Inspection on 16/02/09 for Broadview

This inspection was carried out on 16th February 2009.

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

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

Other inspections for this house

Broadview 16/02/07

Broadview 02/02/06

Broadview 19/07/05

Broadview 01/11/04

Broadview 08/06/04

Broadview 11/02/04

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Coopers Mill Ltd

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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: Broadview King Street Winterton On Sea Great Yarmouth Norfolk NR29 4AT The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Judith Last Date: 1 6 0 2 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. 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 38 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 38 Information about the care home Name of care home: Address: Broadview King Street Winterton On Sea Great Yarmouth Norfolk NR29 4AT 01493393653 01493393653 H2021@mencap.org.uk www.mencap.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Royal Mencap Society Name of registered manager (if applicable) Mrs Susan Shreeve Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 5 0 care home 5 learning disability Additional conditions: Date of last inspection 1 6 0 2 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 38 A bit about the care home Broadview is a medium sized care home, owned and managed by Mencap. It has a long pathway with shallow steps on the way up to the front door. This means that people using wheelchairs would need help to get in. Up to five people can live there. The home has its own gardens and is not far from the centre of Winterton village, with shops, a pub and the beach. Care Homes for Adults (18-65 years) Page 5 of 38 Everyone has their own room, no one needs to share a room. It costs from £685 to £753 per week to live at the home. Our Inspection reports are available in the home. People living in the home would need help to understand the information, but staff discuss what we said in staff meetings. Care Homes for Adults (18-65 years) Page 6 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 38 How we did our inspection: This is what the inspector did when they were at the care home Before we went to the home we looked at all the information we had about it, including what the manager sent us. We had letters about it from people living and working there and one care manager. Care Homes for Adults (18-65 years) Page 8 of 38 We visited the home and looked round parts of it. Our main method of inspection is called case tracking. This means we look at records and try to find out from observation and discussion, how well people are supported in their daily lives We talked to two people living in the home and one staff member. Some people found it difficult to talk to us so we had to look and listen to what was going on when we visited. Care Homes for Adults (18-65 years) Page 9 of 38 We used all the information we gathered, and the rules we have, to see how well people are being supported. What the care home does well Staff work hard to make sure people have opportunities to go out and make use of community facilities, like the swimming pool and shops. Sometimes people try new things they haven’t done before. Care Homes for Adults (18-65 years) Page 10 of 38 They also give the support people need to help them join in with the domestic routine, like doing their washing, cooking and cleaning. People have their own rooms which they can keep how they like. If they want to and can manage it, they can have a key to keep their room more private. The home is comfortable and clean. Care Homes for Adults (18-65 years) Page 11 of 38 They have a say in how their rooms are decorated Staff try to involve people in making decisions and choices about their care. This is not always easy because some people find it difficult to say. However, one person who visits the home says people “are asked what they wish to do and have choice. Staff support people to go and see other professionals who can help to keep them well and healthy. Care Homes for Adults (18-65 years) Page 12 of 38 What has got better from the last inspection Care plans have been looked at to make sure the ways staff are expected to promote peoples safety are more clearly set out. There has also been work to improve how peoples goals and aims are set out in their plans so staff know how to support people to achieve them. Locks have been fitted to peoples bedroom doors so they can have keys if they want to. Care Homes for Adults (18-65 years) Page 13 of 38 The manager has made sure that there is evidence of proper checks on new staff. This helps to show that the way staff are recruited helps protect vulnerable people living in the home. The way that medication is given to people has improved so that it is safer The staff team have looked at peoples diets to make sure that these are better and to help reduce the need for medicines to help with peoples digestion. Care Homes for Adults (18-65 years) Page 14 of 38 What the care home could do better We have not found anything that needs to happen by law where the home is breaking the rules. (the manager) should think about. Some training needs to be kept under review to make sure staff always have up to date knowledge about meeting peoples needs. There were some difficult times with staffing last year and relief staff had to be used. Sometimes people could not do what they wanted because of this. This has now been sorted out but it should not happen again. There are some things Care Homes for Adults (18-65 years) Page 15 of 38 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 Judith Last CSCI CPC1, Capital Business Park Fulbourn Cambridge CB21 5XE Her telephone number is 01223 771300 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 16 of 38 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 17 of 38 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 have the