Inspection on 10/12/08 for Ashcroft

This inspection was carried out on 10th December 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashcroft 09/01/08

Ashcroft 23/04/07

Ashcroft 03/07/06

Ashcroft 22/11/05

Ashcroft 18/07/05

Ashcroft 27/04/05

Ashcroft 31/08/04

Ashcroft 20/05/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

1 Marten Road

Extracts from inspection reports are licensed from CQC, this page was updated on 26/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ashcroft Ashcroft 1 Wiggie Lane Redhill Surrey RH1 2HJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Jewell     Date: 1 0 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 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: Ashcroft 1 Wiggie Lane Ashcroft Redhill Surrey RH1 2HJ 01737789656 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Aruna Devi Ramful Type of registration: Number of places registered: Mr Roopesh Ramful care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: Persons accommodated in the category (LD) Learning Disability category must be aged over 40 years or over. The total maximum number of persons to be accommodated must not exceed five Date of last inspection Brief description of the care home Ashcroft is a semi-detached domestic house situated in a residential area half a mile from Redhill town centre. The home was first opened in 1990. The home provides care and accommodation for up to five people who have a learning disabilities or mental health past or present condition. Currently all residents are male and the majority are over sixty five years old. The home is presented across two floors with stairs providing access to the first floor. Resident accommodation consists of five single occupancy bedrooms. Communal space consists of a Kitchen, conservatory, lounge and separate Care Homes for Adults (18-65 years) Page 4 of 31 1 1 Over 65 3 0 Brief description of the care home dinning room. There is a small rear garden. The homes literature states that it aims to make sure that the care provided within the home is personal and unique. 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The information contained in this report has been comprised from an unannounced inspection undertaken over seven hours and information gathered about the home before and after the inspection. This includes an improvement plan which recorded the actions taken to address the shortfalls in practices noted at the previous inspection. The manager had completed an Annual Quality Assurance Assessment form prior to the inspection and the information contained in this document has been used to inform the inspection. The inspection was facilitated by Mr R Ramful (Registered Manager) and in part, by the deputy manager. The inspection which consisted of a tour of the premises, examination of the homes documentation and discussion with all residents, staff and two visiting Care Homes for Adults (18-65 years) Page 6 of 31 health care professionals. Three relatives were also consulted about their experiences at the home. There were five residents living at the home at the time of the inspection. Although the homes registration is for the care and accommodation of people who have a learning disability as the majority of residents accommodated are over the age of 65 years some key National Minimum standards for Older people have also been taken into consideration as part of this inspection. This includes Standards: 10 (Privacy and Dignity) and 14 (Autonomy and Choice ). . What the care home does well: Residents continue to live in a clean and homely environment, which is decorated and maintained to a good standard. Residents private accommodation is personalised, safe and comfortable. Comments received regarding the environment include, it is always spotless clean Environment generally clean needs a little updating in places improved a great deal new furniture dinning room smartened up a bit Bedrooms kept clean and tidy 24. The home provides both prospective and existing residents, with a good range of information about what services are provided and what to expect when living at the home. The home is able to identify and meet the wide range of residents needs being accommodated. A sample of comments about residents experiences at the home included: Taken care off very well Always happy here This place is very nice it is my home Very happy living here I can do what I want whenever I want. Relatives commented He has everything he needs at Ashcroft, very patient and understanding and has a very comfortable life there He is really settled there the home carers have done a good job, they make him feel very much at home. Residents benefit from a good care planning process, which provides clear, up to date and accurate information about their needs and goals and the support needed to achieve them. Residents lives are enriched by the promotion of independence, choice and being enabled to live their chosen lifestyle. Residents commented: I can go to bed whenever I want I can do what I want whenever I want and they know how to push you to be more independent. Residents benefit by being supported to maintain relationships with their families and friends, with all relatives commenting upon how welcomed they are made to feel when visiting. Residents dietary needs are well catered for with a balanced and varied selection of food available that meets resident’s tastes and choices. A sample of comments made about food included: Food very good three meals a day new dinning room is very nice Food varied but interesting always an alternative and not a compromise you get something just as nice and all depends on who is cooking as to how good it is. Residents and relatives felt comfortable to approach the manager with any concerns. A resident said I would report to mike if I was not happy and he would make it alright. A relative said Any little concerns always been addressed promptly. . The staff group includes a core group who have worked at the home for many years. Their experience, together with training indicates that they have a good level of competence and are motivated and committed to supporting residents. Comments about staff included very good great kind, competent very professional do everything by the book spoke they are not just kind but compassionate great asset to this household Staff kind they work hard Staff very friendly very calm always someone there and if they don’t Care Homes for Adults (18-65 years) Page 8 of 31 know the answer they contact the manager and Staff very friendly and welcoming. The management team promotes a relaxed atmosphere at the home, with all persons consulted speaking positively about them, their comments included approachable listens really good great sense of humour very gently very service users focused Mike very nice man he has a very good knowledge of residents and tries to accommodate and discuss ideas and any problems and we decide together the best cause of action easy to contact. