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Inspection on 11/11/08 for Ashley Phoenix Unit

Also see our care home review for Ashley Phoenix Unit for more information

This inspection was carried out on 11th November 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.

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

What the care home does well

The service users spoken with are happy living in the home. A core of experienced staff have a good knowledge of service users` needs and how to communicate effectively with them. The relatives who wrote to us said they are very satisfied with the quality of the care and support provided and think that staff have the right skills and experience to look after people properly. Staff members spoken with, or who wrote to us, said they are always provided with up to date information about the care needs of the people they support. They are provided with appropriate training and remain well supported in their roles. The health professionals who wrote to us said service users` health care needs are well met and their privacy and dignity is respected. The home continues to develop person centred approaches to support service users. The home is well run and provides an open and inclusive atmosphere for service users and staff. The home is well maintained and adapted to meet the needs of the people who live at Ashley Phoenix.

What has improved since the last inspection?

All staff members are now supervised on a regular basis. This ensures they are supported to provide a good quality service to the people who live in the home. Fire safety has now been improved and this promotes the welfare and safety of the people who live or work in the home. The home continues to review progress in providing information to service users in a range of formats they can understand. This helps each person to make informed choices and be involved in their care planning in a meaningful way.

What the care home could do better:

The home must continue to keep staffing levels under review to ensure service users` opportunities are not limited unnecessarily. Risk Assessments must be regularly reviewed and updated. This would promote the welfare and safety of service users. Each member of staff must complete their planned training programme to ensure they have the knowledge and skills to support service users appropriately. The new shower should be attended to as this would enable service users to use this if they choose.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ashley Phoenix Unit RNID Poolemead Centre Watery Lane Twerton Bath Bath & N E Somerset BA2 1RN     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: David Smith     Date: 1 1 1 1 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: Ashley Phoenix Unit Watery Lane RNID Poolemead Centre Twerton Bath Bath & N E Somerset BA2 1RN 01225332818 01225480825 julie.sheppard@rnid.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: RNID care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 sensory impairment Additional conditions: May accommodate up to 11 persons aged 18 to 64, requiring personal care. Date of last inspection Brief description of the care home The Ashley Phoenix Units are one of the services operated by the Royal National Institute for Deaf People (RNID). They are situated on the first floor of the central Poolemead building and provide support and care for adults with a single or dual sensory loss, and associated learning disabilities. The building is divided into two distinct areas, Ashely and Phoenix, with 11 bedrooms in total, although only 9 people currently live in the home. Each separate area has a lounge, kitchen and dining space. There is no structural barrier between the areas, but each provides for a specific group of service users and retains its own identity. Each person who lives in the home has impaired hearing and vision. Staff are provided with specialist training to enable them to meet each persons support needs and communicate effectively with them. Staff are supported to become proficient in using a number of communication methods including British Sign Language, Deaf Blind Manual Alphabet, hands on signing, body language, Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 11 Brief description of the care home gestures and clear speech. A patio and garden provides external space for service users to spend time in a relaxed and pleasant environment. 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: The last Key Inspection of this service was carried out on 11/01/07. This was an unannounced visit to the home as part of a Key Inspection of this service. The pre-inspection planning involved reviewing the report of the last Key Inspection carried out in January 2007, the Annual Service Review carried out in June 2008 and the service history, which details all contact with the service. We (the CSCI) provided the home with their Annual Quality Assurance Assessment (known as an AQAA). This is a self-assessment, which focuses on how well outcomes are being met for the people who live at Ashley Phoenix. The home sent us their AQAA Care Homes for Adults (18-65 years) Page 6 of 31 when we asked for it. It was clear and gave us all the information we asked for. We provided a number of surveys for service users, their relatives, health professionals and staff members to enable us to carry out the last Annual Service Review. Twelve surveys were completed and returned and the views of the people who wrote to us have also been included in this Key Inspection report. We gathered additional information for this report by looking at a number of records within the home such as care plans and associated records, risk assessments, accident and incident reports, staffing and health and safety records.We also viewed all communal areas of the home and two of the service users own rooms. We spoke with service users and spent time informally observing interaction and communication between staff members and some of the people who live in the home. We also spoke with some staff members who were working in the home on the day of our visit, one Senior Support Worker, the Activities Co-ordinator and the Registered Manager. What the care home does well: What has improved since the last inspection? What they could do better: The home must continue to keep staffing levels under review to ensure service users opportunities are not limited unnecessarily. Risk Assessments must be regularly reviewed and updated. This would promote the welfare and safety of service users. Each member of staff must complete their planned training programme to ensure they have the knowledge and skills to support service users appropriately. The new shower should be attended to as this would enable service users to use this if they choose. Care Homes for Adults (18-65 years) Page 8 of 31 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. People are provided with the information they need to enable them to chose if they wish to live in the home. Their needs are fully assessed before they are offered the opportunity to move into this home. Evidence: The home has a Statement of Purpose, which clearly describes the services the home is able to provide. This also contains photographs of the home and the grounds, which readers may find of interest. They also have an annual operational plan, which can be read with the Statement of Purpose, as it includes the objectives the home is working towards. There have been no new admissions to the home since our last visit, however the care records we looked at show that each person has their care and support needs Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: thoroughly assessed before they are given the opportunity to move into Ashley Phoenix. 