Inspection on 20/01/09 for Balmain Care Home

This inspection was carried out on 20th January 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

The Vicarage

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Stepping Stones

Cornerstones

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Balmain Care Home 1,2,3 & 4 Keppel Terrace Stoke Plymouth Devon PL2 1BT     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: Clare Medlock     Date: 2 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 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: Balmain Care Home 1,2,3 & 4 Keppel Terrace Stoke Plymouth Devon PL2 1BT 01752556546 01752556135 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Karlyon Care Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 28 Number of places (if applicable): Under 65 Over 65 0 0 mental disorder, excluding learning disability or dementia physical disability Additional conditions: 28 28 The maximum number of service users who can be accommodated is 28. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (Code MD) Physical disability (Code PD) Date of last inspection Brief description of the care home Balmain care home is made up of four large terraced houses in a residential area of Plymouth. The home is close to local shops and amenities. The home is registered for up to twenty eight people of either gender who need care and support for mental health illnesses. The home is made up of four houses which have been joined and adapted to meet the needs of people living there. The home is arranged over three Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home floors with stairs being the only way of accessing all floors. There are ramps and grab rails to assist with mobility. There are many commual areas throughout the home and front gardens where people sit in fine weather. Each person has their own room with nearby bathing and toilet facilities. 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 quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Prior to this inspection we received a well completed Annual Quality Assurance Assessment from the Registered Provider. The AQAA is a self-assessment record that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. This key inspection also consisted of an unannounced visit to the home on Tuesday 20th January 2009. Care Homes for Adults (18-65 years) Page 6 of 31 During this time we spoke to the Providers, manager, assistant manager, senior care staff and three people who live in the home. We spoke at length to 1 relative, and 1 other staff member. We case tracked three people who use the service. Case tracking means we looked in detail at the care three people receive. We spoke to staff about their care, looked at records that related to them and made observations if they were unable to speak to us or able to provide feedback. We looked at three staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the safeguarding systems work and what this means for people who use the service. We asked about the fees charged at Balmain and were told the lowest fee is two hundred and eighty five pounds and the highest fee is six hundred and seventy five pounds. The Provider informed us the fees depended on such things as individual need. During the inspection we watched interactions between staff and people living at the home. All this information helps us to develop a picture of how the home is managed and what it is like to live at Balmain. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 8 of 31 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care 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 who use the service and their relatives have the time care and information they need to decide whether Balmain is the right home for them to move into. The admission procedure shows that staff make sure they can meet the persons needs. Evidence: A statement of purpose and Service User guide are available in the foyer of the home. The document is clear to read and sets out what the service provides and contains all information people would need to decide whether Balmain is the right place for them to be and whether staff could meet their needs. People living at the home told us that they had an opportunity to visit the home before they made a decision. Staff told us the length of visit was entirely the choice of the persons needs. Staff also told us they work closely with NHS mental health teams and that some admission processes can last up to six months. One person told us that they knew the staff before they came to the home. People spoken to said they liked living at the home. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: People at the home said the previous staff had come to see them before they moved to the home and asked questions about their needs. Staff confirmed that this continued to be normal practice and an opportunity to discuss the persons needs with the person, their family and health care professionals. A new pre admission assessment is completed before the person comes to the home. This is then used as a basis of the care plan. NHS care plans are also used for staff in the home to begin to gather as much information as is possible. Staff told us that because of the nature of the service provided emergency admissions are not usually accepted. Staff also told us this was because the home need to prepare for any specialist care, equipment or staffing the person may need. Each person has a folder where care records are kept. The pre admission assessment and health care professional assessments are stored here and used as a basis for the care plan. The Provider explained that once the trial period is complete people deciding to stay at the home will be issued with a contract, alongside the contracts issued by social services. An example of this contract was provided for inspection. This contained all the relevant information. 