the previous key inspection. Both documents were comprehensive and included the homes philosophy of care, facilities and services and complaints procedure. The manager said these were made available for prospective residents and their representatives. Copies of the statement of purpose and service user guide were also seen in each residents room during the site visit. Six relatives who completed surveys as part of this inspection confirmed they had received sufficient information to enable them to make a decision. The admission procedures were discussed with the registered manager who explained that referrals are received from social services and a needs assessment form (Com 5) Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: is provided. Residents needs are clarified and additional information requested as necessary to ensure needs can be met at the home. Assessments are undertaken in the residents home or in hospital wherever possible. Prospective residents are invited in to the home to view the premises and to have an opportunity to meet with other people living there and encouraged to spend the day and to have a meal with other residents. Three residents care files were examined during the site visit. Each of the three files contained a pre-admission assessment form that had been completed prior to admission and a range of risk assessment tools (for example nutritional, skin integrity, manual handling, continence) that had been regularly reviewed. All six relatives who completed surveys stated that the care home always meets the needs of their friend or relative. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Alder House can expect to have their care needs met by robust care planning and be assured they will be supported to make independent decisions about their lives. Evidence: The care plans for three people living at Alder House were viewed. All records included good detail of the residents needs and provided guidance for staff on how they were to be met. Care plans for different elements of need were recorded (personal support/nursing plan, communication, mobility, behaviour, medication etc.) The records confirmed that all three had received a review at three months and this had included various assessments that had been undertaken, for example moving and handling. This ensured that care staff had current information on the residents care needs enabling them to provide appropriate care to them. The AQAA informed us that each resident has an individual service plan of their care of which they have full involvement in developing together with their relative or representative if they wish. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: Residents are encouraged to make decisions about their lives. When asked do you make decisions about your lives? Four residents who completed surveys told us always and two said usually. One resident told us I am treated as an individual. As my own person. Risk assessments were undertaken for risks to individual residents, for example seizures, use of bed rails, baking etc and confirmed from the care files viewed. These demonstrated that risks to the individual were minimised. Policies and procedures were in place for staff guidance and to enable residents to be supported to take responsible risks as part of their independent lifestyle. Care Homes for Adults (18-65 years) Page 14 of 31 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. People living at Alder House can expect to be supported to maintain personal and family relationships and to have their lives enhanced through a planned programme of meaningful activities that satisfies their social and cultural expectations. Evidence: The arrangements for people living at Alder House were discussed with the manager. The care records viewed included an assessment of residents religious/spiritual needs and how these were to be met. We were told that some residents attended a local church and a resident also confirmed that a vicar attended the home. The records confirmed that one resident also attended a Jewish Club. Due to the complex needs of people living at Alder House, none were able to take up paid employment. However two residents attended a local college for a poetry and Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: drama group. A further two residents also attended a Day Centre organised by Scope, with one attending one session per week and the other two sessions per week. The home employed an activities coordinator for thirty hours per week who had worked at the home for five years and who confirmed they were supported by a physiotherapy assistant. We were told that a quarterly newsletter was produced for residents and their families and also distributed to stakeholders. Activities were supported by volunteers (currently twenty) who assisted with social events for example coffee morning, annual fête, Chinese Night, drama classes and shopping. One relative told us the activities coordinator had a good relationship with x. The programme of activities was viewed and photographs of various events that had taken place were seen displayed throughout the home. A range of individual and group activities were organised including card games and quizzes, art and craft, cooking, yoga and reading. Various outings arranged since the previous key inspection included visits to Southend, Eltham Palace, shopping and boat trips. The manager told us that entertainment was brought into the home six weekly and during the Christmas celebrations local school choirs had attended the home to entertain residents. We were told that in order to encourage their independence two residents had been supported to attend a curry night and arranged to travel by taxi. The manager stated that there had been no holidays