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 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. The home provides both prospective and existing residents, with a good range of information about what services are provided and what to expect when living at the home. The home is able to identify and meet the wide range of residents needs being accommodated. The way in which prospective residents would be assessed ensures that the home admits only those residents whos needs can be met by living at the home. Evidence: In line with previous requirement there is now a wider range of information about the home and its services available. This includes an updated statement of purpose and service guide which provides useful information to help prospective residents make an informed choice about whether to move to the home and informs existing residents of Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: the range of service and facilities provided and the terms and conditions of residency. This information is made accessible to residents. There have not been any new admissions to the home since the previous inspection. Therefore, this standard was assessed in respect of the admission procedure for future prospective residents. The manager was aware of the admission criteria for the home and knowledgeable about admissions practices that would ensure a comprehensive range of information is gathered about prospective residents. This would then inform their decision whether prospective residents needs could be met at the home. There is a range of residents needs being accommodated at the home. The majority of residents are assessed as having low to medium level of needs and include residents who have physical needs, learning disabilities, and residents who have mental health needs. Through observation, looking at records and speaking to residents and relatives, evidence was gathered that the home is able to meet this wide range of residents needs. All residents consulted with spoke positively about their experiences. A sample of comments about experiences at the home included: Taken care off very well Always happy here This place is very nice it is my home and Very happy living here. Relatives commented: He has everything he needs at Ashcroft, very patient and understanding and has a very comfortable life there He is really settled there and the home carers have done a good job, they make him feel very much at home. The manager stated that any prospective residents would be provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home with their family and representative. The length and type of any visit would depend on the individuals needs and preferences. Residents have now been provided with an updated written contract of terms and conditions of residency with the home. This can be used with residents and their families to make explicit the placement arrangements and clarify mutual expectations around rights and responsibilities. A signed copy of the contract is retained in resident’s files. 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. Residents benefit from a good care planning process, which provides clear, up to date and accurate information about their needs and goals and the support needed to achieve them. The home tries to balances the rights of residents to take reasonable risks as part of an independent lifestyle with some further work recommended to the management of risk to further promote residents safety. Residents are involved in decisions about their lives and are consulted in planning the care and support they receive. Evidence: A new care planning system has recently been introduced, this has addressed the shortfalls noted at the previous inspection. All residents care plans were examined and Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: were person-centred in their formation and involving residents in the process. The care plans provided staff with a range of guidance on the needs and preferences of residents this would enable staff to deliver consistent support to residents based on their individual needs and preferences. Changes in residents needs and preferences were identified through the review of care plans. Annual placement reviews are also held with the placement authorities and residents families. This helps to identify that the home can continue to meet the resident’s needs. The home continues to try and balance the rights of residents to take reasonable risk as part of an independent lifestyle against the risks faced and posed by themselves or others. This is generally supported through the written assessment of risks, in areas specifically related to an individual. For example diabetes and self medication. To further support the management of risk it is recommended that generic risk assessments are also undertaken in order to identify any general areas of risk. For example with mobility and the environment. Where restrictions are placed on a residents freedom this decision has been agreed with them and documented. Residents confirmed that they have some control over their lives and the decisions they make on a daily basis. A range of ways was seen of how residents are involved in the running of the home. Residents spoke of undertaking light household jobs and being involved in planning their day. Staff demonstrated an awareness of good practices about confidentiality, ensuring that sensitive information is kept secure and knowledgeable about the circumstances under which information must be shared with management and others. During the inspection staff were seen to be respectful and considerate to residents and visiting health care professionals. Staff were observed using residents preferred forms of address and knocking on bedroom doors prior to entering. Staff consulted with showed an understanding of good practices in preserving residents rights to privacy and dignity and were able to give examples of how they promote these rights in their every day care practices. A resident spoke of how staff continue to respect their privacy by never entering their bedroom unless invited to do so. 