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. The detailed care and support plans allow staff to plan how they enable people to make decisions and take appropriate risks in their lives Evidence: Each person has a folder where care records and support plans are kept. These are securely stored in a locked office. The manager explained that they were in the process of changing and modifying the existing plans. Both the old and new care plan formats were inspected. Both contained detailed information and instructions on how to care for that person and how to support them with their needs. The pre admission assessment and health care professional assessments are stored here and used as a basis for the care plan. Care Plans were clearly written and showed how care should be provided. Plans also contained personal details, contact numbers of health care professionals and next of Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: kin and assessments for ability, daily living tasks and preferences. It was clear to see what needs each person had, what triggers caused behavioral problems and details of how staff could support the person. People told us they could be involved in what was written in their support plan but did not want to be involved in this. One person said I am asked to attend my review but sometimes Id rather go out. Another person said they had attended reviews. One person knew the name of their psychiatrist but said they would go to staff if they needed any thing. People told us they were able to make decisions about their lives. Staff explained that in some cases restrictions on decision making was limited after an assessment of the persons needs and risk. An example of this was restricting people to cigarettes or tobacco because of risks to health or safety. Any restrictions are written in the plan of care and communicated to all staff and the person concerned. One person said there was a smoking room now as people were not allowed to smoke everywhere in the home because of the new law. Staff told us there is a missing persons policy and communication with the police is good. People who live at the home told us they can chose whether to participate with the day to day running of the home. One person said he cleans and tidies his own room and does his own washing. Staff said this varies and some people need more support and prompting than others and that some people are encouraged or prompted to do some tasks as part of their short and long term goals. There were specific support plans for some people who needed specific support to become more independent. The Provider showed us a unit in the new therapy room with sink and cooker, which will be used to practice independent living skills. People living at the home also said there had been resident meetings held. The AQAA told us that the service use meetings as a way to hear what people living there have to say. Records showed that the last resident meeting was held in November 2008. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The flexible and supportive staff group support people to make decisions about their lives, routines and development opportunities. The food provided at the home is good. Evidence: People living at the home told us that recently they have been provided with opportunities to access more activities and trips. One person said we never used to go out on trips before the new owners came but some of them have gone for a trip to Looe. Another person told us they had a member of staff they linked with (Key worker) who provided one to one care. Staff told us there would be two key workers attached to each person. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: Staff explained that due to the complex needs and illnesses some people are not appropriate to gain employment or attend further education, however if this is appropriate staff would offer this support. Records are maintained that describe short and long term goals. People told us they were able to maintain links with family and friends as they wanted. One relative the new staff are friendly and make me feel welcome. Staff told us some people do not have links with their families whilst others still have contact. Records are also kept of any community links. Each person has an assessment performed on admission, which is used to obtain social history and likes and dislikes of people in the home. Following this an activity diary is kept of what a person does or declines. We were shown a new activities/therapy room by staff. We were told by staff that this room would be used for various activities such as arts and crafts, music therapy and independent living skills. We were also told that there are plans to provide a computer and internet access. People told us they were happy at the home. Some people were going out independently whilst others preferred to stay at the home. On the day of inspection some people were taken out on a trip to a nearby town. Another person said he had been asked but chose not to go. Staff said sometimes their role was motivating people to go out, perform activities and join in on trips and that some people wanted to be told what to do. We were told by one person I can sort out my own decisions and am able to come and go as I please We saw knocking on doors before being invited to enter. Each person is given a key which can be overridden by a master key in the event of an emergency. People said staff were respectful towards them but occasionally had to nag to get them to do things. Staff explained that some people needed alot of encouragement to perform every day tasks or reminders to adhere to rules of the house. An example of this was the non smoking policy which people in the home ignore despite frequent reminders. People told us food at the home was very good. People had the option of main meal at lunch time and were seen going to the kitchen to ask for seconds. People are consulted about what they would like for lunch and this information is then given to the chef. Within the kitchen there are lists of specialist diets and preferences. People at the home were also able to approach the chef directly for requests. Staff said there was a designated chef and assistant at the home who were responsible for the preparation of food at the home. Fridges and freezers were well stocked. Storage was organised although some areas of the kitchen were less clean and showed Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: signs of inground dirt and debris. This was rectified by the end of the inspection. The chef told us he has a routine for kitchen cleaning, although there were no clear records to show how this was managed. The safer food better business programme was in place for the safe running of the kitchen which included food temperatures, fridge and freezer temperature checks and records of menus. On the day of inspection a chilli con carne and jelly and cream was served. People told us it was really good, lovely and nice. Some people who chose not to eat the chilli were given salads. Those people at risk of weight loss or gain are monitored closely. Nutritional assessments and records are maintained for this purpose. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and health care support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive a good level of support in respect of health and personal care. The management of medication systems are good. Evidence: One person told us the staff are kind and helpful. Another said he appreciated staff coming to hospital appointments with him. Care Plans show what specific physical and mental health needs each person has. Specific care charts are implemented when observation is required. Staff said at present they do not perform personal hygiene tasks but that Thieu role is to monitor and prompt people to self care. Staff told us that this varied from person to person and that staff knew who needed more prompting than others. Records of health care professional visits are recorded in the care records. Examples seen included visits from district nurses, visits to the dentist and optician, and chiropodist. Staff contact the GP or mental health team appropriately and accompany Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: people for out patient appointments where necessary. Contact details for each persons health professional contact is stored in the support plan. Staff told us each person will also have two key workers who will provide 1:1 contact for the person. People in the home appeared relaxed and calm whilst being able to come and go as they pleased. One person said the door is never locked except at night but even then we can go out if we want. Medication is well managed the home. The system of managing medicines has changed at the home. Staff told us that the supplying pharmacist has been so pleased with improvements they have been provided with a new medicine trolley. A recent pharmacist inspection has highlighted only minor issues which are planned to be implemented. The home use the blister pack method but medicines which can not be placed in blister packs are stored in an organised and safe way. The storage of controlled drugs was good and record keeping is clear. There were specimen signatures, drug information leaflets, homely remedy policies and reference books available. Staff told us senior care staff are responsible for administration of medicines and that these staff have received training. Storage of medications was secure. There were clear processes for the ordering and returns of medication. The majority of people in the home are not elderly, although some have associated physical illness. Staff record any preferences with regard to illness, death and contact details. 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. The policies in place mean that complaints will be well managed at the home. The policies, staff knowledge and training about safeguarding issues help protect people from abuse. Evidence: People told us they knew who to speak t if they were unhappy or needed something. One person said the staff now are lovely, I am much happier. The home has a clear complaints procedure. This encourages the complainant to speak to the manager in the first instance but to go to the CSCI if they are not happy. The Provider told us they have not received any complaints since they have been at the home. The Commission for Social Care Inspection have not received any complaints since the new ownership. People told us that staff were kind and approachable. Relatives told us the staff now always seem to be on the go and are always friendly One person said the new staff have been kind. During the inspection one person was beginning to show signs of challenging behavior. Staff quickly but sensitively managed this situation, calming the person whilst Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: protecting others. Staff told us they had received training in safeguarding and POVA (Protection of vulnerable adults) and were due to attend the deprivation of liberty training provided by Plymouth City Council. Staff were aware of the adult protection policy and procedure and knew the different types of abuse possible and what action should be undertaken if this was discovered. The Manager listed the key elements of appropriate reporting. All staff have a POVA first check (Pre employment check) to ensure they are suitable to work with vulnerable people. A CRB (criminal record bureau-police check)is also performed, although the Provider said there has been a delay in receiving these back. A discussion was held about how CRB checks were performed at present. The manager told us she was not happy with the current service as the proof of identity and clarity of the information was not as robust as that used in the home the providers also own. It was agreed that as the Providers were the same employers for both sets of staff and the manager is the countersignatory for CRBs, the CRBs would be applied for from Balmain but processed through the other home. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home live in a well maintained homely environment. Evidence: Balmain has been formed from a row of four terraced houses in a residential area of Plymouth. There are local shops, religious centres and amenities within local distance. The home is arranged over several floors and is linked in different places and on different floors. Bedrooms and communal areas are are refereed to as room numbers in the corresponding house number. The Provider gave us an action plan of what has been done within the environment so far and what is planned. The maintenance man told us he has been employed to work at the home full time and has access to petty cash for everyday jobs and authority to purchase larger items. The Provider told us that the first job to do was to repair leaks to the gutters and roof, installing a hot water system, repairs to some windows and replacement of a draughty window. The Provider explained that these have been unexpected costs. We were shown the action taken following a fire safety audit. Fire plans have been Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: introduced and fire risk assessments have been written. New fire servicing contracts and a new fire training provider has been introduced. Many doors were being replaced or adapted to make them safe in the event of fire. Each person has their own room which contains furniture and personal items of their choice. The Provider told us that four rooms have been gutted and others will be decorated and re furbished as an when people request or allow staff to perform the upgrades. Staff told us that one person was consulted about colour schemes in her bedroom. New furniture was present and awaiting the new flooring that had been ordered. The Provider was keen to share the plans of what needs to be done. A new therapy room is in the process of being provided and was awaiting the final plumbing of the independent living unit. Lockable boxes were also in the process of being fitted in each room. A new smoking room and extractor fan have been fitted to enable communal areas of the home to be smoke free. The staff told us they had recently had an environmental health inspection. Prior to this, a screen on the window, an ultraviolet insect trap and shelving had been installed in the kitchen. New freezers and fridges have been purchased and a new pest control contract has been commenced with frequent visits to the home. Outside storage areas have been cleared and outside lighting installed in the yard areas. New IT systems have been introduced at the home which improve the standards of records kept in the home. New mugs and crockery have been purchased. New dining tables are awaiting construction. The Provider told us more furniture was to be replaced as and when rooms are decorated. Detailed timescales were in the action plan provided. People were able to access all areas of the home and were able to come and go as they chose. There were no offensive odours present on the day of the inspection. People told us they are encouraged to keep their own room tidy and clean. We were told of specific examples where staff had to intervene to reduce the spread of infection or examples of where extra support and encouragement was needed to support self care. Staff told us they were responsible for cleaning at the home and there were routines to ensure this took place. Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: Laundry facilities were available and separate from kitchen areas. Floors and were easily cleanable and washing machines were suitable for their purpose although the provider told us new machines had been ordered. Staff told us that if they dealt with soiled laundry there are bags which the laundry is placed in before being directly placed in the sluice cycle machine. There were gloves, aprons and hand washing facilities throughout the home. Care Homes for Adults (18-65 years) Page 24 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported and cared for by competent, qualified staff who have the necessary pre employment checks performed. Evidence: At the time of inspection, there were four care staff on duty, a chef, maintenance man, the manager and both providers. Records showed that as a minimum three care staff would be on duty in the morning. The Providers were overseeing day to day issues. People living at the home knew who to go to for specific needs. Staff told us the new staff team work very well together and that morale was good. Off duty records showed that agency staff are not used and that staff tend to cover shifts themselves. Staff files contained job descriptions which clearly listed specific tasks. All staff have a formal induction and are issued with the general social care council code of practice. Staff told us they are able to share new ideas and able to bounce ideas off each other. The senior carer told us there is a plan to perform 8 weekly supervision sessions where training needs can be identified, but the programme is just beginning because of the new staff. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: Staff files were organised and showed what checks staff had received prior to employment. All files contained photograph, application form, medical declaration and suitable references. Staff had been given terms and conditions and attended induction, given a handbook and attended staff training. Not all files contained forms of identification, although a discussion confirmed that this was because of the umbrella body not returning copies of documents rather than the home requesting them. A solution was agreed and a recommendation made in a earlier section of this report. Care Homes for Adults (18-65 years) Page 26 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. Balmain is run in an efficient and effective way. Evidence: The Providers told us they were present most days to oversee the day to day running of the home and had identified alot they want to achieve, despite no Requirements or recommendations being set at the previous inspection. We were told about and shown the detailed action plan showing what had been achieved under the new management. All staff were clear about what there roles were, all but one of the staff are new to the home but all have experience in working in care settings before. Staff told us that the provider was very approachable wanted the home to do well and really good. Staff said they felt able to raise new ideas and felt the leadership was good at the home. The providers have experience of running another care home in the area and have a background in law and regulation of care homes. The manager told us she was just waiting for the doctors reference before she was able to submit her application to be come registered with the CSCI. Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: The Provider has updated and introduced many policies and procedures, although these were not inspected at this visit. One complaint procedure contained out of date contact details for the CSCI. The Provider gave assurances that these would be updated. However, the standard of record keeping was very good in the home and reflected the level of care that was provided. All records were securely stored. The Providers showed the quality assurance audit programme which is being introduced. The Provider manages personal monies of people in the home and has access to the safe. Records were seen to show this system is robust and based on the capabilities and needs of each person. The maintenance man showed a supply of lockable boxes which was being introduced to people who wanted them in their room. Staff did explain that restrictions are placed on some people for their own protection. These examples were seen in care plans. One common restriction was the access to cigarettes. Training records were well managed and showed that all staff had either received or were booked on mandatory training sessions. Records showed that staff had received training in respect of POVA, Food Hygiene, Fire safety, medication, 1st Aid and moving and handling training. Staff explained that because of the abilities of people in the home, they do not move or lift people in the home however, the manager explained that as a sign of good practice staff were given full training just in case of emergencies or for when staff that would need to move heavy loads or boxes. Records showed that outside contractors are used for the management of some systems and equipment in the home. Accident records were seen and were well managed, new first aid boxes have been purchased. Staff explained that the major health and safety issue they are faced with is people not adhering to the non smoking ban in the home. The Provider showed us the action plan of the forthcoming year. This, together with the AQAA show that the Providers are aware of what changes are needed and what needs to be achieved. Care Homes for Adults (18-65 years) Page 28 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 29 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 23 The Provider should obtain proof of identity for the files identified where the umbrella body has not returned the information from The Provider should ensure any policies contain the correct contact details of the CSCI 2 40 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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