Inspection on 30/10/08 for Bursted Houses

This inspection was carried out on 30th October 2008.

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

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

Bursted Houses 01/11/07

Bursted Houses 26/05/06

Bursted Houses 16/01/06

Bursted Houses 17/03/05

Bursted Houses 09/09/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Bursted Houses 227-235 Erith Road Bexleyheath Kent DA7 6HZ     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: Lorraine Pumford     Date: 1 4 1 1 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. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Bursted Houses 227-235 Erith Road Bexleyheath Kent DA7 6HZ 02083315196 02083315196 bursted@mcch.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: MCCH Society Ltd care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is:23 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 Date of last inspection Brief description of the care home Bursted Houses is run by MCCH Society Ltd and offers accommodation for adult service users with a learning disability. It is made up of four self-contained properties, three of which are bungalows and one a house with stairs. These properties are laid out within a quiet cul-de-sac facing each other. Each house has domestic style facilities, such as a kitchen, dining area, lounge, bathrooms and toilets. The management responsibility for Bursted Houses rests with the Registered Site Manager who has an office adjoining one of the houses on the site. 23 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place over two days. We met with a number of people who live in the home and with the manager and staff on duty on the days we visited. In addition surveys were sent to staff, residents advocates and health care professionals that meet with people living and working in the home and some of their Comments have been included in this report. We also looked at the Annual Quality Assurance Assessment (AQAA) sent in by the provider. This self-assessment document focused on the outcomes for people using the service and plans the provider is making for the future operation of the service over the forth-coming months. The last inspection report was also viewed. We also looked at what the provider had told us about events that have happened in the service these are called notifications and are a legal requirement. During the time we spent at Bursted Houses we also examined a number of policies, Care Homes for Adults (18-65 years) Page 5 of 31 procedures and documents and undertook a tour of the buildings. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 7 of 31 Guidance on pressure area care must be included in residents care plans. The registered person must ensure that the wheel on scales are calibrated so that residents who cannot stand on standard scales can be weighed when necessary. New staff must receive training before working with people who have challenging behaviour. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home benefit from their individual needs being assessed and staff that have the skills and ability to meet these needs. Evidence: From records seen it is apparent that a comprehensive assessment of needs takes place prior to admission, which included participation by relevant health and social care professionals, the resident and their advocates. People living in the home have very specific individual needs linked to learning disabilities, complex behaviours, autism and epilepsy. Staff spoken to had a very good understanding of the individual needs of the residents. A requirement was made at the time of the last inspection that the provider needed to confirm in writing that following the pre admission assessment they were able to meet Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: the prospective residents needs prior to admission and it was apparent that action has been taken to address this. Staff stated that prospective residents were able to visit the home for short visits and overnight stays before being offered a place on a trial basis. Each resident has been provided with a pictorial contract and the document has been updated to include a recommendation made at the time the last inspection. New people moving to the service have access to information in an appropriate format to tell them about the home. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standard 6, 7,9 People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service.The people living in the home can be confident that they will be supported to have an individual care plan and risk assessments which enables residents to make choices in their daily lives. Evidence: Care plans examined for two people who had lived in the home for a number of years had an up-to-date care plans which were reviewed at regular intervals and were reflective of their needs. The care plan provided information about the individuals needs and the action that staff should take to meet these needs. In addition each resident has a communication passport which includes detailed information about the persons likes and dislikes and the best way to communicate with the person. Members of spoken with had a good understanding and knowledge of residents and Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: their preferred routines. There was clear guidance to staff about the residents morning, daytime bedtime and nighttime routines. The organisation does not have a set care plan format so it is commendable that staff have developed this care plan system which ensure the needs of the people they provide care to are met. Records examined for two people who have moved into the home in the last few months were more difficult to follow. Files contained a lot of information i.e. medical reports from hospitals and appointments past and future which made them bulky. One resident had moved to Bursted Houses from another service managed by the provider and the file contained documents from the persons previous home as well as some new guidelines and risk assessments. Discussion took place was staff regarding the need to streamline files to ensure that staff had easy access to information they required to meet residents day-to-day needs. One resident was at risk of developing a pressure area and one resident was receiving treatment from the district nurse in relation to a pressure area. Discussion took place regarding the need to include guidance for staff on where necessary preventing and managing pressure area care. Staff stated