information they need to make an informed choice about whether the home is able to meet their assessed needs. They have the opportunity to visit and try out the service to make sure it will be right for them. Evidence: We had comments from someone who has moved to the home recently. These say that the person was asked about moving in and got enough information about the home before they went there. Their records also show that the staff team made efforts to explain information about the service. This means people should know what they can expect from the home. There is a process for assessing peoples needs before they think about moving in. One person has been admitted on an emergency basis. The staff team are still working to gather information about the persons abilities so that they can further develop the basic plan they have and understand the persons needs better. Everyone has an assessment of their needs on their files and information is gathered from a variety of sources including other professionals and peoples family Care Homes for Adults (18-65 years) Page 18 of 38 Evidence: representatives where possible and appropriate. We know from past feedback from other professionals that the service takes appropriate action if it finds it can no longer meet someones needs. Records show there is a trial period and that a review takes place to make sure Broadview is able to meet the persons needs and that they are happy to live there. These things mean that the manager tries to ensure the home will be able to meet the needs of anyone admitted. Care Homes for Adults (18-65 years) Page 19 of 38 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 are involved in decisions about their daily lives and play an active role in planning their care, so far as they are able. Evidence: Each person has an individual plan setting out their needs. The staff team have worked hard to make sure that support plans are more accessible to people and use some pictures as well as simple language. Feedback from a social worker shows that any decisions made at review meetings are carried through and the results are then discussed with me. The person also says care plans are realistic. This means that the home can show they cooperate with others in supporting people effectively. Two people filled in surveys for us and say that they are able to decide what they want to do. A care manager told us that the service users are fully treated as individuals and they are asked what they wish to do and have choice. Care Homes for Adults (18-65 years) Page 20 of 38 Evidence: There are some aspects of support plans that have not been kept under review, although these are limited. For example, one persons detailed support plan from January 2007 has no update or change to arrangements for personal hygiene and continence, although a referral indicates some problems in this area. However, further information is in the persons health action plan so staff do have access to up to date information although it is not always clear where to find it. The risk assessment about washing and drying up and cooking and food preparation does not cross-reference with potential risks from continence difficulties. This presents concern about guidance for the maintenance of food hygiene when staff are supporting the person in this area. However, this is a small staff team with a core of people who are experienced. There are regular opportunities to discuss issues during the day to day working of shifts so that staff are up to date and aware of any problems. Where possible, people have signed their care plans to show they were involved and that it was discussed with them. Records show that people are encouraged to take part in the day to day running of their home and that regular residents meetings take place (on alternate months) to encourage discussion of their views. There are risk assessments setting out whether people would be able to manage their finances and what support they would need to do so. We have seen before that staff have made efforts to help people learn to recognise their money - or if this is not realistic - to understand that they need to exchange money for goods when they go shopping. Care Homes for Adults (18-65 years) Page 21 of 38 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 . People are able to make choices about their lifestyle and are supported to develop their skills. Their lifestyle meets their needs and expectations. Evidence: Records, recorded goals, photographs and comments from people living at the home show they have opportunities to decide what they want to do in their daily lives and how they would like to spend their leisure time. We could see that people are also supported to take part in the domestic routine of their home for example making drinks, planning and preparing meals and doing their laundry. Photos are used to help remind people of what they have done and any steps involved in the activity (for example making drinks). One person told us that they do the vegetables sometimes. Support plans set out peoples communication needs and how staff can recognise situations that might lead to challenging behaviour if they do not respond appropriately. Care Homes for Adults (18-65 years) Page 22 of 38 Evidence: Although staff feel shortages last year sometimes made it difficult to sustain the level of activities and opportunities that people and staff might wish, this has now been addressed. These things mean people can make decisions about how they spend their time, have opportunities to experience new things and to use community facilities. One professional told us that people are fully treated as individuals and they are asked what they wish to do and have choice. One person says I went to the shops. We were also told they were going to go swimming to see if I like it and Ive never done it before. People are able to go to college and learn new skills and certificates support this. One person says yes they did go to college. There is information