Inspection on 30/01/09 for Auckland House

This inspection was carried out on 30th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Auckland House 55 St Ronans Road Southsea Hampshire PO4 0PP     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: Janet Ktomi     Date: 3 0 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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 33 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 33 Information about the care home Name of care home: Address: Auckland House 55 St Ronans Road Southsea Hampshire PO4 0PP 02392739600 02392739600 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Auckland Care Ltd care home 10 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 10 The maximum number of service users to be accommodated is 10. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Auckland House is registered to provide care and support to ten residents with learning disabilities and is one of two homes run by Auckland Care Ltd. It is a large Victorian terrace house is situated in a residential area of Southsea, close to local facilities and the seafront. Accommodation is organised over three floors, with eight single bedrooms and one double. At present there are only nine service users as the double room is not used as a double. The home has ample living space including a basement activity room and separate sensory room, and a small enclosed rear garden. There are a number of quiet areas and a communal lounge. Care Homes for Adults (18-65 years) Page 4 of 33 Brief description of the care home The home aims to run a person centred planning system with residents, based on their individually assessed needs and wishes. Residents are encouraged and supported to use their local community for work, education and leisure activities Care Homes for Adults (18-65 years) Page 5 of 33 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: This report represents a review of all the evidence and information gathered about the service since the previous inspection. This included a site visit that occurred on 30th January 2009 and lasted six hours. During this time we toured the premises, looked at the files of three service users, met with five service users and had detailed discussions with three of them. We also observed the support they were receiving. We met with the Responsible Individual and spoke with two other members of staff and observed interaction between staff and service users. All records and relevant documentation referred to in the report was seen on the day of the inspection visit. We also referred to the services own self assessment of the home and had written surveys returned from six people living in the home and three members of staff. Care Homes for Adults (18-65 years) Page 6 of 33 Current fees in the home range from 338.24 to 446.53 pounds per week. The Registered Manager left the service in December 2008 and no new Manager has yet been appointed. The service is currently being managed by the Responsible Individual. During this inspection the Responsible Individual was available and was able to explain what had happened since the previous manager left and what measures were being put in place to rectify problems that he had identified in the service. 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. 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 8 of 33 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 9 of 33 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. Service users benefit from having their needs and aspirations assessed prior to moving into the home. Evidence: The home requires a full care management assessment for each person before they move into the home. In addition to this, the home does its own comprehensive assessment. Records showed that all assessments were in place prior to the person moving in and that service users and their families had been involved in the assessment process. We spoke with one person who had recently moved into the home who told us their move had gone smoothly and that they had visited the home for tea once and stayed for a weekend before actually moving in. They said they had been involved in their assessment and was aware that their care plan was still being developed and staff were getting to know them so that they could complete this accurately. Care Homes for Adults (18-65 years) Page 10 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported to make their own decisions but care plans and risk assessments are not being kept under review and so the service cannot be sure it is meeting service users current needs. Evidence: All service users, except the person who recently moved in, had care plans in place. The person who had recently moved in came from one of the companys other homes and their care plan was being updated since the move. Records demonstrated that care plans were not all being reviewed on a regular basis. The Responsible Individual had identified this as a problem in the service and was planning to review all care plans in the week after the inspection. Staff spoken with were aware of the care plans and were involved with them on a daily basis. Daily diaries were kept for all service users, along with more specific recording in relation care plans. The care plans we saw were clearly written and identified the service users needs, the Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: goal they were aiming at and the actions staff had to take in order to support people to address their needs. Service users spoken with told us they were involved in devising their own care plans and the plans had been signed by service users to demonstrate that they had agreed to them. The Responsible Individual had identified that care plans had not been carried out properly over the past few months, one example being that people were not being supported to shave. He told us that this had been discussed in staff meetings and that staff had been made aware of the importance of following care plans. Care plans also contained risk assessments where specific risks had been identified. Some of the risk assessments had not been kept under review. The Responsible Individual had identified this and was planning to review them along with the care plans. Some risk assessments were not dated, so it was not possible to know if they were current or if they being reviewed. Risk assessments were used to ensure that people were supported to take risks that were important to their personal development but that this was done in a managed way and involved them fully. Some service users had financial risk assessments in place, but some did not. We discussed with the Responsible Individual the need to ensure that all services users had a risk assessment in place regarding their finances. The care