that the district nurse visited frequently to monitor the situation and staff said they would ask for guidance to include this information in residents care plan. The initial assessment for one person indicated they had seizures however there was no guidelines for staff about how they should manage seizures or what stage they should seek medical advice staff had addressed this issue on the second day that we visited the home. Some of the people living in Bursted Houses have challenging behaviour and their care plans contained comprehensive guidelines for staff regarding the behaviour that person was likely to exhibit and the action required by staff to address the matter. Requirements were made following the previous two inspections regarding the need for care plans to fully reflect the individual needs of people living in the home and it is apparent that staff have worked hard to address this requirement. Each resident has a named key worker. The staff were asked about their role as a keyworker and this showed that the support they provided was very comprehensive including helping with personal shopping, attending healthcare appointments, ensuring all the residents personal care needs were met, organising leisure activities maintaining daily records. The majority of people living in Bursted Houses have limited communication skills. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: Staff told us that although people were not always able to verbally express their likes and dislikes people expressed themselves in other ways and staff were able to give examples of this. Record seen provided evidence that potential risks are identified and there were clear strategies recorded for staff to follow to reduce the risk to the resident and the people supporting them being harmed. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 11,12,13,14,15,16 and 17 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home benefit from support to develop their daily living skills. The home has made progress in supporting the residents to enjoy a range of activities based on their individual interests. Residents benefit from a healthy and varied diet. Evidence: Records in relation to activities were examined for four people. Files contained a weekly activity plan however it was not always possible to evidence that some of the activities recorded had actually taken place. Staff stated that the system had only recently been introduced. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: From discussion with staff it was apparent that some residents living in the house attended a local college, residents also participate in music sessions, birthday parties and go bowling, staff were preparing to host a Halloween party that other people living on the site would be invited to attend. We looked at information in relation to activities for people living in house 235. One resident attends a day centre on a regular basis, records also indicated that staff support residents to go shopping and out for pub lunches. While we were there a resident also enjoyed a hand and head massage. Some entries seen in daily records stated done activities. It would be beneficial to staff and residents to know what the activity was and whether or not the person had enjoys participating in it. We did not meet any relatives during the time we spent in Bursted Houses however information provided in the AQQA and records seen indicate staff help residents to maintain contact with relatives and friends outside of the home. Staff stated that relatives are also invited to social events held at Bursted houses. Staff support residents to go on annual holidays. We observed lunch being served in house 231 and 235. It was apparent that residents are provided with a nutritional diet which includes fresh fruit, salads and vegetables. Food being served looked appetising and where necessary staff assisted residents to eat. Staff in house 231 were asked to record vegetables provided at mealtimes to reduce the possibility of repetition. The majority of residents are unable to participate in daily housekeeping tasks however whenever possible staff help residents develop their independent living skills in line with their individual needs. For example residents in 227,229 take their cups and plates back to the kitchen after mealtimes. Care Homes for Adults (18-65 years) Page 16 of 31 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. Standards 18,19,20 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home benefit from being supported in a manner that protects their privacy and dignity. People are supported to access professional healthcare based on their individual needs. Guidance on pressure area care must be included in residents care plans. Residents are protected by the home medication policies and procedures. Evidence: It was observed that all residents were wearing clean age appropriate clothing that was in good condition. When we arrived in the home on the first day we saw a member of staff wheeling a resident on a shower chair along the hallway to the bathroom. The person was not wearing any clothing and was only partially covered by towels. This matter was discussed with staff on the day and fed back to the manager on the second visit. The manager stated that a towelling cape had been purchased to prevent the incident occurring again. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: Healthcare records indicated that people are supported to access a range of healthcare including GPs, psychiatrist and other appointments according to their individual needs. The manager stated they also work closely with the Community Learning Disability Team to address issues relating to people who have more complex needs. Records for one person seen indicated that they were at risk of choking. It was apparent that speech and language therapists had assisted staff to develop guidelines in relation to the person eating and drinking, however there was no evidence that the persons weight was being monitored. Staff said that the person had been weighed recently however the weight had not been recorded as it appeared to have dropped and did not seem correct, staff were asked to arrange for the wheel on scales to be calibrated and make alternative arrangements to weigh the resident in the interim period. The physiotherapist and assistant physiotherapist came to see a resident living in house 235 and began the residents exercise programme in the lounge where other residents were seated watching television. Discussion took