to help people decide how they would like to spend their leisure time, including holiday opportunities. These are also discussed in residents meetings. Records of these discussions show what decisions people have made and that they have the opportunity to go on holidays or outings with those who share similar interests. One person has elected to go out for days rather than stay away from the home. This means people are able to decide what suits them best. Locks have been fitted to doors and people who wish to, can have a key. One person collected theirs from the staff office while we were there as they prefer to do this than keep the key with them. Records show another person enjoys having a key and that a third does not wish to do so. There are records to show people are encouraged to keep in contact with their families, including arrangements for keyworkers to assist them with sending birthday cards or presents for example. A professional connected with the service tells us that the manager and keyworkers actively encourage family contact. Sexuality is referred to in care plans or risk assessments as appropriate, but is not always cross-referenced with the detailed support plan or the relevant section of the health book as an additional source of information for staff about how to support people safely in this area. Care Homes for Adults (18-65 years) Page 23 of 38 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 . The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: Care plans we saw set out the support staff are expected to offer people with their personal care and how they are to balance risk (for example when bathing) with privacy. They reflect the efforts that are made to encourage people to do things for themselves and their progress. For example one person now uses the new shower attachment for their hair where they were reluctant before because its modern and I like it. Each person has a health book setting out which health professionals are involved in keeping them well so staff know who to contact for advice. Records in care plans also reflect their involvement and the outcome of any appointment so staff are aware of any additional support or monitoring they may need to offer. People are also offered screening checks and records show appointments for example, with the optician, consultant psychiatrist and well man clinic. This helps to ensure people have access to opportunities to maintain and promote their mental as well as Care Homes for Adults (18-65 years) Page 24 of 38 Evidence: physical health. Support plans we saw set out how people with communication difficulties would show they were in pain or distress. This means that staff can be alert to the need to monitor someones condition or refer them to professionals for advice about their health. Some people have problems with their mental health in addition to learning disabilities. There is reference material for staff but no formal training to increase their insight into how to support people affected by particular conditions, more effectively. We looked at the arrangements for storing and administering medication to see if these promoted peoples safety and welfare. There is a proper medication cabinet for storing drugs safely. This also provides for storage of controlled drugs if these are needed. Each persons records contain information about what medicines have been prescribed for them, what it looks like and what it is for. This helps staff understand what is to be given and why, as well as enabling them to establish whether medicines are working as intended to promote peoples welfare. Medication charts provided clear records of medicines received and given so that the manager could audit supplies and make sure they were being used properly. We tested the system and found balances we checked for medicines not in the monitored dosage packets, were correct. Where medicine is needed occasionally, there is guidance about its use and the intervals between doses. Proper records are made both on the medication record and in peoples daily notes to show why the medicine was needed and what was the outcome of its administration. This helps ensure medicines are administered as intended by the person prescribing them, to help manage particular conditions. Staff have formal training in administering rectal diazepam safely. However, the formal training is set out as time limited and expires after one year. The training records for one staff member showed they had last attended this training in February 2007. The manager has identified in information sent to us, that this area could be improved. Staff told us they are not expected to administer medication until they have had formal training. The confirm the manager also carries out assessments of their competence to follow safe practice and organisational guidelines and the outcomes of these assessments are recorded. Since our last visit, a lockable portable case has been provided for temporary security where staff are administering medication, so they are not leaving packs open and accessible while they are supervising someone with taking their medicines. The manager says that the service is expecting a visit from the pharmacist from the primary care trust who will offer additional advice should this be needed. These things mean that the manager and staff team work hard to ensure safe systems Care Homes for Adults (18-65 years) Page 25 of 38 Evidence: for the administration of medicines are followed and people are not placed at unnecessary risk. Care Homes for Adults (18-65 years) Page 26 of 38 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 . Peoples concerns would be taken seriously and there are systems in place to help keep vulnerable people safe. Evidence: One person has moved into the home since we last visited. Their records show that the manager explained how to complain and who they should speak to. Two people who gave us written comments (with staff support) say staff treat them well and they know