plans emphasised the need for service users to make their own decisions and observation of staff interactions with service users throughout the day demonstrated that staff understood this and were able to support people to make their own decisions rather than making decisions for them. Care Homes for Adults (18-65 years) Page 12 of 33 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. Service users benefit from having their rights respected and from being able to choose nutritious and varied food options. They also benefit from having the opportunity to engage in a wide range of activities both inside and outside of the home. Evidence: The home encourages and supports service users to be involved in a wide range of community facilities and leisure pursuits according to their own individual needs and preferences. Records of activities and discussion with staff showed that service users were supported to make use of a wide variety of local facilities and to be involved in the activities they had chosen. All six of the service users who responded to our written surveys said they were able to make decisions for themselves about the activities they were involved with. One Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: person also said that they would like more staff so that they were able to go out more. Individual preferences about activities were recorded in peoples care plans and it was clear that the activities arranged for each person reflected their interests. Service users spoken with said they had full and busy weeks and were spending their time doing the things they wanted to do. Employment was arranged for people who wanted it. Each person living in the home had their own weekly timetable recording the activities they were taking part in and those spoken with were aware of their timetables and said they reflected the activities they had chosen. In the house there was an activities room in the basement which contained a wide range of different activities for people to do within the home. Some people living in the home were being supported to move on to more independent living and the home had a structured approach to help people develop the skills they needed for this and liaised with Care Managers and the local college in helping people to develop those skills. Throughout the inspection visit there was a lot of laughter and enjoyment in the home and people living there communicated a lot with each other and with the staff who support them. People living in the home were supported to maintain contact with their friends and families. Service users were encouraged to have visitors at any time that was suitable to them. Staff spoken with said that understood that this is the service users home and they should have visitors whenever they wanted to. There was a payphone in the hall which received incoming calls for service users and there was also a hand held phone so that people could make and take calls in the privacy of their own room. The home had a very positive approach to supporting people with their relationships and, through policies and staff training, recognised that relationships were important to people. At the time of the inspection visit the home was liaising with the Community Learning Disabilities Team in establishing one persons ability to consent to a personal relationship. This showed that the home supported the building of relationships but also understood their duty to protect people living in the home and to ensure that they were not open to any kind of exploitation. Menus in the home were devised in consultation with service users during house meetings. The menu for the week was displayed on the wall in the dining room and each person chose the meal they wanted for each day on a weekly basis. They could also change their mind and have an alternative if they did not fancy the meal they had chosen for a particular day. Care plans also highlighted that people could choose alternatives to the set menu if they wanted to. Menus showed that the food was varied Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: and nutritious and records were kept of individual food intake. Service users spoken with were very positive about the food in the home and said they always received sufficient portions. Service users were involved in helping to prepare meals and those observed on the day of the inspection visit appeared to enjoy this. The Responsible Individual had identified that over the previous months the menus had not been followed properly and records of what food each person had were not being completed. He had also identified that food in the fridge was not being labeled correctly. Plans were in place to address this Care Homes for Adults (18-65 years) Page 15 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are not protected by the homes medication practices, but do benefit from having their other healthcare needs addressed. Evidence: Care plans contained information on how people preferred to be supported with their personal care. The files of people living in the home demonstrated that healthcare needs were monitored and that people were supported to use healthcare services as necessary. There were comprehensive records relating to each persons health. Where people had used healthcare services there were records of the visits and all issues appeared to be followed up. Care plans contained specific information about responding to individual healthcare needs where they had been identified. One persons file contained a care plan in relation to their epilepsy and there was also information for staff on the usual pattern of their seizures. There were records of each occasion where a seizure had occurred and the action the member of staff needed to take. The homes medication policy was clear and the procedure for administering Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: medication was on the wall next to where the medication was stored in order to ensure that staff were aware of how they were expected to administer medication. All staff involved in administering medication had received training. The storage of medication was safe and there were weekly audits of the medication in the cupboard and the records. We identified three problems with medication during the inspection visit. There were some gaps in the records of medication that had been administered and these were unaccounted for. Therefore the home is not able to demonstrate that people living there are receiving their prescribed medication on a regular basis, as prescribed. If people do no receive their medication as prescribed it may have a detrimental effect on their health. Also, we observed a service user being given her medication and it was put in front of her at the dining room in a pot. The homes policy