Inspection on 15/10/08 for Beaufort House

This inspection was carried out on 15th October 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Beaufort House Beaufort House 2 St Vincent Terrace Redcar TS10 1QL The quality rating for this care home is: 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: Michaela Griffin Date: 1 5 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 35 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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 35 Information about the care home Name of care home: Address: Beaufort House Beaufort House 2 St Vincent Terrace Redcar TS10 1QL 01642481114 01642481114 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Potensial Limited Name of registered manager (if applicable) Ms Margaret Lea Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 8 0 care home 8 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code 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 - Code LD, maximum number of places 8 The maximum number of service users who can be accommodated is: 8 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 35 A bit about the care home Beaufort House provides a home for seven people in a large, but homely, double fronted terraced house, which blends into a street with similar properties.It is close to shops and other community services and facilities in Redcar and near bus routes. Each person has their own large bedroom. There is a pleasant, comfortable living room and dining room downstairs and a garden area at the front of the house and a sheltered private courtyard at the back. The home has plenty of bathrooms with equipment for people who need assistance to use them. There is a large bedroom on the ground floor, which has enough space for someone who uses a wheel chair to move around in. But the entrance to the home is up wide, shallow steps and so someone who uses a wheelchair would need a portable ramp to get in and out. Care Homes for Adults (18-65 years) Page 5 of 35 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: Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 35 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. The home was not told when the inspection would take place until the day before. The inspection took place on one day. But before the inspection the inspector sent survey forms to the people who live and work in the home and to health and social care professionals who visit it. The surveys asked people for their views on the service. Fourteen were returned. The inspector looked around the home, she met five people who live there and three of them talked to her. She also talked to the manager and three care staff. She checked the paperwork kept in the home. After the visit to the home, the inspector rang three more health professionals to ask them about the service. The charges for the home are 408.75 a week. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well What has got better from the last inspection What the care home could do better There should be more staff in the evening at at weekends so that people can do more of the things they want to, inside and outside the home. The home must be improved. It needs new furniture and decorating. It needs a ramp, for people who use wheelchairs to get in and out. The manager should have an office. Care Homes for Adults (18-65 years) Page 8 of 35 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Michaela Griffin 33 Greycoat Street London SW1P 2QF 02079792000 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 35 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 35 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 find out about the home and the manager makes sure that the home can meet peoples needs before they move in. Evidence: Each person has a service user guide in written English. This gave them information about the service and told them what they could expect before they moved in. The people who live in the home have all been there for a long time and know the service and staff well and there are no vacancies. All seven wrote on survey forms that they were asked if they wanted to move into the home and that they were given enough information about it to decide. Five people moved to the home together when it opened. They had previously lived in another home and had been cared for by the same manager and two of the current staff. Two other people have lived in this home for five years. Their files have full assessment information about them, which showed that the home checked that it could meet their needs before offering them places. They also had a chance to find out if they liked the home, by visiting it before moving in and by staying for a trial period. Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: The information in the service user guides should be brought up to date. The service user guides should also be provided in ways that are easier to understand by people who do not read written English, for example with pictures. Care Homes for Adults (18-65 years) Page 12 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People have care plans that explain what they need and want. People can make choices in their daily lives. They are encouraged to lead full lives, within the limits of the support and advice available. Evidence: Each person has a full and detailed care plan that describes their needs and how they prefer their care to be given. Evidence from files, from surveys and from interviews with four staff and three people who live in the home confirmed that individuals and their families/ representatives are fully involved in the care planing process. Care plans are also reviewed regularly and the care and support provided is changed when peoples needs and wishes change. The service is reviewing the way that care plans are written and plans to make them easier to understand for people who do not read written English. Five people who live in Beaufort House were at home on the day of the inspection. It Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: was clear from observations, as well as from written records and the views expressed by a range of people in surveys and interviews, that people are treated with respect. There was warmth and comfortable familiarity in the contact and communication between staff and the people who live in the home. They all know each other very well. This contributes to the lovely, homely atmosphere. Staff try hard to enable people to make choices and to have as much control as they can over the things that matter to them. The home