who to speak to if they have concerns. One person told us they would speak to staff. There are photos on the kitchen wall to remind people who they can speak to if they have concerns. One of the photos is of the area services manager. We asked someone about this and they said I dont know the lady but agreed yes they know Sue and like the staff so they would talk to them. Staff who wrote to us say they know what to do if someone (or a representative of theirs) has concerns about their care. One professional wrote to us that they know how to complain but I have NEVER to date had to raise any concerns. Staff have regular access to training in protecting vulnerable people so they know how to recognise and respond to suspected abuse. The manager has learnt from previous experience of referrals, the importance of the process and about the rights of people to be protected from others they may live with. A staff member we spoke to was clear about the need to report any concerns. Care Homes for Adults (18-65 years) Page 27 of 38 Evidence: The manager recognises in information sent to us, that the service could do better in making sure staff remain aware of systems for whistleblowing and using the procedure appropriately. This means she has identified the importance of ensuring this is raised regularly to promote good practice. Care Homes for Adults (18-65 years) Page 28 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People live in a homely, comfortable and safe environment that suits their needs. Evidence: None of the current service users requires additional aids or adaptations to be able to access the facilities in their home. We looked at shared areas and at one persons room who agreed to show us. The person showed us items they had which reflected their interests, including posters and music equipment. People say they like living at the home and they like their rooms. The areas we looked at were well maintained and comfortable. The lighting in one persons room was not adequate - with one bulb gone and another flickering. However, this was rectified by the manager as soon as she was aware of the situation. We were able to see that the quality monitoring systems in place provide for the manager to report when redecoration is necessary and when equipment or furniture needs to be replaced. This means that she can try to ensure the environment is always homely and comfortable. Records show that systems for detecting fire are tested regularly. A staff member also told us that people living in the home join staff in video training about fire so they Care Homes for Adults (18-65 years) Page 29 of 38 Evidence: know what to do. Records of fire drills show that people living in the home are involved and record any problems. This means that peoples safety in the event of a fire is promoted. We did not have any concerns about cleanliness in the areas we saw and there were no unpleasant smells. We looked at staff training records and these show that people have training in infection control and in food safety. One staff member has been designated as a link with the health authority for infection control in the home. These things mean there are measures in place to help ensure the environment is clean, safe and hygienic. Care Homes for Adults (18-65 years) Page 30 of 38 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 . Staff in the home are skilled to support the people who use the service, although the service is not able to show that there have always been sufficient numbers to avoid compromising the opportunities open to people. Staff are well supported by the manager to understand their roles. Evidence: Staff who wrote to us said they were unable to confirm staffing levels were always sufficient to meet peoples needs but that they had improved recently. The information the manager sent us showed 259 hours had been covered during the previous three months by the homes own permanent relief staff. This means that she had made efforts to minimise the impact on people living in the home by using staff they knew. We asked about this and were told this had some impact on people living at the home. For example, one person is shadowed at a distance to be able to use a local shop on their own but in some safety. This had presented some difficulty because experienced and permanent staff would need to work alongside relief staff at all times and so arrangements were insufficient for the person to do this activity for a time. There are two new staff. We could see from records that staff have a full induction and one person had brought their work book in to cover some aspects of this with the Care Homes for Adults (18-65 years) Page 31 of 38 Evidence: manager, while we were there. Staff tell us that they have good training and induction to help them understand and meet peoples needs. One person says I like the staff. Staff changes mean that there have been changes in the proportion of staff with formal qualifications, but the organisation has a history of ensuring people are able to register and work towards these. Experienced staff have had training in managing and responding challenging behaviour. New staff have not yet attended this in order to ensure they have the skills they need to respond in a way that promotes their safety and wellbeing as well as that of people living in the home. However, the client group living at the home has changed and it may be that the needs of people living there at present indicate the training is no longer a priority. We looked at recruitment records for the staff newly taken on in the service. These show that appropriate checks (including references and checks on identity, health and criminal records) are made before staff start work. This helps to ensure staff do not present a risk to vulnerable people. Interview records show efforts are made to involve people living in the home where they wish to or are able. This means that they are able to have some say in staff appointments. Records show that staff have regular