Inspection on 02/01/09 for Bel-Air Residential Care Home

This inspection was carried out on 2nd January 2009.

CSCI found this care home to be providing an Adequate 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

Bel-Air Residential Care Home 14/12/09

Bel-Air Residential Care Home 27/10/08

Bel-Air Residential Care Home 17/07/08

Similar services:

Chesham House

Argyll House

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Bel-Air Residential Care Home 76 Bushey Hall Road Bushey Watford Herts WD23 2EQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Claire Farrier     Date: 0 2 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Bel-Air Residential Care Home 76 Bushey Hall Road Bushey Watford Herts WD23 2EQ 01923332540 01923332540 mo@portlandcarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Portland Care Homes Ltd Name of registered manager (if applicable) Mr Mohammad Nooranny Dookhun Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is 6 The registered person may provide the following categories 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: Mental Disorder, excluding learning disability and dementia - Code MD Learning Disability - Code LD Date of last inspection Brief description of the care home Bel-Air is a care home providing personal care and accommodation for six people with mental health needs. It is owned by Portland Care Homes, a private company. The home was opened in 2007 and consists of a three storey terraced house in a residential road. It is indistinguishable from the other houses in the road. Care Homes for Adults (18-65 years) Page 4 of 33 care home 6 Over 65 0 0 6 6 Brief description of the care home The home is located close to the centre of Watford, with its shopping malls, community health facilities and hospital. There is a small parade of shops within a short walking distance and easy access to major rail, bus and road transport. All the homes bedrooms are single. All the bedrooms have ensuite toilet and washbasin, and three have an ensuite shower. There is no lift and the home is not suitable for service users with mobility difficulties. The garden at the rear is mainly laid to grass with a large paved patio. The garden is shared with the company?s sister home next door. The current fees range from £800 to £1400 per week. Information regarding the service is available in the Statement of Purpose & Service Users Guide. A copy of the CSCI inspection report will be available from the manager. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection took place on 17th and 21st July 2008. On this occasion we spent one day at Bel-Air, and the people who live there and work there did not know that we were coming. The focus of the inspection was to assess all the key standards. Some additional standards were also assessed. During our visit to the home we talked to two people who live in the home. Several members of staff also gave their views about the home, and some time was also spent looking at records and care plans. We also visited the home on October 27th 2008 to monitor the progress that has been made towards meeting the requirements from the last key inspection. The manager Care Homes for Adults (18-65 years) Page 6 of 33 sent us an improvement plan, with the actions that were being taken to meet each requirement, and the timescale for completing the actions. During our visit to the home we discussed the improvements that had been made with the manager. We looked at a sample of care plans, and we checked the current staffing rotas. We looked at staff files for new staff who have been appointed since the last inspection, and the records of staff training. We saw the new statement of Purpose and Service Users Guide, and the new procedure for safeguarding vulnerable people. We have used our findings from this visit in this inspection report. What the care home does well: What has improved since the last inspection? What they could do better: We saw some poor practice in administering medication, and in December 2008 one person was given a double dose of their medication. The poor practice that we saw on this occasion caused a risk of people having the wrong medication, and of other people taking their medication. The manager needs to be fully aware of the requirements for meeting the training needs of the staff. This includes knowledge of the content of training courses, whether Care Homes for Adults (18-65 years) Page 8 of 33 they provide the required qualifications, and whether the trainer is suitably qualified. All staff must have a certificated training in moving and handling. This will make sure that the staff practice good techniques so that there is no risk of injury for the staff or for the people they support. Following the last inspection red alginate bags have been provided to use for soiled linen, but the staff who we spoke to were unaware of the correct procedures for using these to prevent the spread of infection. The staffing rotas show that some staff work very long hours. People who work excessively long hours may be too tired to provide a good quality of care for the people who live there, and there is a risk of errors due to poor concentration. The complaints procedure is not written in a format that the people who live in the home can understand and follow. This means that they may not be confident that their concerns will listened to. 