has a choice, empowerment and risk policy that builds on the established good practice of the manager and staff who work there. This provides guidelines for staff on how they should support people to make decisions and take reasonable risks to lead full lives, without being placed in danger. Each person has their own bank account and staff keep careful records that show that people are given support and opportunities to spend their personal allowances in the way they chose. The home has residents meetings every week and this is one way that people are involved in decisions about the service and get a chance to give their views. During the inspection, one service user joined in the discussions between the inspector and the manager about decision- making and consultation in the home. She was clearly comfortable and happy to be involved in this way. She said I like meetings. Another way the staff have worked to achieve the aims of the choice, empowerment and risk policy has been by helping two people to get direct payments from the local authority. Direct payments are money that the individuals get to employ staff to help them to do the things they enjoy. One person who gets a direct payment talked about all the things she does with one to one support paid for in this way. Staff commented on how this individual attention had helped her develop skills and become more independent. But there are only two staff on duty within the home for most of the time and sometimes only one. This means that most of the seven people who live in this home do not enjoy this sort of individual attention, support and encouragement to develop their skills and confidence and to make decisions. The provider is currently considering plans to develop this service in way that will give the people who live there more independence, more rights and more opportunities for greater choice and control in their lives. These plans could mean important changes to the service and to the way that individuals claim benefits and pay for their accommodation, food and the support they receive. The people who use this service do not currently have the support of an independent advocacy service and some of them do not have any relatives who are able to visit regularly and speak up on their behalf about matters that affect their day to day lives. The provider should work with peoples care managers and representatives to ensure that each person has independent advocacy and advice. This will enable people to make informed decisions when they are consulted about these important issues that may affect them. Care Homes for Adults (18-65 years) Page 14 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are involved in activities they enjoy within the home and the local community, but their opportunities are sometimes restricted by the limited staff time available. People choose what they want to eat and when and where they eat it. Evidence: There was evidence from surveys, records kept in the home and interviews with staff and people who live there that manager and staff encourage people to lead interesting lives, to get involved in activities in their community and to spend time with people they care about. It was clear from the interviews that the manager and care team try hard to get people involved in the community, to make family, friends and partners welcome and to find out what each person might enjoy. They are creative and flexible in arranging trips and making use of any socialising opportunities offered that people can afford. Staff show a high level of loyalty and commitment to the people who live in Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: this home. All staff see helping and supporting people to lead enjoyable lives as a rewarding aspect of their work. Each person has their own weekly programme of activities that suits them and when possible they are encouraged to try new things and take part in special events that are not part of the usual routine. The places that people have been lately include the local pub, coffee mornings and trips organised by a local church, the cinema, bowling, the Gateway club, shopping and line dancing at the Coatham Bowl, a well-known social venue in Redcar. A care professional who visits people in the home had many good things to say about the lifestyle it offers. She wrote on a survey that people are enabled to follow up their interests and hobbies, go on holidays in small groups to places that they enjoy, have good social networks and that the staff encourage family involvement. One person talked about the holidays the staff have arranged for her. She said Ive been to Turkey, to a hotel in Blackpool, to the Isle of Wight and to Disneyland, Paris. During the week people attend day services, arts projects, adult education and work placements outside the home. But the activities that people can get involved in on evenings and at weekends are limited by staffing levels and rotas. So are the opportunities for people to have individual support and supervision, while developing new skills. The staff rotas show that there is only one member of staff on duty from 90 pm most evenings. People must return home by 830 pm so that there are two staff to help them with personal care tasks and to get ready for bed safely. The rota showed that on Saturday, there is only one carer on duty from 60pm, so this restricts opportunities go out separately at a weekend or in the evening even further. People are asked what meals they want. They can eat in the homes comfortable dining room or in their own rooms if they prefer. Each person chooses the main meal of the day once a week, but anyone who does not want that choice can have something made for them especially. Staff know the people they support well and know what they are able to do. People are encouraged to help prepare meals and some make themselves snacks if they can do so safely. One person said I like to make cakes. I help to make the Yorkshire puddings. I wash the vegetables. I eat them all. But a professional who visits the home commented that people would benefit from more opportunities to learn to cook for themselves. The kitchen is currently due to be refitted, with better equipment and work spaces. Improvements to the cooking area and facilities may enable more people to get involved in preparing food, but only if there are enough staff on duty to ensure that some people can work safely in the kitchen while others get the care and support they need elsewhere in the house. The people who live in the home seem to be happy with the lifestyle