arranged on behalf of residents since the previous inspection, although this could be facilitated. The home statement of purpose included the visiting arrangements for Alder House and stated that residents would be supported in maintaining their relationships with friends and families. Relatives spoken with during the site visit confirmed they were welcomed into the home and one said they appreciated having access to the visitors room where they could make a cup of tea and have a snack. From discussion with the manager it was evident that people living at Alder House are supported in developing and maintaining personal relationships and a policy was in place to provide guidance to staff in this event. The homes daily routines were observed to be relaxed during the site visit. Staff were observed to knock before entering residents rooms and the records confirmed they were addressed by their preferred name. Residents spoken with said they were treated with respect and their dignity was upheld when staff were assisting them with personal care. The kitchen was viewed during a tour of the premises and was seen to be clean and well organised with plentiful food supplies in stock. The kitchen had been upgraded since the previous inspection and fly screens fitted. The chef explained that menus were discussed with residents to determine their preferred choices and a four weekly rotational menu organised. The lunch time meal offered during the site visit comprised a choice of braised pork, with rice or potatoes, fresh vegetables (carrots, peas, celery Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: and leeks), or pizza with a salad followed by plum crumble with cream or custard or fruit. Special diets were provided for diabetics and those requiring a soft diet. One relative told us the food is nice but indicated by their comments there was sometimes a lack of flexibility: they may have a late breakfast and are then not ready for lunch. A resident who completed a survey also told us there was a lack of choice for people with diabetes, especially at breakfast and they would sometimes like an egg instead of weetabix every day. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Alder House can expect to have personal and health care needs met and to be safeguarded by the homes medication policy, procedures and practices. Evidence: Residents each had their key worker who supported their personal care needs and residents who completed surveys said they felt they were treated well by staff. When asked do you make decisions about what you do each day? Two people living at Alder House told us usually and four told us always. Another person told us I am treated as an individual, as my own person. I am more independent here...I go out on my own a lot. I wouldnt want to be anywhere else. A relative also told us their loved one was supported to have their hair done and make-up applied and able to choose what jewelry they would like to wear. From discussion with relatives and observation it was evident that residents were provided with appropriate equipment and aids to support their care needs and to maximise their independence. The arrangements for meeting residents health care needs were discussed with the manager. All residents are registered with the local general practitioner. Access to Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: health care professionals is enabled following assessment and as indicated by need. The records viewed showed that residents had been seen by GPs, district nurses, chiropodists, opticians, dentists, dietitians, physiotherapists, speech and language therapists and a clinical psychologist. Information on advocacy services was available at the home to enable people living there to have the support of an independent person to help them make decisions about their care should they choose. A health care professional also told us overall it provides an excellent service in all areas. The medication systems were discussed with the manager and senior care worker. The home had policies and procedures in place for staff guidance that were kept under review. Medication was supplied from a local pharmacy in monitored dosage systems and in individual containers and stored in a storage cupboard and in two locked trolleys that were secured to the wall in the dining room. Room temperature monitoring was undertaken to ensure medicines were stored within safe recommended temperatures and therefore protected from deteriorating. A drug refrigerator was also available for medicines that required cold storage. Medicines were administered by staff with appropriate training and confirmed in discussion with a senior care worker and from the staff records viewed. A list of up to date staff signatures and initials of staff designated to give medication was seen. The medicines administration records and medication for three residents were inspected. All medication was available as prescribed. Records were generally well recorded. However one omission of signature had not been followed up with the reason recorded and one pain relief medicine had been reduced but this had not been confirmed by date or the signature of the person making the change. Care Homes for Adults (18-65 years) Page 19 of 31 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. People living at Alder House can expect to have their concerns and complaints listened to and acted upon and to be protected by the homes practices regarding their monies. Evidence: The home had a complaints policy and procedures that included the timescales for a response. The procedure was included in the information pack provided to residents on admission. One resident who completed a survey indicated they did not know how to make a complaint and four relatives stated