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 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has sufficient information on the needs of the people who live there and access to appropriate services to enable their needs to be met. Evidence: We looked at the care plans and information for two of the four people who live in the home, including one person who has moved into the home since the last key inspection. Both the care plans contained a detailed evaluation (assessment) that was carried out before the person moved into the home. The evaluation provides comprehensive information on each persons history and up to date information on their interests and needs. The evaluation of needs provides the basis of each persons care plan. But for one person there was no care plan for some behaviour and health risks that were identified in the evaluation(see Individual Needs and Choices). Each persons file contains a copy of the service agreement with Hertfordshire Adult Care Services. Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: The support staff who we spoke to said that the care plans contain sufficient information so that they can meet each persons needs, and the staff have had training to improve their skills. (But see Staffing for our concerns about the quality of the training.) The Statement of Purpose and Service Users Guide have been revised, and we saw the new documents when we visited the home in October 2008. Both these documents now contain all the information that people need to help them to choose whether to live in Bel-Air. The Service Users Guide could be improved further, so that it is easier for people to read and understand, and so that it shows what the home is like for the people who live there. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home are involved in their own care planning and are consulted on their lives in the home. Evidence: We met two of the people who live in the home, and one person told us about their life in the home. They said that they are able to make decisions and choose what they want to do, and they are able to make their views known. Portland Care Homes has a Person Centred Planning Book that involves each person in writing their own care plan and making decisions and choices about their lives in the home and the support that they need. The staff who we spoke to said that they complete the Person Centred Planning Books with the people concerned, but people do not write them themselves. We looked at two care plans, and used them to track the care and support that is provided for the people who live in Bel-Air. All the care plans have been reviewed and revised since the last inspection. The care plans are clearly Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: written, with good details of each persons needs and procedures and guidelines for meeting those needs. The format of the care plans describes the need to be met, the persons goal for meeting the need, and the route and actions for the staff to follow to support them to achieve their goal. The risk assessments that we saw include a management plan for supporting the person to achieve the activity and manage any risk involved. Examples of the risk assessments we saw were for self medication, aggression and smoking. There is also a missing person procedure for each person, with individual protocols for the actions to follow if they do not return to the home when they are expected. The risk assessments are written from each persons point of view, for example, [Named person] agrees..... [named person] acknowledged he had a problem. One person has clearly written risk assessments for some aspects of their behaviour, including aggression, sexual inhibition and being overweight, but there are no care plans for these risks. Although the risk assessments have information on managing the risks, they are not monitored and reviewed regularly as the care plans are, and care plans should also be in place. Care Homes for Adults (18-65 years) Page 14 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home are encouraged to make choices for their activities, and the staff support them to develop their skills for independence. Evidence: The care plans include a section on independent living skills, and people are asked what they would like to do. None of four people who currently live in the home has paid employment or attends a college or day care. Each person chooses what they want to do every day. One person spends most of the day every day visiting a friend. One person chose not to have a structured programme, and goes out most days to the shops or a local coffee shop. One person told us at the last inspection that they would like to have the opportunity to work, and they repeated this on this occasion. The staff told us that they encourage this person to be more active, but the person lacks motivation. One person had an assessment when they moved in that showed a need to Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: look for day care. This has not been achieved, and the daily records showed that this person spent most of their time in their room with occasional outings to shop or for a pub meal. The staff said that they dont want to do anything else. However this person was in hospital when we visited the home, and their mental health has not been stable since they moved into Bel-Air. Everyone is encouraged to keep in touch with their families and friends. Two people go out independently every day and meet friends, and one person is visited by their family. The menus on display in the kitchen show that there is a cooked meal in the evenings, and at lunchtime on Sunday, and people choose individually what they would like for lunch and breakfast. Two people buy their own food, and they are given a budget by the home for this. Care Homes for Adults (18-65 years) Page 16 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff support people to maintain their health needs and to consult other medical professionals. However poor practice in administering medication