supervision and appraisal with the manager. This helps to ensure that they are working within the aims and objectives of the home and are carrying out their duties as expected. There are also regular staff meetings at which any changes or problems can be discussed and good practice promoted. For example, one set of notes relates to discussion of the needs and preferences of a person newly admitted and shows that their changing wish for their preferred name were communicated to staff. Subsequent records show that this preference is adhered to by staff. Staff told us in discussion and in written comments that they feel well supported by their manager and meet with her regularly to get support and advice about the way they are working with people living in the home. Care Homes for Adults (18-65 years) Page 32 of 38 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents benefit from a well run home and can be confident their views and those of their representatives will be taken into account in developing the home. Their health, safety and welfare is promoted. Evidence: We know from our previous visits that the manager has many years of experience working with people who have learning difficulties. She has also achieved the qualifications national minimum standards set out as needed and participates in regular training updates. This means that she has the skills and underpinning knowledge she requires to help ensure the effective running of the service. There are regular audits of the quality of the service and there is a continuing improvement plan to help address identified shortfalls. The quality assurance process provides for consultation with people connected with the service. Questionnaires have been under review to try and make them more accessible to people with communication difficulties. This has delayed the annual survey for taking peoples views into account via formal consultation. Care Homes for Adults (18-65 years) Page 33 of 38 Evidence: However, there are regular residents meetings at which people are able to raise issues important to them and talk about the things they would like to see happen. Records show these take place about every two months. They show meetings give people opportunities for example, to talk about activities, plans for special events, the homes decor and menus. The manager completed the information we asked for fully, and gave examples of good practice. However, we had to send a reminder letter because the information was late coming to us. Mrs Shreeve recognised shortfalls and where there is room for improvement. She was able to show from evidence she cited and we saw, that she has worked towards ensuring the home complies with regulations. She has also shown that she acted upon recommendations for good practice made as a result of our last visit. Information shows that she is aware of equality and diversity issues and how people with disabilities may be disadvantaged in their communities. Records show staff make sure that people are able to access local facilities and activities regardless of their disability. They also show peoples rights to make decisions (for example in relation to family contact) are upheld. These things show that the manager is taking responsibility for ensuring that the quality of the service continues to improve, and that people connected with it have some say in the way it develops - even though the formal process has been delayed. We looked at a sample of records to do with the safety of the home and working practices. These show staff have relevant training and there are regular checks. (Seen - fire risk assessments, servicing agreements, fire drills, environmental risk assessments, asbestos survey, testing of hot water valves and temperatures, boiler and electrical equipment.) All staff are expected to sign to say that they have read risk assessments for individuals and for their working practices. Issues are followed up at staff meetings. A staff member also gave us an example of how someones independence was promoted but with due regard to their safety when carrying out an activity. This means that staff are aware of how they are to promote peoples safety and welfare. Care Homes for Adults (18-65 years) Page 34 of 38 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 35 of 38 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 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 9 Risk assessments should be cross-referenced with one another as well as with support plans, where this is appropriate. This is to staff have clear information in all the relevant places about the steps they need to take to reduce risk. Information about sexual expression or risk should be consistent and cross referenced appropriately (for example with the detailed support plan and health book). This is so staff are less likely to overlook this area of support, risk or need. Formal training in the administration of rectal diazepam should be given annually. This is so staff can be sure they are always capable of administering it to the person safely and in accordance with any clinical guidance that may have been updated since their last formal training. Staff should have access to specialist training about peoples mental health. This is to supplement personal research and Internet information and would help ensure staff have the underpinning knowledge to understand and Page 36 of 38 2 15 3 20 4 20 Care Homes for Adults (18-65 years) support people with particular conditions. 5 35 Given the changing composition of the group of people living at the home, the manager should keep under review the need for new staff to complete approved training for dealing with difficult behaviour and in breakaway techniques. This is so staff are skilled to support people in a way that promotes the safety of everyone living and working in the home. Care Homes for Adults (18-65 years) Page 37 of 38 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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