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. Service users assessed and changing needs and personal goals are generally reflected in their personal plan. Each person is supported to make choices about their lives and to take risks. Evidence: We looked at three peoples care records. These have been changed into a new, improved format since we last visited. Each person now has the following files: care plan, risk assessments, daily notes, health professionals visits and incident forms. These records generally provide clear details of the care and support each person requires. Care plans are written in a person centred way as they only describe the support each person requires such as with personal care, communication, mobility, their money and any daily routines they have. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: Two peoples records contained up to date information. One person does not have a current care plan due to recent significant changes in their care and support needs. We did spend time with this person during our visit and discussed their care plan with their Keyworker. It is clear that the home is working hard to ensure they are meeting this persons changing needs. There is a great deal of information in their care records, relating to their current needs, which needs to be included in the new care plan. This individuals Keyworker said they will begin bringing all the latest information together and writing the new care plan later in the week as they have been given time to complete this. Care files have records of the multi agency review, which service users, family members, staff from the home and representatives from each funding authority attend. These are carried out annually, although formal reviews can be arranged more often if required. The home produces a comprehensive report for each meeting and the outcomes of each review are used to update care plans. Keyworkers are also now completing monthly summaries for service users. This gives an overview of events for each person and is used as part of the homes internal review process. A new format for these reports has been developed and is in use for most of the people who live in the home. It is hoped that all Keyworkers will be producing these reports in the next few weeks. Service users are supported to make choices and staff are provided with the training they need to enable them to communicate effectively. People who live here use a variety of methods to help them communicate, such as sign language, body language, gestures and speech. We did communicate directly with some people who live in the home and they appear to be happy living here and are comfortable with the staff who support them. However, more in depth communication would require an extremely good knowledge of each individual which can only be built up over a significant period of time. We therefore spent time with service users and staff in communal areas of the home so we could observe interaction and communication. This shows that staff have a good knowledge of how each person communicates. Staff members let people make choices and gave them the time and support they need to make the best use of their skills and abilities. Each service user has a number of personal risk assessments to support them to take risks as part of their lifestyle. Most of the assessments we looked at are well written Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: and up to date. Others have not been reviewed recently and some new assessments need to be added to one persons care plan. The manager and care staff we spoke with agreed that this area needs to be improved for one or two people who live in the home and staff will be given time to complete this as soon as possible. Care Homes for Adults (18-65 years) Page 15 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. Each person is generally provided with the opportunity to take part in a range of activities, both locally and in the wider community, and personal relationships are supported. A healthy and balanced diet is offered to each person who lives in the home. Evidence: Service users continue to have the opportunity to attend RNID Educational Development Studies or the workshop, where a variety of courses or activities are on offer. People are also supported to use community facilities and records show that people go out on shopping trips, for meals out and other activities such as swimming and horse riding. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: The home has an activities co-ordinator who works as part of the staff team. We spoke with this member of staff and they said they continue to support service users on trips out of the home and on holidays as well as generally overseeing each persons education and activities programme. Service users have been supported to choose and go on holidays, both in the UK and abroad. There have been day trips to the coast, to the circus and to see different shows at the theatre. Each person continues to be supported by their Keyworker to choose and plan their activities programme, with new activities offered wherever possible. The home currently has vacancies in the staff team, although the home is currently advertising these vacant posts. The manager and staff members we spoke with, and those who wrote to us, said this does sometimes restrict opportunities for service users to be able to go out or limits the range of activities available to them. Staff shortages are covered by existing staff working additional hours, the RNIDs relief staff and agency staff. In contrast to our last visit, the home now uses agency staff regularly. They cannot support people in the community or remain in the home without RNID staff, and this inevitably limits opportunities for people who live in the home. Each service user is supported to maintain contact with their family and friends and visitors to the home are welcomed. The relatives who wrote to us said they are very satisfied with the quality of care, are kept up to date with important issues and feel the home supports people to live the life they choose. Comments from relatives include: we are fortunate to have our daughter in such a marvellous unit and I couldnt wish for a better place for my son to be looked after. It is clear that service users are respected and treated with dignity. Staff respect their privacy, such as waiting for permission prior to entering their rooms. Health professionals who wrote to us said that they feel staff always respect individuals privacy and dignity. Service users are offered a choice of meals which provide a healthy and balanced diet. Clear records are kept of what meals each person has chosen to eat each day. There are two dining areas, one in Ashley and one in Phoenix, which are suitably furnished. 