they are offered. The staff team know them well and understand their needs and preferences as individuals. But these people have lived in this home for some years and, like the staff, they are all from the White British majority community. The manager explained that if someone from a minority ethnic community expressed an interest in moving into the home, she would need to carry out research to ensure that the home would Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: understand and satisfy the individuals dietary, cultural and religious needs. The home should consider how it can show that it would welcome people from minority communities and with lifestyle preferences that differ from those of the majority, including people who are lesbian, gay, bi sexual or trans-gender. Care Homes for Adults (18-65 years) Page 17 of 35 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 . Peoples personal and health care needs are explained in care plans and individuals have a say in how their care is provided. People who use the service are protected by the homes procedures for managing medication. Evidence: The evidence from interviews, observations, records and surveys showed that staff provide sensitive personal and health care support in ways that people prefer and that promotes their privacy and dignity. The home has a key worker system and continuity is maintained, in the way that people receive care from people who understand their needs and wishes, by a very stable staff team. But staff shift patterns mean that there is limited flexibility about bedtime for people who need more assistance. This is because there is only one carer at work from 90 pm on six nights and from 60pm on Saturday. A lone worker cannot leave the other service users without support or supervision while she spends time privately with individuals, meeting their intimate care needs in a dignified and respectful way. Each persons health care needs are clearly explained in a care plan. The managers and staff seek specialist advice and support for individuals from appropriately qualified health care practitioners. Individual care files included records of how the home has Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: cooperated with nurses, general practitioners, occupational and physio-therapists, a consultant physician, psychiatrist and dentist. One person has recently been discharged from hospital and she is waiting for an appointment with another specialist . She described how staff are supporting her to get the medical attention she needs and helping her to explain to medical and nursing practitioners that the newly prescribed medication is causing unpleasant side effects for her. The staff have the knowledge and skills required to meet the personal and health care needs of the people they currently support. The instructions provided in each persons health care plan are very clear. Records demonstrate that staff are meticulous in following guidelines and information is shared appropriately between staff. Some peoples health care needs are becoming more complex. An increasing amount of staff time is taken up with monitoring peoples health, carrying out health care related tasks and keeping records. This means that they have less time to spend with people. Two people have conditions that staff worry are life threatening, so the person on duty alone at night feels the need to check on them regularly although night staff are only employed to sleep-in and to be on call for emergencies. The home has a policy and procedure that gives clear guidelines to staff and accurate up to date records are kept of all medicines received, stored, given out and that have left the home. All the staff who give out medication have had training on the safe handling of medication. One person manages his own medication. Care Homes for Adults (18-65 years) Page 19 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are encouraged to express their views about the service and they are confident that they will be taken seriously. The homes policies and procedures protect people from abuse and harm. Evidence: The home has a clear complaints policy and procedure and a picture based/ easy read version is included in the Service Users Guide that each person is given. The complaints records were checked during the inspection. No complaints have been received since 2006 and only three in total since the home opened in 2003. All the people who returned surveys indicated that they would know who to talk to if they had a complaint or concern. Two mentioned the manager by her first name, this suggests that they know her well and would feel comfortable talking to her. Four people also wrote the staff always listen to what they say and three wrote sometimes. One care worker who returned a survey wrote We try to keep clients happy by giving choices of social and living skills, working in different environments and learning to get on with each other despite all being very different. Residents meetings give individuals time to air grievances and discuss options. Records are kept of residents meetings and what action is taken to respond to peoples requests or concerns. One person interviewed said that she likes to attend the meetings. Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: The home has policies and procedures that tell staff what they must do to keep people safe and how to record and report any concerns they have that someone could be abused or neglected. All the staff have had training on these issues and know how to recognise the signs and symptoms of abuse. Care Homes for Adults (18-65 years) Page 21 of 35 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 . People live in a homely, comfortable environment but some of the decoration, fittings and furniture is not in good condition. The home is kept clean. Evidence: The home is in a convenient central location in Redcar, near to community facilities and social meeting places, including pubs and shops. There is limited on-street parking nearby, but it is close to major bus routes. The home blends in with the mix of other properties in the street. There are wide shallow steps up to the front door, so people who use wheelchairs can not easily get in or out. Each person has their own bedroom. Several are big enough to be double rooms for a couple. The seven people who currently live in the home are single. They have furnished them to their own taste. There are adequate bathing and toilet facilities for people to share, but none are en suite. People interviewed said that