they knew how to complain but all were generally happy with the service. We were informed that an analysis of all complaints, whistle blowing and safeguarding issues was undertaken at quarterly intervals and used to improve practice. There had been no complaints or safeguarding alerts made either to the home or CSCI since the previous inspection. The home had a protection of vulnerable adults policy and procedures for staff guidance that was viewed at the site visit. A copy of the updated Essex procedures was available on CD together with the handbook for staff reference. The manager told us that staff received training from Leonard Cheshire Training Department and this was also confirmed from the training records. There had been no safeguarding alerts made since the previous inspection. Residents rooms viewed included a lockable facility. The manager said that residents Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: who preferred to look after their own monies were also provided with a safe. The personal allowances for two residents were inspected. A book was maintained for each resident with records of income and expenditure recorded and receipts held. However when money was taken out, the records did not clearly record who the money was given to. Care Homes for Adults (18-65 years) Page 21 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Alder House can expect to live in a clean, homely and well maintained environment that maximises their independence. Infection control policies and procedures are in place to provide guidance to staff and minimise the risk of infection. The provision of alginate bags for laundry will ensure the risk of infection is minimised for staff. Evidence: A tour of the premises was undertaken during the site visit. The premises were secure with a digital door lock entry fitted. The accommodation was single storey. All residents rooms were wheelchair accessible and all had en-suite shower/wet room facilities. There were a number of communal rooms that were fully wheelchair accessible. A large lounge with library had views over the lake. The manager said the lake had recently been purchased and there were plans to provide decking to improve access for residents and visitors. Fire safety precautions were in place and records viewed confirmed that fire safety equipment was appropriately maintained and fire safety practices were in place to meet the requirements of the local fire service. The home had a planned programme of maintenance and repair and confirmed from the records viewed. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: The home had grab rails and was wheelchair accessible throughout. Individual and communal rooms were appropriately fitted with low level light switches and other equipment to maximise independence. Specialist equipment was provided to meet residents individual needs (pressure relief equipment, overhead and mobile hoists etc). There were a range of hoists and we were informed that all residents were provided with individual slings for their specific needs and to minimise the risk of infection. Systems were in place for the repair and maintenance to ensure its safe and continued use. The home was clean throughout with no odorous smells. There were sluice facilities with a mechanical sluice and hopper sluice provided. Infection control policies and procedures were available for staff guidance and hand washing facilities (liquid soap and paper towels) were provided in all en-suites, bathrooms and clinical areas. The laundry was fitted with two washing machines and a drier all confirmed to be in working order. Washing machines had the capacity to carry out laundering of soiled linen (wash at 65 degrees for a minimum of 10 minutes). However there were no alginate bags availabe for use when laundering foul linen and to minimise the risk of infection. Linen and personal clothing inspected was well laundered and organised to ensure the return to individual residents. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Alder House can expect to be cared for by skilled and experienced staff who are robustly recruited, clear of their role and responsibilities and supported through an ongoing training and development programme. Moving and handling training provided annually will ensure that residents are protected by staff who are competent in their moving and handling practices. Evidence: From discussion with the manager, training officer and an inspection of records it was evident that staff are skilled, experienced and competent to meet residents needs. The personal file of one member of staff was viewed and seen to include a job description that ensured they were clear of their responsibilities while working for Leonard Cheshire Homes. One resident who completed a survey told us they are caring, attend to my hospital appointments and have me ready to attend my social and educational activities....they make me feel welcome. The AQAA informed us that there were a total of twenty five staff of whom twenty one have an NVQ level 2 qualification which is substantially more than the fifty per cent needed to meet the standard. Two staff were working towards an NVQ level 2 qualification and a further two staff had a qualification above NVQ level 2. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: In addition to the manager there were six care staff on duty for eighteen residents. Residents appeared well cared for and well supervised by staff. We were informed that staff turnover was low and this was also confirmed from the records viewed. Ancillary staff included a physiotherapy assistant that provided rehabilitative support/exercises for residents and there was evidence from the records that access to occupational therapists and other health professionals was enabled to meet their health needs and maximise their independence. Recruitment procedures were discussed with the manager who informed us that that residents have been involved in their recruitment. We were also informed that staff turnover was low and no staff had been recently recruited. The recruitment records for one member of staff employed during 2005 was inspected. The file contained evidence that the required checks had been undertaken prior to appointment (two satisfactory references, CRB Disclosure/POVA First Check, evidence of identification etc). The AQAA informed us that regular staff meetings were held and that attendance had increased. This was also confirmed from discussion with staff. A discussion was held with the training and development officer and records were inspected. We were informed that the organisation had a training team who provided internal training and professional journals were also purchased to provide staff with the opportunity to keep their knowledge updated. The training records confirmed that training in management of swallowing difficulties had been provided for care staff since the previous inspection to ensure staff were able to provide first aid in the event of a choking incident. Several people had also attended training in personal relationships with the aim of this being cascaded to staff. On the day of the site visit training was being provided for fifteen staff in disability empowerment. The training file was viewed and included evidence that training during 2008 training had been provided in improving services for people with communications impairment and NVQ level 2. Training in fire safety (including evacuation), medication training, infection control and manual handling had also been provided. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Alder House can expect to live in a well managed home with good standards of health and safety that protect them and staff. Evidence: The registered manager is a registered nurse with a qualification at NVQ level 4 in Management & Care. From discussion with manager and the files inspected it was evident that regular updated training had been provided. Since the previous inspection this had included effective investigations, Mental Capacity Act 2005, managing sickness and absence and safeguarding adults. The manager stated that he operated an open style of management and when present in the home, was freely available to residents, relatives and staff. Comments received from relatives confirmed this: good management and manager is very approachable and a staff member told us I am free to call him at anytime. The homes quality assurance programme was discussed with the manager who explained that regular monitoring meetings are undertaken by a senior manager and Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: reports written to meet requirements of regulation 26. Annual surveys are undertaken from residents, their representatives and other stakeholders to obtain feedback on how the service is doing. Results of the surveys form the annual plan together with results of regular audits, for example health & safety, medication, care plans and quality of activities. The plan is then actioned to improve residents experience of life at the home. Records held on behalf of residents were seen to be kept up to date, and stored safely in accordance with the requirements of the Data Protection act 1998. Records viewed at this inspection included: statement of purpose, service user guide, policies and procedures, staff recruitment and staff training records, medication administration records, residents financial records and maintenance and health and safety records. The home had health and safety policies and procedures that were available for staff guidance and were kept under review. The records viewed confirmed that staff received training on health and safety, first aid, Control of Substances Hazardous to Health (COSHH), food hygiene, moving and handling etc. The manager confirmed that since two manual handling trainers were available a programme had commenced to ensure that all staff received annual updated manual handling training. A sample of maintenance records viewed confirmed that there were systems in place to ensure the servicing of equipment and utilities (e.g. gas, electrical, annual PAT testing etc.) and there was evidence of appropriate weekly checks being carried out on fire equipment, alarms, emergency lighting, hot water temperatures etc. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Changes made on the 28/02/2009 medicines administration record must be confirmed by date and signature of the person making the change. This will minimise the risk to residents of not being given their medication as prescribed and provide a clear audit trail should an investigation be required. 2 20 13 Omission of signatures on medicines administration records must be followed up and the reason recorded. This will minimise the risk of residents not being given their medication as prescribed and enable adverse incidents to be appropriately followed up. 28/02/2009 3 30 13 Alginate bags must be provided for use in laundering of foul linen. 28/02/2009 Care Homes for Adults (18-65 years) Page 29 of 31 This will minimise the risk of infection for staff. 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 2 14 17 Residents should be enabled to have an annual holiday of their choice to enhance their lives. Choice and flexibility of meals should be promoted to ensure they are supported to maintain an independent lifestyle. When residents money is taken out, their records should clearly record to whom it is given. 3 23 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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