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. Individuals are provided with personal support in the way they prefer and their physical and emotional needs are met. The homes policy and procedures relating to medicines protect service users. Evidence: Each service user is registered with a local GP, dentist and other relevant professionals such as an optician. Other professionals support the home when required, such as the physiotherapist, speech and language therapist and audiologist. Contact with each professional is clearly recorded and their advice is acted upon. The health professionals who wrote to us said the home works in partnership with them, they are satisfied with the care and support provided and feel staff have a clear understanding of service users needs. One commented all aspects of client care are well taken care of. The staff we spoke with have a good knowledge of the care and support service users Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: need and how best to provide it. They have attended training sessions, such as intimate care, to ensure they have the right knowledge and skills to provide support in a sensitive way. The knowledge and awareness staff have regarding the service users health needs remains crucial in ensuring these are met. Some people who live in the home have very limited communication skills and therefore rely on staff to recognise any changes or signs which give them cause for concern. Staff work hard to ensure that individuals changing needs are met. The home uses the Boots monitored dosage system of medication administration. Medication records contain a profile and recent photograph of each service user, details of the medication they take and times, and manufacturers notes on all the medicines used in the home. There is a list of staff signatures and a sample of the initials they use on medication records. Each person has there own daily medicine record and the ones we looked at were well written, with no gaps evident. Staff members, who support service users, are provided with formal training to enable them to administer medicines safely. 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. Service users views are listened to and acted upon. They are protected from abuse, neglect and self harm. Evidence: The home has a formal Complaints Policy, an Adult Protection Policy and a Whistle Blowing Policy, which staff can use in confidence to raise any issue or concern they have regarding the service. The homes AQAA confirms there have been no complaints in the last twelve months. We have not received any concerns or complaints regarding Ashley Phoenix. Some service users would be able to communicate if they are unhappy or if they do not feel safe. Others would rely on staff to pick up on this and those staff we spoke with said they use their daily observation and interactions to help them identify any changes which cause them concern. Relatives who wrote to us said that they know who to speak to if they are unhappy and know how to make a complaint. The health care professionals who responded said they have never had cause to complain and had received no complaints themselves regarding the home. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: The home has clear guidelines and risk assessments in place for supporting service users who are distressed or present behaviours which may be perceived as challenging the service provided. People who live in the home can display a variety of behaviours such as self-harm, aggression towards staff and each other. Staff receive training in responding to these using the MAPA (Management of Actual or Potential Aggression) system, accredited by the British Institute of Learning Disabilities. The staff members spoken with said they feel confident in supporting individuals who are distressed and that this is generally easy to diffuse. Some members of staff feel that some of these behaviours are caused by the issues with staffing, described earlier in this report, limiting service users opportunities to leave the home. Staff are also provided with training in relation to the Protection of Vulnerable Adults, Child Protection and are subject to Criminal Record Bureau enhanced disclosures. Staff record each incident of challenging behaviour. The home also maintains records of all other accidents and incidents and notifies us of any significant events which occur in the home. We looked at three service users finance records. These are well audited with regular checks on the funds coming into or going out of their bank accounts. Service users keep a small amount of personal money in the home, which the staff support them with. Each time they spend some of these funds, staff ensure they obtain a receipt and two staff then sign the records to confirm how much has been spent and what it has been spent on. The staff then have to check that the remaining balance is correct. The manager checks each of these records monthly. 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. Ashley Phoenix provides a homely, comfortable and safe environment for people to live in. Evidence: Ashley Phoenix is a self contained unit, on the first floor of the main Poolemead building. There are large communal grounds on the site and the home has its own attractive garden area. The home is divided into two distinct areas, Ashley and Phoenix, with eleven bedrooms in total. Each separate area has a lounge, kitchen, and dining area. There is no structural barrier between the two areas, but each provides for a specific group of service users and retains its own identity. Many communal areas and some bedrooms have been redecorated since our last visit and new furniture has been purchased. The home continues to make good use of contrasting colour schemes, which benefits people who have a visual impairment as it may help them when they move around the home. A large shower room and toilet has been created by removing a bath and a dividing Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: wall. This area has been redecorated and the new fixtures are of a good quality, although problems with water pressure are currently preventing the shower from working properly. There are many tactile features fixed to the walls, which help people to map their environment and provide stimulation. Staff members discussed adding some tactile features to one service users bedroom on the day of our visit as they thought this would improve the room for them. Both Ashley and Phoenix units have many photographs of the people who live there, together with various pictures. This helps with the homely feel. We viewed two peoples bedrooms. They chose the style and colour schemes used in their rooms. Both individuals have many personal item, pictures and furnishings which reflect their personal taste and interests. Both units were clean and tidy on the day of our visit. Service users help keep their home clean and tidy, with the support of staff. 