they are very happy with their bedrooms and three were pleased to show them when asked. One person said I like my room. I have room for all my things. I have lots of CDs. Most of the bedrooms are upstairs and there is no lift. This means that individuals who have mobility problems or unstable medical conditions that make them vulnerable to falls and accidental injuries require the supervision and/ or support of a member of staff to enable them to go to their rooms safely. This restricts their freedom to move Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: about within the home, according to their preference, because of the limited number of staff available to provide this sort of one-to-one attention. Downstairs there is a pleasant communal lounge and a dining room, which can also serve as an activity room. The kitchen fittings and equipment are in poor condition and are on the homes programme for improvement to be replaced. Although some improvements to the decor and furnishings have been carried out in the last year, other rooms need new furniture and decoration. This issue was identified in the last three inspection reports, before the home was re-registered. This means that the people who live in this home have been waiting for these improvements to be carried out for almost three years. The accommodation overall appears to be homely and comfortable, if a little shabby in places like the kitchen and dining room. It is very clean, tidy and odour free, although the home does not employ any cleaning staff and all domestic tasks are carried out by care staff. However, on the day of the inspection the front lawn was overgrown and weeds were extending on to the path. This spoiled the outside appearance of the home, which did not give a positive impression to the local community and was not good for the image of the people who live and work there. Overgrown grass and weeds could make the path slippery in poor weather. The manager explained that this was because the member of the care team who usually looks after the garden had been off work due to illness. The home has a comprehensive programme of health and safety checks. They are also carried out by the care staff who make details records and fax them every week to the providers senior management. This shows that the home is generally a safe place for people to live and work. However, some repairs appear to be overdue and neglect of the physical environment will make it more difficult to keep clean and safe. There is a sleep-in room for staff, on the first landing between the ground and first floors, where the bedrooms of the people who live in the home are. But it is not served by a call system that would enable people to summon help during the night. This may not have been necessary in the past when peoples assessed needs did not require attention or monitoring during the night. However, as peoples needs increase or become more complex, night time support and monitoring provision must be reviewed. And this review must include an assessment of the risks of relying on the current arrangements for summoning help from night staff employed to sleep-in only. Care Homes for Adults (18-65 years) Page 23 of 35 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 . Staff have the skills, knowledge and attitude required to meet peoples needs. People are protected by the homes recruitment procedures. But the amount of individual attention each person receives is limited by staffing levels. Evidence: Staff had lots of good things to say about the support, supervision and training they get. The records showed that the home has an annual training programme. All the staff in this home, except the newest employee, have already achieved at least level three in the National Vocational Qualification in Care, which is the recommended qualification for people in care services. The newest employee is already working towards a National Vocational Qualification. This number of qualified staff exceeds the 50 recommended in the Care Standards Act National Minimum Standards. So it evidence that the manager has high standards and expectations of the care staff and is willing to support them to achieve them. It also means that staff are committed to acquiring skills and knowledge to benefit the people they care for, as well as for their own professional development. This is despite the day to day demands of caring for service users, cooking and keeping the home clean. The people who work in this home are all women and they are all from the white British majority community. Their ages range from 34 to 63 and their family circumstances vary. Most are from the local area. All the staff interviewed showed that Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: they understood the importance of recognising and respecting the differences between people and they said that they would be interested in learning more about the way that people are different and how this might affect their care and support needs. All staff should have training on equality and diversity issues, so that they recognise and respect the differences between people, including those related to sexual orientation, identity and lifestyle choice, ethnicity and culture, as well as disability, illness and impairment. Then the provider, manager and staff can feel sure that they are not unintentionally or indirectly excluding any individual or community, from applying for a place or a job in the home. The staff rota shows that there are never more than two people on shift to meet the care and support needs of up to seven service users. There is only one person on duty from 90 pm most evenings and from 60pm on Saturdays. The manager is included on the care rota, so carries out management tasks while caring for service users. Other staff do cleaning and cooking tasks while they are on the rota to care for service users. The low ratio of staff to service users means that it can be difficult for staff to provide individual attention and support for people, for activities outside the home or for developing new skills. It also limits the range of opportunities to take people out in a group, when two staff would be required for safety reasons and to meet peoples personal care needs in a dignified, respectful way, for example when using public toilets. This is because one member of staff may be needed to stay at home with someone who is ill or expecting a visitor or does not want to go out with the group for another reason. There are similar issues if an individual service user needs the support of