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. Residents lives are enriched by the promotion of independence, choice and being enabled to live their chosen lifestyle. Resident’s benefit by being supported to maintain relationships with their families and friends. Resident’s dietary needs are well catered for with a balanced and varied selection of food available that meets resident’s tastes and choices. Evidence: A relative continued to confirm the gradual improvements in their relatives personal development and how they felt that the stable environment provided at the home has aided this progress. Residents spoke about being encouraged to maintain their independence, this included participating in the daily running of the home or going out independently. A resident said they know how to push you to be more independent. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: Residents spoke of visiting a day centre, church events and a local market where they undertook some voluntary work. Several of the residents said that they preferred to be based at the home throughout the day with some support to ensure that they were suitable occupied. A resident spoke of receiving help to purchase a large TV for their bedroom which was their main focus of occupation. Consistent feedback was received that due to staffing increases more opportunities are now provided for residents to go out. Residents spoke of going for drives, shopping and local walks. On the day of the inspection most residents were going out for lunch and undertaking Christmas shopping. A relative commented in response to how the home could improve perhaps more variety of light entertainment within the home. Residents spoke positively about the holiday they had undertaken as a group. The home has its own mini bus, which is used for individuals and group activities and to access the wider community. Relatives continue to comment upon how welcomed they are made to feel when they visit, this included being offered beverages or meals and staff being friendly and approachable. Relatives consulted felt that the home was good at communicating with them and supporting their relative to keep in contact with them. Several relatives said they often kept in contact via regular telephone calls. The provider children often visit the home. All of the residents spoke of how much they enjoyed having the children at the home and that they never entered their private accommodation without their permission. All residents consulted mentioned flexibility in the daily routines and respect for personal freedom and lifestyles. Several residents spoke of the importance of being able to live an independent lifestyle and how the home enabled them to do this. Resident commented I can go to bed whenever I want I can do what I want whenever I want . A resident spoke of how staffing hours were changed in order to enable him to get up earlier and go to work. A four week rolling menu provides a varied diet. A sample of comments made about food included very good three meals a day new dinning room is very nice ood varied but interesting always an alternative and not a compromise you get something just as nice andit all depends on who is cooking as to how good it is.A resident spoke of the efforts gone to provide them with a range of foods from their culture, this included also going out for meals. Staff spoke of how menus are changed in response to feedback from residents. The record of residents food intake was not always recorded which is necessary in order to established whether specialist diets were being catered for appropriately. The manager agreed to address this immediately to ensure that the records provided sufficient detail to determine whether diets are satisfactory, in Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: relation to nutrition and variety. 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. Residents benefit from personal and health care support that is individual, respects their privacy and dignity and encourages them to remain as independent as possible. The recording of medications must be improved in order to further promote residents safety. Evidence: The majority of residents do not require direct personal care. Instead, staff provide emotional and practical support which residents said is provided in ways that promoted their dignity and independence. A relative feedback very caring to wards health hygiene and personal interests. A staff member felt that what the home did best was to provided individual care and support. Staff support residents to ensure their health needs are met, with care plans containing a record of any visits or contact with health care professionals. There was evidence of current involvement from General Practitioners, dieticians and specialist Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: nurses. It was clear that where any health concerns have been noted by staff that these have been followed up promptly. A visiting health care professional spoke of how staff have phoned for advice in the past and that staff have follow their suggestions as to how to improve a residents mental health. A resident spoke of the physiotherapy support they had received in order to support their return to the home following an accident. The