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. Service users are supported by a competent, well supported and generally well trained staff team. The homes recruitment policy and practice protects service users. Evidence: There continues to be shortages within the staff team, however the home has a core of experienced staff who have a good knowledge of service users needs and how to provide appropriate support. The staff who wrote to us, and those we spoke with, said that they enjoy their jobs, everyone works well as a team and feel they are well supported. Observation of their work practice shows they are confident supporting service users and skilled at communicating with them. Newer members of the staff team spoke highly of their induction to the home. Relatives who wrote to us said they feel staff have the right skills and experience to support people properly. One relative said the staff are first class and another said the staff are marvellous. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: Health professionals who wrote to us said staff support individuals health care well and they are able to respond to different needs. One said that all staff are professional and caring. The staff teams continue to meet regularly in each unit and records are kept of each meeting. Staff take turns in organising these meetings and those spoken with said they find them useful, feel able to talk openly and they are able to add any item to the agenda for discussion. The RNID has a robust recruitment process. Before staff are able to start work in the home they need to provide proof of their identity, at least two satisfactory references and an Enhanced Criminal Record Bureau disclosure. The staff we spoke with, and those who wrote to us, said all relevant checks had been carried out before they started working in the home. Each member of staff now has their own file where these records are kept. Staff members said the RNID provides excellent training and a number of courses have been organised for staff since our last visit. The records we looked at show that the following courses have been provided in the last year: fire safety, food hygiene, first aid, intimate care, medication administration, epilepsy, diabetes, how to move or handle people safely and MAPA. The home keeps a record of each course staff members attend. Whilst most staff have completed their training programme, some members of the team still require core training such as adult protection. Additional training sessions have been planned which run into 2009. These sessions include training on health and safety, people who selfharm, fire safety for managers and sexual awareness. Staff have an annual appraisal and are provided with formal supervision by their line manager in 1:1 meetings. The frequency of supervision has improved: staff we spoke with said they are supervised every six weeks and found these sessions to be very useful. The home keeps records of each meeting as well as a list of supervision dates for staff. 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. Service users views are sought and they benefit from living in a well run home. Their rights and best interests are safeguarded and their health, safety and welfare is promoted and protected. Evidence: The Registered Manager, Mrs Sheppard, has worked in the home for four years. She has a number of years experience in the social care field and is suitably qualified. She attends regular training sessions to ensure she remains up to date on new legislation or ways of working. The management team consists of the manager, supported by two seniors, one with deputy manager responsibilities. This has changed recently, as one senior is on maternity leave. This post is being covered by two experienced support workers being Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: given extra duties. We spoke with both of these staff who are looking forward to their new roles and feel they are being well supported. The management approach remains open and positive. The staff we spoke with said they feel the home is well run and they are able to discuss issues with any member of the management team in an open and honest way. The manager said she continues to enjoy her job and feels well supported by the RNID. The management systems and structures are efficient and record keeping in the home is good, with some areas being improved since our last visit. It is evident that the home continues to look for ways of improving systems they use and the service provided to the people who live here. The home works hard to obtain the views of service users and other people with an interest in the service. They use surveys and act on the information contained in them. They have also started to use a communication tool called My Say which uses symbols to help the people who live in the home to express their feelings on a number of topics. The RNID has a large number of policies and procedures to ensure the home is run in accordance with the law and remains aware of areas of good practice. The manager provided full details of each policy as part of the last AQAA she completed. The registered providers representative continues to visit the home each month to audit the service. They produce a comprehensive report of their findings, which the homes manager now has the opportunity to comment on as part of each report. There are health and safety recording systems in place which are now being used consistently. We looked at records relating to fire safety checks and fire drills, water temperature checks and visual health and safety checks. All of these records are up to date. The home has a number of general risk assessments in place to support safe working practices. These are well written and they are reviewed regularly. 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 9 13 The home must ensure risk 14/01/2009 assessments are regularly reviewed and updated where necessary. This will promote the welfare and safety of service users. 2 13 18 The home must ensure staffing levels and the complement of staff is kept under review. This will ensure that service users do not have their opportunities limited. 14/12/2008 3 35 18 Each member of staff must complete their planned training programme. This will ensure staff have the knowledge and skills to support service users appropriately 14/03/2009 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. Care Homes for Adults (18-65 years) Page 29 of 31 No. Refer to Standard Good Practice Recommendations 1 6 The home should continue to review its progress in providing information in formats which service users are able to understand. The new shower should be attended to as this will ensure service users are able to use this if they wish to. 2 27 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. 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