a carer to attend a medical appointment. This seems to have become a greater problem as peoples personal and health care needs have increased and they need more individual attention for these reasons. In interview staff demonstrated that they feel a great sense of loyalty to each other, to the service, to the manager and most of all to the people they support. There is a culture of mutual respect and willingness to share responsibility. Comments from all the staff indicated that they find enabling people who live in the home to enjoy a good quality of life and to develop their independence as the most rewarding aspects of the job. The average length of service and low turnover is also evidence that staff feel a strong commitment to the service and service users and that they are satisfied with the support they get from their manager. Of the team of six staff, two have supported the original group of people for 18 years, one for 15 years and another two have worked in the home for more than four years. Because the home has a very stable team of staff, most have supported the people who use this service continually since they came into residential care. This means that the people who live and work in this home know each other very well and communicate easily. However, some of the longest serving employees have reduced their hours and some are considering leaving. The home has recruitment policies and procedures that meet the requirements of the Care Standards Act regulations and National Minimum Standards. Only one person has been appointed in the last year, when a longstanding member of the care team moved to another home run by the same provider . The recruitment records show that the provider carried out all the checks required to make sure that there was nothing in the Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: employees background that could mean that she was unsuitable to work in a care setting. The new member of staff also went through a programme of induction, so that the manager knew that she had the basic knowledge and skill required to care for people safely, before she was allowed to work alone with service users. People receive regular supervision from their manager and annual appraisals. This was confirmed by records and interviews. These one-to-one meetings give the staff a chance to get feedback from their manager about their work performance, to talk about their training needs and discuss any help they require to improve the way they do their jobs. Care Homes for Adults (18-65 years) Page 26 of 35 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 manager has the skills, knowledge and professional standards required to run the home, but would benefit from more resources and support. There is a quality assurance system in place but needs further development. The health, safety and welfare of service users are promoted and protected. Evidence: The manager is very well qualified and has the experience required to run the home well, including eight years managing this service. The records examined, interviews, surveys and comments from professionals indicate that the service is run smoothly and effectively because of her organisational ability and leadership. The provider seems to have high standards and expectations of the manager, with regard to accountability and reporting. All records are kept meticulously and up to date, but are hand-written. They show that the manager fulfils her responsibilities well. She ensures that policies and procedures are followed, she monitors staff performance and provides staff with support and supervision, she carries out health and safety checks and arranges for maintenance work and tests to be done by approved contractors. She communicates with the relatives and representatives of service users, she understands their changing needs and personal preferences and she liaises with professionals on Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: their behalf. However, she appears to achieve all this without administrative or technological support (other than a fax machine and a telephone) or protected time off rota for management duties. At the time of the inspection the manager did not have an office suitable for a private meeting, interview or supervision. She did not have a desk, access to e mail or the internet, word processing or electronic record keeping. Policies and procedures, filing cabinets and the telephone and fax machine were kept in what appeared to be a tiled utility room. None of the service users, staff or professionals consulted criticised the manager or how she does her job. Staff said in interview that she is approachable and supportive and does her best for staff and people who live in the home. One person wrote that the home is well-managed and the service users interviewed said that they can talk to her, she looks after them and she does things that they want her to. But a professional commented that all the managers time is committed to the care rota and she does not seem to have any protected time for carrying out specific management responsibilities. The manager is the only member of the care team who works full time hours. She is on call when she is not at work and also covers for staff absences and comes into work in her off-duty time, when required to attend a meeting or care for a service user who is unable to go to day time activities because of illness (as happened on the day of the inspection). The home has its own basic quality assurance system, based on staff consulting service users individually and through the weekly residents meeting. However this is not translated into on overall action plan for the service, but is reflected in weekly programmes of activities, menus and individual care plans. The provider ensures that a member of the organisations management team carries out monthly quality visits to the home. The manager said that the provider has a supported decision making tool that it uses to survey service users and staffs views. She said that she understands that the organisation has an annual quality plan but she could not produce it on the day of the inspection. The manager completed the Annual Quality Assurance Assessment of the service promptly and by hand, on the basis of her own knowledge of the service and plans for improvement. This is an annual report that services registered with the Commission for Social Care Inspection are legally required to provide. A professional who returned a survey form mentioned plans to change the way this service is provided. The