states that staff must observe service users taking their medication and then record that the medication was taken. In the case of this person, the member of staff left the medication on the table and failed to observe the person taking it. The member of staff recorded that the person had taken their medication but, in reality, did not know whether or not this was the case. A further problem with this is the fact that the medication could have been consumed by any of the other service users who walked through the dining room at that time. The member of staff had also failed to give the service user a drink of water to take her medication with and she had to ask for this. There were processes in place to identify when people needed as necessary medication and these were recorded in peoples care plans. Some of this medication was to assist people in calming down when they became distressed. The Responsible Individual told us that other ways of responding to the persons distress were also in place, but these had not been detailed and ordered in the plans. The plans need to clearly describe the range of interventions that need to be tried and these need to be in the order they need to be tried, with the administering of medication being after all other responses had been tried. Care Homes for Adults (18-65 years) Page 17 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from being able to make complaints where necessary, but are not protected by the way the home manages and looks after their finances. Evidence: The home had recently had an issue where a large amount of money was stolen from people who live there. It is believed the money was taken by someone who worked in the home. Since that time, the person suspected of taking the money has left the service. The service had acted promptly and suspended the member of staff from duty on the same day that their suspicions were raised. The service also followed the local safeguarding procedures and reported the incident appropriately. The Responsible Individual has told us that the service will repay all the money each service user has lost. He also told us of the measures the service has put in place and is planning to put in place in order to ensure that this kind of incident cannot be repeated in the future. They have re-emphasised the existing policy on dealing with service users money. This policy had not been followed properly during the time the money went missing. In addition they reviewed the policy to ensure that it is robust enough to protect service users. The Responsible Individual and one member of staff are the only people who currently have access to service users money. The organisation has also appointed a finance administrator to monitor finances across all the homes the organisation owns, including individual service users finances. Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: For the future the service has planned to have monthly audits of all the money in each of the homes, including service users money. These audits will be in addition to the regular monthly visits to the home by the Provider. (See also the Conduct and Day-toDay Management of the Home section of this report.) Staff in the service look after the finances of six of the people living in the home. This had been audited four days prior to the inspection visit. During the inspection visit we looked at the financial records for those six people and compared them with the amount of money each person actually had in their cash-box. We found that the records for two people showed discrepancies between the amount of money the people should have had and the amount they actually did have. When we pointed this out we were told that there had probably been a mix up between the service users money and the homes petty cash money. In following this through we found that this was actually the case. However, after paying back money from the petty cash there were still discrepancies. We discussed with the Responsible Individual that the management of service users money must be given the time and attention it deserves. Accepting that the organisation is planning further improvements to managing service users money, we have still made a requirement in respect of this in this report as there was evidence that measures they had already put in place had clearly been ineffective in ensuring that the financial interests of people living in the home were being adequately protected. The home has good policies and procedures in place for dealing with allegations or suspicions of abuse. Staff had received relevant training and had read the homes policies. Staff were aware of the importance of potential abuse issues and of the need to ensure that incidents were well recorded. The home has a complaints policy in place and a system for recording and responding to complaints. Of the six service users who responded to our written surveys, four told us that they were aware of how to make a complaint and five told us that staff in the home listen to and act upon the issues they raise. It was clear from complaints records that service users were supported and encouraged to make complaints. Some people had made their own written complaints and others had had support from in recording the complaints they made verbally. The kinds of complaints recorded included topics of discussion during mealtimes, being sworn at by other people living in the home and being kept awake by the person in the next room. One person had complained about staff not accurately recording issues in relation to his care plan. All of these complaints Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: had been taken seriously and had been responded to by the service and good records were kept to demonstrate this. The homes Complaints Policy was visible throughout the home and was also available in an audio format. Care Homes for Adults (18-65 years) Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from living in a homely environment. They would benefit further from the garden area being maintained and from staff respecting their home. Evidence: The house is very homely and comfortable. There are pictures of service users throughout the house. Service users are able to move freely around the home and appeared to feel comfortable and at home. The house is very large and there were sufficient rooms so that people could spend time with each other when they wanted to but could also have personal space when they wanted to as well. Service users bedrooms are well equipped and they have been able to bring their own possessions with them to the home. Service users spoken with felt that it was their home and that they could use it as they wished. There is one double bedroom in the home and the Responsible Individual told us that this would only be used as a double room if there were two people who had a relationship and specifically wanted a double room. At present this room is being used by just one person. There are plans at present to update parts of the home and a new kitchen is about to be installed. Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: The garden area was small but pleasant and was used in the summer for barbecues. There was some rubbish in parts of the garden which the Responsible Individual told us would be removed. There were also a large amount of cigarette ends outside the back door. None of the people living in the home smoke and so all the cigarette ends had been left there by staff. This was despite the fact that an external ashtray had been attached to the back wall of the house. We discussed with the Responsible that this showed a lack of respect by staff for the service users home and could affect their enjoyment of the garden area. The Responsible Individual had identified that the cleanliness of the home had not been adequately maintained over the previous six months and was beginning to appear not as clean as it should be. A team of staff have been identified to go into the home and work through each room to bring them up to a standard acceptable to the Responsible Individual. A rota for cleaning the home will be implemented so that cleanliness is maintained on an ongoing basis. Service users were supported to be involved in the cleaning of the house if they had identified this as something they had wanted to do. Over the past six months they had not been adequately supported to do this, but the Responsible Individual was now ensuring that the necessary support was available to them on a regular basis. The issue of the cleanliness of the home had been raised by the Responsible Individual at a recent staff meeting and was beginning to improve. Hygiene policies and practices in the home were observed and monitored and no hygiene issues were identified through the course of the inspection visit. Care Homes for Adults (18-65 years) Page 22 of 33 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 benefit from being supported by adequate numbers of well trained staff and are protected by the homes recruitment policies and practices. Evidence: Examination of three recruitment records in the home demonstrated that staff were employed within the homes recruitment policy and that all necessary pre-employment checks had been undertaken prior to them beginning work in the home. Staff told us they had been required to provide all relevant information prior to beginning work in the home. Staff training was well managed and good records were kept of the training that each member of staff had received, what training they still needed to do and when updates were required. Staff told us the training was useful and relevant to their role and that access to training was good. Records showed that staff received training appropriate to the needs of people living there. Service users told us they thought the staff had the skills to support them and meet their needs. Observation of staff during the inspection visit showed that they were skilled in communicating with people living there and that they demonstrated an understanding of the needs of people who have a learning disability. Observation of interaction between staff and service users showed that staff Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: worked in such a way as to maintain a happy and enjoyable environment for people. Examination of staff records showed that they had not been receiving support and supervision on a regular basis and this was confirmed in the responses from staff to our written surveys. The Responsible Individual was aware that this had been the case and was beginning to re-start formal supervision sessions with all staff. The home employs nine staff and has two members of staff working throughout each day. In addition to this the Manager is available and is used to support people in the home so that other staff can take people out. In addition to these staff hours there are sixteen hours a week that can be used at the Managers discretion to support one-toone activities with people living in the home. At night there are two members of staff in the home, one of these is awake all night and the other sleeps-in and is available if necessary. The Responsible Individual had identified that rotas in the home had become inaccurate and did not accurately reflect the times when staff were actually working. He has begun to address this by completing the rotas himself and initiating a procedure whereby changes to the rota are clearly recorded. Care Homes for Adults (18-65 years) Page 24 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has been badly managed and badly monitored. The home has failed to ensure that the needs of service users are fully met and that people living in the home are protected from harm. Service users would benefit from more thorough management of health and safety issues in the home. The views of people who use the service are sought and do provide a focus for improvements in the home. Evidence: The Registered Manager for the service has recently left the organisation and so there is currently no Registered Manager in place. At present the home is being managed by the Responsible Individual, who is also a Director of the organisation. He is supported in this by the Assistant Manager. In discussion with the Responsible Individual we were told that the organisation will be appointing a new person to become the Registered Manager of the home, but will take their time to ensure that they get the right person for the job. The interim management arrangements will remain in place until the new Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: person is appointed. The responsibility for carrying out the required monthly visits to the home by the Provider had been delegated to the manager of another home in the organisation. Reports of these visits were then completed and passed on to the Directors of the organisation. We were told that the person undertaking these visits had been ineffective in identifying issues in the home and had also recently left the organisation. As a result of this, many aspects of the service had deteriorated and money was being stolen from service users. The Responsible Individual acknowledged the role he and the other Directors of the company had in this process and they have now decided that the responsibility for carrying out monthly visits would not again be delegated. In future only the Directors of the company will carry out these visits. New formats have been developed for carrying out these visits and in future they will be more thorough and based on seeing evidence evidence of good