system for the administration of medication is satisfactory with arrangements in place to ensure residents medication needs are met safely. To further promote residents safety however, it is recommended that additional instructions are provided for staff on the administration of As required medication, which make clear the individual requirements for when this medications was prescribed. This is necessary in order for staff to know when to administer these medicines. Hand written MAR charts should be signed and dated by the person recording and in order to fully eliminate the associated risk when copying prescribed instructions onto medication administration records, it is recommended that these records should be checked and countersigned for accuracy by a second member of staff. In order to ensure that medical records are clear the manager agreed to cleanse the records of medicines no longer prescribed in consultation with GPs. The manager and staff demonstrated a good awareness of the needs of older people and services and facilities were aimed appropriately for the age range of residents being accommodated. The manager demonstrated a clear knowledge of when a residents needs would go beyond that which the home could safely manage. 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. An effective complaints procedure and appropriate adult protection policies helps to protect the rights and interests of residents, however the manager must ensure that all reportable events are reported to the appropriate authority in order to further safeguard residents safety. Evidence: There is a written accessible complaints procedure in place for residents, their representative and staff to follow should they be unhappy with any aspects of the service. All residents and relatives consulted with said that they were aware of how to raise any concerns and continue to feel comfortable to do so and that where they have done so their concerns have been addressed promptly. A resident said I would report to mike if I was not happy and he would make it alright. A relative said Any little concerns always been addressed promptly. The manager reported that there have no formal complaints made since the previous inspection. Residents continue to raise minor concerns relating to some of the difficulties of communal living. A relative spoke of how the manager listens to all parties concerned in these circumstances and agrees a compromise. There are written policies covering safeguarding adults and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: report any concerns they may have to a responsible authority for investigation. The staff member consulted with, although had not yet undertaken safeguarding adult training demonstrated an understanding of their roles and responsibilities in this area. The manager had not reported an event to the Commission or other external agencies which has significantly effected the well being of a resident. This is of particular concern and the manager must now have a clearer understanding of their reporting obligations in order to promote residents safety. This issue is further discussed under standard 42. 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. Residents continue to live in a clean and homely environment, which is decorated and maintained to a good standard. Residents private accommodation is personalised, safe and comfortable. Evidence: The home comprises of a converted domestic dwelling in a residential area on the outskirts of Redhill. Standards of maintenance are good, with the home having undergone a gradual refurbishment over the last eighteen months. Since the previous inspection a conservatory has been built which is now used as a dinning room and the original dinning room used as an office and sleep over room. Much effort is made throughout the home to promote a domestic and homely feel. A sample of comments made about the environment included. Comments about the environment included Environment generally clean needs a little updating in places The environment improved a great deal new furniture dinning room smartened up a bit and Bedrooms kept clean and tidy 24. Communal space consists of a kitchen, conservatory, lounge and office. There is a rear very small courtyard garden which the manager was aware of the need to make more Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: inviting and spoke of their plans to pave this areas and provide some seats. All residents consulted with liked their bedrooms. Bedrooms were seen to be personalised in accordance with the individuals taste and preferences. A resident spoke of recently purchasing new furniture for their bedroom while another resident said that their bedroom had everything they needed including sky TV. Bedroom doors had been fitted with locks with one resident choosing to lock their room when not in use. There are sufficient number of toilets and bathrooms located around the building, this includes two standard baths/showers, which all residents are assessed as able to use with support. The manager anticipated the need to replace a bath with a shower in the near future as some residents mobility is declining. The home is not suitable to admit residents with physical disabilities and the steep internal stairs and other access arrangements would make it unsuitable for people with significantly restricted mobility. Fitted throughout the home are call points, which enable assistance to be summoned when pressed. A resident felt that if they pressed it staff would come quickly. All parts of the home visited were observed to be cleaned to a good standard. A relative said it is always spotless clean. A resident spoke of being responsible for cleaning his own room and how important this was to him. 