manager understands that the provider organisation intends to develop the service to enable service users to have individually tailored services and more independence, choice and control over their accommodation, housekeeping and support arrangements. She can see the benefits for service users, so is keen to support the changes. But at the time of the inspection it was not clear that the manager, staff, service users and their representatives were currently engaged in the discussions between the provider and local authority. All the people who may be affected by any changes proposed to this service should be fully consulted and have the opportunity to contribute to planning and introducing changes to ensure that they Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: meet peoples needs and wishes more effectively than the residential care service currently does. Care Homes for Adults (18-65 years) Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes  No  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 30 of 35 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 Description 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 Description Timescale for action 1 1 5 The provider must review the 01/05/2009 service user guide every year and when any changes are made to the service, its terms and conditions and its policies and procedures. This is to make sure that people who live in the home or who are considering moving in have correct and current information about the service they can expect and what their rights are. 2 24 23 The provider must ensure that the assessment of the premises, access arrangements, facilities and equipment is up-dated. 16/05/2009 This is to ensure that the accommodation and facilities continue to meet the needs of the people who live in the home, and that everything Care Homes for Adults (18-65 years) Page 31 of 35 that can be done to keep people safe and enhance their independence is done. 3 24 23 The home must provide a 16/05/2009 safe, clean internal and external environment that meets the needs of the people who live and work there. Repairs must be carried out as soon as is practical after they are reported. All the rooms must be kept in good decorative order and furniture must be in good condition. These improvements are required to ensure that the people who live in this home enjoy a safe, clean and comfortable environment. 4 33 18 The provider must review 16/05/2009 that staffing levels and rota with regard to the personal and health care needs of the people who currently live in the home, taking into account their physical needs for assistance and supervision, given the features and layout of the accommodation and their social and cultural needs and wishes. This is to ensure that there are enough people on duty at all times to keep people safe, to promote their health welfare and Independence and to enable them to lead satisfying age and culturally appropriate lifestyles. 5 37 23 The provider must review the 16/05/2009 Page 32 of 35 Care Homes for Adults (18-65 years) office accommodation and storage facilities available for the manager. This is to ensure that the home provides suitable accommodation and facilities to achieve its aims and objectives and meet regulatory requirements. Space and facilities must be appropriate to keep confidential records securely and to hold meetings in private, including interviews with staff and discussions with service users, their relatives and visiting professionals. The manager must also have a suitable and safe working environment to write reports and to maintain records. 6 37 18 The provider must review the 16/05/2009 management time available. This is to ensure that the manager has enough time to carry out management tasks and administrative duties without detracting from the care hours she is required to provide to meet the assessed care needs of service users. 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 1 The provider should offer all the information it provides, for current and potential service users and their representatives, in alternative forms to just written English, Page 33 of 35 Care Homes for Adults (18-65 years) for example as audio recordings, with pictures and in other languages, including Braille. This so that everyone who uses or may benefit from this service has a fair chance of finding out about it. It will also let people know that the home welcomes and respects people with different communication needs and preferences and from different communities to the English speaking and reading majority community. 2 7 The provider should ensure that the people who live in this home have the support of independent advocates to help them to express their views and to make informed decisions about matters that affect their lives and the service they get. Staffing levels and rotas should be reviewed. Staff time with and support for service users should be flexibly provided and include enabling people to choose whether and when to take part in the activities enjoyed by most adults in their community. The home should ensure that people who use wheelchairs, including current and prospective service users, visitors and professionals can enter and leave the home easily and safely (for example by provision of an access ramp at the front entrance). The provider should consider employing domestic staff or contracting for cleaning and maintenance services, to allow care staff more time to spend supporting service users. All staff should have training on equality and diversity issues, so that they recognise and respect the differences between people, including those related to sexual orientation, identity and lifestyle choice, ethnicity and culture, as well as disability, illness and impairment. The provider should ensure that the manager has training and access to technology to support her in carrying out management duties and to keep up to date in developments in regulations, relevant policy and procedures and good practice within the social care sector (for example access to the Commission for Social Care Inspection and the Criminal Records Bureau websites). The provider should develop its quality assurance system further and ensure that plans for developing the service take into account the views of the people who use the service and their representatives, including independent advocates as appropriate. 3 13 4 24 5 30 6 35 7 37 8 39 Care Homes for Adults (18-65 years) Page 34 of 35 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. 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