place with staff regarding the need for future sessions to take place in the residents bedroom to safeguard the persons privacy and minimise the effect to other people living in the house. Requirements have been made following the last two inspections regarding the need to improve medication procedures to safeguard residents. We looked at medication procedures in relation to residents being tracked and the overall system that is operated and found that standards continued to improve. There is a system in place for recording the receipt and disposal of medication into the houses. Handwritten entries on medication charts were checked and countersigned by a second member of staff. In house 233 staff had not always included adequate information such as the frequency medication was required to be given. The medication record for one person was difficult to follow, staff had not used the supply in sequence however the balance of these medicines was correct for all but one medicine. There was a photograph of each resident attached to their Medication Administration Record and the doctor had signed the MAR sheet when medication was changed. In house 227,229 medication for one person indicated that a medicine prescribed PRN had ceased however staff did not know when and why this happened. Staff had recorded a clear protocol to provide guidance for the administration of other PRN medicine. One resident in 231 was at risk of developing a pressure area and one resident in 235 Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: was receiving treatment from the district nurse in relation to a pressure area. Discussion took place with staff that guidance on preventing and managing pressure area care must be included in individual care plans. Staff stated the district nurse visited frequently to monitor the situation and said they would ask for guidance and include this information in care plans. Staff spoken with stated that each house which accommodates wheelchair dependent people is provided with a hoist to assist residents who are unable to stand. Each person has their own designated sling following a moving and handling assessment. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standard 22 and 23 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home have access to an appropriate complaints procedure. Training for staff on safeguarding vulnerable adults helps protect people living in the home. New staff must receive training before working with people who have challenging behaviour. Evidence: Copies of the organisations procedures and social service procedures are available in the home. Staff training records show that some of the staff had received safeguarding vulnerable adult training and further training is booked. We spoke to the care staff about the safeguarding adults procedure and they all displayed a good knowledge of the procedures and the importance of speaking to the manager about any issues that may arise. We looked at training records to see if the staff had been trained on how to appropriately support people who have complex challenging behaviours and this was also discussed with staff who work with people identified as having challenging behaviour. Some staff had attended relevant courses and other people said they had been told training would be provided in the near future. Recently appointed staff must received training before working with people with challenging behaviour as both they Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: and the resident may be at risk of harm if a staff member does not know how to manage an incident appropriately. Action must be taken to address this. Since the last inspection the provider has received three complaints. Details of complaints were clearly documented along with the action taken by then to address the concerns raised. There is a clear complaints procedure which is in a suitable format for people living in the home. Three incidents have arisen since the last inspection which the organisation forwarded to the local authority to be investigated under the joint working safeguarding adults protocol. We checked the personal finances for two residents including their finance records, money and receipts. There is an individual finance record for each person and money is held in a lockable filing cabinet. All expenditure is recorded and receipts are available. The record of expenditure was inspected and money had been spent appropriately and receipts were available. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 24 and 30 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use this service benefit from living in a clean, homelike and well maintained home. Evidence: Communal areas in all houses seen were clean, tidy and odour free. Each house has a television and a music centre in addition some residents have their own equipment in their bedrooms. The communal areas were warm and welcoming. There was adequate seating for all the people residing in each house and since we last visited residents living in houses 227 and 229 have benefited from their home being redecorated and refurbished. The seal around the refrigerator door in house 231 had split staff stated that they had chosen a new refrigerator but were still awaiting funding to purchase this. A mattress purchased but not required for one resident in house 235 was being stored in another persons bedroom this matter was discussed with the manager, on the second day that we visited it has been removed. Pillows on one persons bed were particularly lumpy and could be uncomfortable to sleep on. The manager stated that she had asked staff Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: to purchase new pillows. Generally residents bedrooms were well decorated and individually personalised. Each house has appropriate bath and shower rooms and where necessary these are equipped to assist people with limited mobility. Each house has its own laundry facilities and staff spoken with stated that they meet the current needs of the people accommodated. Cleaning materials were found to be stored securely. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 32,33,34,35 and 36 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The residents are supported by a committed and stable team of staff. The staff receive a range of training and supervision sessions that enables them to work to a high standard and deliver good care. Evidence: A total of 42 members of staff are employed to work in the five houses on the Bursted site on a shift basis. Although residents continue to benefit from a stable staff group who have worked there for a number of years. Information provided in the AQQA indicates that a number of staff have recently been recruited to work in the home. We looked at the recruitment process for four employees recruited since the last inspection. Staff files were well organised, we found that all the staff had two references and staff had provided proof of ID, a POVA check, a CRB disclosure and confirmation from the providers occupational health department that a satisfactory health declaration had been received. The manager stated that if any issues arose HR would contact her and request she discuss the matter with the applicant directly before the person would be offered a post on a permanent basis. The staff had completed and Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: signed contracts of employment. We inspected the training records. An ongoing programme of training had been booked till the end of the year covering most mandatory training as well as specific training to support staff to work effectively with the residents they support. Staff said the training they received was of a good standard and very useful in their work. Staff were less clear about the organisations induction. The manager stated she is expected to instigate an induction and received little guidance from the provider on what areas this should cover. The manager has devised a comprehensive induction format however this contains a lot of information and discussion took place around prioritising to enable staff time to take on board so much new information. It is recommended that the provider looks at introducing a common induction programme to ensure that all employees are receiving a fair and even induction when joining the organisation. Staff stated they had been able to look at the organisations policies and procedures and spent time shadowing more experienced staff, before working independently. Over 50 of staff working in the home have now attained an NVQ 2 in care, the home needs to continue to work towards reaching the current National Minimum Standards of 70 . We discussed the issue of supervision with the manager in was apparent that supervision currently takes place to monitor the general practice of care staff. We discussed the need for supervision to not only include practice but also training and personal development. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 37,39 and 42 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home benefit from effective leadership. Health and safety measures are in place to safeguard the people living in the home, however staff must have training in moving and handling before they work with people who require this level of support. The quality improvement system monitors and seeks to improve the service provided. Evidence: Standards in the home have continued to improve since the appointment of the current manager. Staff members, relatives advocates and health care professionals who completed our survey supported our view. One relative said management have a good listening ear, which was attributed to the site manager and her professionals approach. The manager explained that a quality assurance system is in place including regulation Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: 26 monitoring visits. These are completed by another registered manager from one of the providers homes. A sample of these were seen, some were every short and it was not possible to see an effective audit had taken place. The manager has an action plan relating to improvements she wishes to make in the home. The company has questionnaires to seek the views of residents, relatives and other care professionals as part of a quality improvement exercise. The staff training records show that staff attend training in relation to food hygiene, health and safety and moving and handling however, the moving and handling training may not take place until sometime after people have been working with residents. The manager said staff would not be expected to undertake the task until after the training, however acknowledged that an untrained staff member may be present when a resident requires assistance and attempt to assist with the best intentions which could result in either the resident or staff member being harmed. We looked at fire safety in the home. The fire alarm and fire extinguishers had been serviced. The fire alarm records show the alarm is checked weekly and the fire drills have been taking place on a regular basis. The AQAA showed that all the health and safety maintenance checks had taken place. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 15 The registered person must ensure that care plans contain clear guidance on pressure area management and staff implement the advice provided by health professionals. To ensure residents health needs are met. 31/12/2008 2 18 12 The registered person must 30/01/2009 ensure that the wheel on scales are calibrated. To ensure that residents can be weighed when necessary. The registered persons must 31/12/2008 ensure medication is safely managed in the home in this instance Staff date records correctly, staff administer medication in the sequence it was brought into the home, staff record the reason medication is no longer required. to safeguard residents 3 20 12 Care Homes for Adults (18-65 years) Page 29 of 31 4 23 13 The registered person must ensure that new staff must receive training before working with people who have challenging behaviour. To safeguard residents and staff. 30/01/2009 5 42 13 The registered person must ensure that staff are provided with appropriate training, in this instance moving and handling before they work with people who require this level of support. To safeguard residents and staff. 02/01/2009 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 2 3 4 12 17 18 32 Staff need to keep a comprehensive record of activities residents have participated in. Staff need to record vegetables served to residents at mealtimes to help reduce the possibility of repetition. The residents physiotherapy session should take place in the privacy of their own bedroom. The provider should develop a comprehensive induction,which is implemented in all services for new members of staff. Staff supervision should include staff members training and development needs as well as monitoring staff practise. 5 36 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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