may cause a risk that people do not have the medication that is prescribed for them. Evidence: The care plans contain good details of each persons care needs. The healthcare records seen included references to hospital visits, and contact with GPs and other health professionals. These include the psychiatrist and community nurses. Everyone has contact with the psychiatric services and regular CPA (Care Planning Assessment) meetings. People are encouraged and supported to take responsibility for their own healthcare and to visit GPs and other health professionals independently. One person looks after their own medication, and there is a risk assessment in place for this. There is a three day training course in mental health needs for people with learning disabilities, but not all the staff have had this training. (See staffing.) The staff who we spoke to said that they have good information on each persons needs, and they are encouraged to use the internet to find further information. Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: Good records are kept of any changes in weight that may indicate a health concern, and records of what people eat at each meal. A request was made to refer one person to a dietitian following a gain in weight. Another person lost weight. This was discussed with the person, who said that they would go to the GP, and their weight then improved. One person was in hospital when we visited the home, following a deterioration in their mental health. This was monitored and recorded, with appropriate referrals to medical professionals, and resulted in a mental health assessment and admission to hospital. The home has systems in place to manage peoples medication safely. All the staff have training in administering medication, followed by supervision until they are judged to be competent to administer medication without supervision. We checked the medication records for the people who we were case tracking. The records were free of errors, with no signature gaps found on the MAR (medication administration record) charts. However we were notified before the inspection of an incident when a double dose of medication was given to one of the residents. The GP was informed, and their advice was followed. The staff member involved was forbidden to administer medication. During this inspection we observed a member of staff administering medication at lunchtime. The medication cupboard is in the office on the first floor. The member of staff dispensed the tablets for two people into unmarked pots, and then took the pots downstairs. One pot was left in the kitchen while the other was given to the person concerned. The second person then asked to have their medication later, and their pot was taken back to the medication cupboard, and left there, still unmarked with no indication of who it was for and what it contained. Portland Care Homes medication policy is in the MAR chart file, and clearly states the proper procedures to follow when administering medication, including identifying the resident and the medication before it is administered. But the member of staff concerned said that they knew what the tablets were in the unmarked pots, and they were unaware of the risks of leaving medication in an accessible place in the kitchen. What we saw caused a risk of people having the wrong medication, and of other people taking medication that is not prescribed for them. Care Homes for Adults (18-65 years) Page 18 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure is not written in a format that the people who live in the home can understand and follow. This means that they may not be confident that their concerns will listened to. The procedure for whistle blowing does not encourage the staff to carry out their responsibility for reporting their concerns. As a result, the people in the home may not be fully protected from the risks of abuse and neglect. Evidence: When we visited the home in October 2008 we saw Portland Care Homes new procedure for safeguarding vulnerable people. It contained clear guidelines, including the Hertfordshire interagency procedures and contact details for reporting allegations. On this occasion we saw the whistle blowing policy (Making a protected disclosure) in the staff handbook. This contains the procedure for reporting any concerns to the manager or to an appropriate external organisation. However it also states that, if the procedure has not been invoked in good faith (eg for malicious reasons or in pursuit of a personal grudge) then it will make you liable to immediate termination of engagement or... lesser sanction. This is a punitive attitude that nay not encourage people to carry out their responsibilities of reporting concerns. However the staff who we spoke to confirmed that they would report any concerns to the manager. All the staff have had a full days training on safeguarding vulnerable people within the last nine months as part of the Portland Care Homes three day mandatory training course. Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: No complaints have been made to the home since the last inspection. We looked at Portland Care Homes new complaints procedure. It has been written as procedure for staff, and needs to be rewritten with clear procedures for the people who live in the home. Care Homes for Adults (18-65 years) Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable and well-maintained environment for the people who live there. The staff maintain a good standard of cleanliness, but people may be at risk of infection because the procedures for control of hygiene and prevention of infection are not followed in practice. Evidence: Bel-Air is a mid terrace family style house. It looks no different from the other family houses in the street. It is within walking distance of local shops and services and is not far from Watford town centre. The home employs a part time cleaner and the home appears to be clean and well maintained. A shed on the patio outside the lounge has been furnished with a table and chairs so that people who wish to smoke can use it. One person enjoys spending time in there reading and listening to the radio. Since the last inspection domestic style laundry equipment has been installed in a room on the first floor, so that people can do their own personal laundry. Liquid soap and paper towels have been provided in all the toilets and bathrooms, to prevent any risks of spread of infection. Red alginate bags have been provided to use for soiled linen, but the staff who we spoke to were unaware of the correct procedures for using these to prevent the spread of infection. We were told that the soiled items are taken Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: out of the bags before laundering, instead of putting the whole sealed bag in the washing machine. The domestic style machines are used, which do not have a sluice programme, and everything is washed at a medium (40 degrees to 60 degrees) temperature. This is not sufficient for effective infection control. There is a laundry outside of the home, in an outbuilding in the garden, which contains suitable equipment for prevention of infection, including a washing machine with a sluice programme. However since the domestic style laundry has been installed, this is used only for Bellevue and not for Bel-Air. Care Homes for Adults (18-65 years) Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home are supported by a stable staff team. The training provided by the company may not provide them with sufficient skills to understand and meet the needs of the people who use the service. Evidence: When we visited the home in October 2008 we found that there was a separate staff team for Bel-Air, and no one also worked next door in Bellevue. The staffing rota showed that there were two staff on duty throughout the day, and one at night. No one worked excessive shifts or hours. A deputy manager had been appointed, and the manager was not included in rota, but was available to assist if needed. The staff rotas that we saw on this occasion showed that some members of staff are again working excessive hours. During the current week one person was scheduled to work 70 hours, and the same person had worked 62 hours the previous week. The manager said that this was a temporary measure until they could recruit more staff. Four new staff were recruited in December, but for various reasons three had withdrawn. The members of staff who we spoke to said that they are offered overtime, but they can refuse it if they wish to. We discussed with the manager the need to maintain the levels of staff, if necessary by using agency staff, in order to avoid the Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: risks of staff working excessive hours. We did not look at staff files on this occasion, because no new staff have started to work at the home since the last inspection. When we visited the home in October 2008 we saw the file for a new member of staff. It contained all the information that is required to confirm that the person is suited to work in the home. However there was no evidence of a photo ID, and no photograph of the person. The manager said that there are no current photographs of any of the staff in the home. This is required as a confirmation of their identity. Photographs can also be used to help the people who live there to know who is working there. All the staff in the home have a qualification at NVQ level 2 or above. Since March 2008 everyone has completed a three day training for Portland Care Homes that covered all the mandatory health and safety training. It also included training in safeguarding and in basic first aid. The certificates for the most recent training sessions have not yet been sent to the home, and the manager was not able to confirm that the training, particularly in moving and handling and food hygiene, was properly certificated and carried out by people who were qualified to do so. He said that he would give us the details of the training, but we have not yet received this information. When the Environmental Health Officer visited the home in October 2008 a requirement was made for all staff to have updated food hygiene training. The home has no qualified First Aiders on the staff, although everyone has training in basic first aid as part of the mandatory training. As Bel-Air is a small home, it may not be necessary to have a qualified First Aider on duty at all times. However in this case, a first aid risk assessment must be carried out that includes the needs of the people who use the service, how likely it is that first aid will be needed, and what kind of first aid will be required. Further guidance on qualified first aiders can be found at http:/www.csci.org.uk/professional/Docs/qualified-first-aiders.doc. When we visited the home in October 2008 we saw certificates to show that staff attended training in mental health and learning difficulties in September. Three more staff are booked to attend the training in January 2009. The deputy manager has sourced additional training from Hertfordshire Social services in person centred planning, supervision skills and risk management. The deputy manager carries out supervisions with each member of staff every two months. We saw a supervision record that showed that supervision includes discussion of current work and training needs. Care Homes for Adults (18-65 years) Page 