management practices in the home rather than just accepting the word of the Manager. Finances in the home, including service users money, will be monitored during separate and specific monitoring visits and the company have employed someone to undertake this role. In addition, the four Directors of the company now each have more defined roles and areas of responsibility. The Responsible Individual had identified that internal communication in the home was ineffective and he has begun to address this. He had also identified that weekly service user meetings had not been happening regularly and this was also being addressed and we saw evidence that a meeting had been planned for three days after the inspection visit. The quality assurance processes in the home are well developed and include feedback from service users, their relatives and other professionals such as Care Managers. There was evidence that things in the home had improved as a result of feedback from service users. Examples of this included changes to the menus and the redecoration of one persons bedroom. The home had also recently introduced a suggestions box, which was available in the hallway. We discussed with the Responsible Individual that it would be useful if satisfaction surveys were dated so that they could be related to improvements in the service and demonstrate that the service is responding to feedback. The home has a maintenance book where issues are highlighted by staff and then ticked off by the maintenance person when they are addressed. We suggested to the Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: Responsible Individual that it would be better if the maintenance person dated when issues were addressed so that the service could demonstrate how quickly it responds to maintenance issues. There were systems in place for monitoring and managing health and safety issues in the home. Records were kept of all health and safety issues including fire, appliance servicing, substances hazardous to health, accidents and electrical testing. All staff received initial training in health and safety as part of their induction as well as regular updates. Regular checks and records were kept relating to health and safety aspects of the home. Despite this, there were two health and safety concerns we highlighted during the inspection visit. One service users bedroom had a number of extension leads from sockets to the electrical items he had in his room. As well as presenting a potential tripping hazard, it was unclear how safe it was having so many extension leads. The safety or otherwise of this needs to be ascertained by a qualified electrician. Outside the fire escape from the activities room to the back garden was an amount of rubbish that had collected there as a result of being blown by the wind. This represents a hazard in the event of the fire escape needing to be used and the rubbish needs to be cleared away and the exit regularly checked to ensure it remains safe. The quality assurance process in the home is being developed and is focused on the people living in the home and uses their feedback as the basis for improvements to the service. From the quality assurance system we were able to see that improvements had been made to the service as a direct result of issues raised by people living in the home. These included menus in the home being changed and one service user having their bedroom re-decorated. There are regular house meetings where people living in the home have the opportunity to voice their opinions and service users spoken with confirmed that these were useful meetings and that staff listened and responded to what was brought up. Care Homes for Adults (18-65 years) Page 27 of 33 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 33 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 6 15 The Responsible Individual 10/04/2009 must ensure that all care plans are kept under regular review So that people receive the service they require according to their current needs 2 9 13 The Responsible Individual must ensure that all risk assessments are dated and kept under regular review So that potential risks are identified and measures put in place to minimise them and so that this information is current and accurate 10/04/2009 3 9 13 The Responsible Individual must ensure that a financial risk assessment is in place for each person using the service. To minimise the risk of people losing their money 10/04/2009 Care Homes for Adults (18-65 years) Page 29 of 33 4 20 13 The Responsible Individual 10/04/2009 must ensure that the process for administering as required medication lists the full range of alternative interventions to be tried prior to the medication being administered. So that people do not receive medication when other interventions may prove successful 5 20 13 The Responsible Individual 10/04/2009 must ensure that medication records are accurately completed. So that it is clear whether or not people have taken their prescribed medication 6 20 13 The Responsible Individual 10/04/2009 must ensure that all staff observe service users taking medication before recording that they have done so and ensure that medication is not left where it may present a risk to other people living in the home. So that it is clear whether or not people have taken the medication they have been prescribed and to eliminate the risk of others taking medication they have not been prescribed 7 23 13 The Responsible Individual 10/04/2009 must ensure that accounting and monitoring measures are put in place to ensure that service users are not at Care Homes for Adults (18-65 years) Page 30 of 33 risk of losing money that is managed for them by the home So that people have the amount of money they should have and so that it does not go missing 8 24 12 The Responsible Individual must ensure that staff respect service users home by not leaving cigarette ands in the garden So that service users do not have to experience staff cigarette ends when they want to enjoy time in their garden 9 42 13 The Responsible Individual 10/04/2009 must ensure that the wiring in the bedroom discussed is safe both in terms of the safety of the electrical wiring and the risk of tripping on flexes To ensure that the person in this room, and any staff supporting him, are not at risk of electrocution or tripping 10 42 13 The Responsible Individual must ensure that all fire escapes are kept free from hazards o that escapes routes can be used safely in the event of an evacuation being necessary 10/04/2009 10/04/2009 Care Homes for Adults (18-65 years) Page 31 of 33 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 Care Homes for Adults (18-65 years) Page 32 of 33 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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