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. The staff group includes a core group who have worked at the home for many years. Their experience, together with training indicates that they have a good level of competence and are motivated and committed to supporting residents. Staff are employed in sufficient numbers as is necessary to meet the needs of residents and who are robustly recruited in order to promote residents safety. Evidence: Staffing levels have been increased in line with requirements made at the previous inspection. Consistent feedback was received of the positive impact that additional staffing hours have made to residents lives. This includes residents being able to go out more and have more one to one time with staff. It was observed through the inspection that staff understood their roles and had a good rapport with residents and planning skills. The tasks of the day appeared well organised and staff appeared confident in carrying them out. A sample of comments made about staff included very good great kind, competent very professional do everything by the book spoke they are not just kind but compassionate great asset to this household Staff kind they work hard staff very friendly very calm always someone there and if they don’t know Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: the answer they contact the manager and Staff very friendly and welcoming. A health care professional said that staff were knowledgeable about residents needs. Several staff members have worked at the home for a number of years and a resident felt that this stability meant that they received consistent support. The manager reported that over half of the staff have a National Vocational Qualification in care. A new member of staff spoke about the local induction they had and how residents were actively involved in showing them where everything was. The manager confirmed that new staff now undertake skills for care induction, which is the industry recommended minimum inductions standards. The manager spoke of the support they have received from an external training consultancy in ensuring that staff have now undertaken or are in the process of undertaking all of the mandatory areas of training necessary for them to work safely with residents. Staff are supported to only work within the range of their expertise and training and to seek advice from the manager if they are unsure of situations. Staff said they felt well supported to undertake their roles. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the manager provides a clear sense of leadership and direction and is well respected they must ensure they improve the standard of reporting to the Commission and other external agencies in order to ensure residents are safeguarded. There are systems in place to help with the promotion of residents, staff and visitors health and safety. The home acts on feedback it has received regarding the quality of its services and facilities. Evidence: The management team consists of the provider/manager and his wife who is the deputy manager. The manager remains in the process of completing the recommended management qualification. The manager is a qualified nurse and also works part time elsewhere. Without exception all persons consulted spoke positively about the manager, a sample of comments included approachable listens really good great Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: sense of humour very gently very service users focused Mike very nice man Manager he has a very good knowledge of residents and tries to accommodate and we discuss ideas and any problems and we decided together the best cause of action easy to contact. It was clear that the management team provide a clear sense of leadership and direction, however although in general standards of administration have improved since the previous inspection the manager had failed in their responsibility to report a significant accident at the home. Subsequent to the inspection the manager confirmed that they had now reported it to the relevant authority for investigation. It has been required that the commission is notified of all reportable events without delay. In line with the previous requirement the manager stated that they have now developed a feedback questionnaire which was recently been sent to relatives in order to gain feedback on the quality of the services and facilities provided. Changes to menus and communication with relatives have occurred in response to feedback received. Residents have in the main informal methods of providing feedback about the quality of the services they receive. Residents spoke of the changes to the homes practices which have occurred in response to their feedback. Written guidance is available on issues related to health and safety. Records submitted by the manager prior to the inspection stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. Systems are in place to support fire safety, which include, regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The manager reported that they have undertaken a fire risk assessment. This records significant findings and the actions taken to ensure adequate fire safety precautions in the home. 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 42 37 That notice is given to the 22/01/2009 Commission without delay of any reportable events noted under this regulation. With particular relevance to any serious injury of service users. That all accidents are appropriately reported and investigated by the relevant authority. 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 9 That Generic personal risk assessments are completed for all service users as part of their care plan, which are reviewed regularly and records the actions to manage or reduce any identified risks, to ensure that residents safety is promoted. That Hand written (MAR) charts should be signed and dated by the person recording and in order to fully eliminate the associated risk when copying prescribed instructions onto medication administration records, these records should be checked and countersigned for accuracy by a second Page 29 of 31 2 20 Care Homes for Adults (18-65 years) member of staff. 3 20 That additional instructions are provided for staff on the administration of As required medication, which make clear the individual requirements for when this medications was prescribed. 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). 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