24 of 33 Care Homes for Adults (18-65 years) Page 25 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is not sufficiently aware of the quality of training provided for the staff, and of possible risks to the health of the people in the home. This may result in a poor quality of care for the people who live in the home. Evidence: The manager worked at Bellevue, the sister home next door to Bel-Air for many years and he has a level 4 NVQ in management and in care. When Bel-Air opened he was registered as manager for both services. When we visited the home in October 2008 we found that the manager and staff had worked hard to improve the quality of care provided in the home, and we were satisfied with the progress that had been made towards meeting all the requirements from the last key inspection. A deputy manager was appointed for Bel-Air. However the proprietors did not attend a meeting that had been agreed, to discuss the outcomes from the inspection report with CSCI. On this occasion the manager was unaware of the quality and outcomes of the training that the company provides for his staff (see Staffing). Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: The home maintains appropriate records for the health and safety of the residents and staff in the home, including monitoring hot water temperatures, checks of fire equipment and regular fire drills. All the staff have training in moving and handling, fire safety, food hygiene and infection control. (But see Staffing for our concerns about the quality of the training.) The Environmental Health Officer visited the home in October 2008 and made a requirement that all staff must have updated food hygiene training. Portland Care Homes has introduced a procedure for monitoring the quality of the services it provides. Questionnaires will be sent to residents, relatives and other stakeholders in January 2009, and the manager will analyse the returns and write a report on the outcomes. This report should be sent to CSCI. The questionnaire for the people who live in the home has detailed questions on all aspects of life in the home. Care Homes for Adults (18-65 years) Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 All medication must be 02/03/2009 administered and recorded in accordance with the Royal Pharmaceutical Society guidelines and the homes policy and procedures. This will make sure that everyone has the care and medication that they need in a safe and effective way. 2 22 22 Arrangements must be 02/04/2009 made to produce an appropriate complaints procedure for the service. This should provide details of how the people who use the service and their families can make any concerns or complaints known, and the procedures for investigating and acting on any complaints. The complaints procedure must be produced in a format that the people who use the service can understand. Care Homes for Adults (18-65 years) Page 29 of 33 The people who use the service should be sure that they can make their concerns known, and that their concerns will be acted on. 3 30 13 The manager must ensure that the procedures for handling soiled laundry follow the Department of Health guidance on infection control for care homes. Soiled laundry must not be handled more than necessary, and must be washed at a high enough temperature to ensure that there is no risk of spread of infection. 4 33 18 The registered person must 02/04/2009 ensure that sufficient staff are employed in the home in order to comply with the Working Time Regulations. The staffing rotas show that some staff work very long hours. People who work excessively long hours may be too tired to provide a good quality of care for the people who live there, and there is a risk of errors due to poor concentration. 5 34 19 A recent photograph of each 02/04/2009 member of staff must be kept in the home, as required by Schedule 2 of the Care Homes Regulations 2001. 02/03/2009 Care Homes for Adults (18-65 years) Page 30 of 33 Photographs of the staff provide evidence of their identity. This provides assurance that they are fit to work with the vulnerable people who live in the home. 6 35 13 The manager must carry out 02/04/2009 a first aid risk assessment to decide how many first aiders should be on duty and the kind of training they need. All training in first aid must be provided by a person who is qualified to do so. The risk assessment and training will make sure that the staff can provide appropriate first aid when the people who live in the home need it. 7 35 13 All staff must have a certificated training in moving and handling. This will make sure that the staff practice good techniques so that there is no risk of injury for the staff or for the people they support. 8 37 9 The manager needs to be fully aware of the requirements for meeting the training needs of the staff. This includes knowledge of the content of training courses, whether they provide the required qualifications, and whether the trainer is suitably qualified. 02/03/2009 02/04/2009 Care Homes for Adults (18-65 years) Page 31 of 33 The manager needs to be confident that the people who live in the home are supported by suitable trained and qualified staff. 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 6 Care plans should be in place for any risks that are identified. This will make sure that the actions needed to support people to manage the risks are monitored and reviewed regularly. The company should provide clear procedures on whistle blowing that encourage members of staff to report any concerns about the the safety and welfare of the people who use the service. 2 23 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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