Inspection on 16/10/08 for Caroline House

This inspection was carried out on 16th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Caroline House 20/03/07

Caroline House 07/03/06

Similar services:

Flint House

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

The Cotswold Home

Fairways

Treloar College

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: Caroline House 191 London Road Horndean Waterlooville Hampshire PO8 0HJ The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Christine Walsh Date: 1 6 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 40 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 40 Information about the care home Name of care home: Address: Caroline House 191 London Road Horndean Waterlooville Hampshire PO8 0HJ 02392592502 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): dolphin.homes@btconnect.com Dolphin Homes Ltd Name of registered manager (if applicable) Ann Mary Phillips Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 6 6 0 0 care home 6 learning disability physical disability Additional conditions: To accommodate a named child DOB 24/02/1991 through to adulthood. Date of last inspection 2 4 0 3 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 40 A bit about the care home Caroline House is in Horndean Hampshire and is owned by Dolphin Homes Ltd. Up to six people with a learning and/or physical disability can live in the home. The home has been built for people with physical disabilities in mind. It has a lift to the first floor, hoists, ramps and other special equipment. The ground floor is used by all who live in the home and has a large conservatory and enclosed garden. Care Homes for Adults (18-65 years) Page 5 of 40 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: Adequate Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 40 How we did our inspection: This is what the inspector did when they were at the care home * The quality rating for this service is 1 star. This means the people who use this service experience Adequate quality outcomes. Mrs C Walsh regulatory inspector spent one day in the home. She looked at records, spoke with people living in and working in the home, watched how staff work and walked around the home to make sure it meets your needs. What the care home does well Your home does well to help you to: To make everyday choices. To develop your independence. To visit your local community. Such as shops, pubs and gyms. Care Homes for Adults (18-65 years) Page 7 of 40 To keep in touch with your family and friends. Your home does well to well to help you stay well. It helps you visit the doctors, see the nurse, and other health care professionals. Its helps you with your medication. Your home does well to listen to you, and will help you when you are sad or cross about something. It makes sure the staff are trained to keep you safe and stop others from hurting you. Your home does well to offer you a warm and friendly place to live. It meets your physical needs and you have a room of your own that you can decorate and furnish as you want. The manager and her staff receive training to help them to meet your needs. Staff go through an interview and induction process to ensure they are safe to work with you. Care Homes for Adults (18-65 years) Page 8 of 40 What has got better from the last inspection What the care home could do better The home must make sure you are kept safe at all times. It could do better to make sure staff know how to feed you properly. It could do better to make sure it keeps you safe if there is a fire. It could do better to keep you safe from infection. Care Homes for Adults (18-65 years) Page 9 of 40 It could do better to make sure your home is safe to live in and mend things quickly when they need mending. Dolphin Homes Ltd could do better to make sure the care you get at your home is good all the times. 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 Christine Walsh 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 10 of 40 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 11 of 40 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 . To ensure the home can meet prospective peoples needs they will carry out a pre admission assessment prior to the person moving in. The home must ensure the changing needs of the people who use the service are regularly reviewed to ensure they are fully and appropriately meeting their needs. Evidence: The Annual Quality Assurance Assessment (AQAA) told us that the organisation Dolphin Homes would not offer a placement to anyone whose needs could not be met. Service users are only admitted to the home after a full and comprehensive assessment of needs have taken place. This was tested by viewing three service users personal plans, which includes the assessment documentation. The home is currently fully occupied and has not admitted any new service users since Care Homes for Adults (18-65 years) Page 12 of 40 Evidence: 2007. The manager told us that following a referral and receipt of an assessment from a care manager, the home would undertake their own assessment of the service user needs. The assessment documents provided information about the character, strengths and needs of the service users. The document also identifies areas where support will be required such as health, personal care, mobility and communication. Care Homes for Adults (18-65 years) Page 13 of 40 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 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 use the service receive support with their needs and wishes using a person-centered approach. The home must however ensure changing needs are monitored and addressed appropriately. The service does well to encourage and support the people who use the service to make decisions and choices about their lives. The service in some areas does well to identify and minimise the risks to people who use the service by ensuring that detailed and up to date information is available to inform staff. However the service must ensure specific areas of need such eating and swallowing and areas in the home that could cause potential risk to the service users are addressed immediately. Evidence: The AQAA told us that all service users current and changing needs, personal goals are Care Homes for Adults (18-65 years) Page 14 of 40 Evidence: reflected in their individual life plans (Person - centered) and individual procedures are set out for i.e. health care needs, rehabilitation, aggressive and challenging behaviours. These plans are completed with service users who are supported by staff to make decisions about their lives. This was tested by viewing the person centered plans and risk assessments for three service users, by meeting with service users about the care and support they receive, observing practice and speaking with staff. There was evidence that the service has adopted a person centered approach to the care and support they provide to the service users. This includes the person making choices and decisions about their everyday needs and wishes. The plans have been developed using the person centered Who Am I document, which encourages the service user and staff member supporting them to complete their personal profile as if they had written it themselves. The personal profiles include details of what name the service user wishes to be known by, their family and friends (Circles of Support), their cultural and religious beliefs, their lifestyle, how they access and move around their home and community, their health care needs and how they communicate their needs. This is not the full list of the areas the personal plan covers but they demonstrate that the service supports the service users using a holistic and person centered approach. The person - centered plans have been developed using pictures of the service user, easy read sentences and other accessible symbols that the service user is able to relate to. In addition to the person-centered plans, which identify areas of need, support care plans have been produced to inform staff how the service user wishes those needs to be carried out. The manager informed us that the personal plans have been developed in some cases with the full involvement of the service user. Where the service user has not been able to clearly communicate their wishes, goals and aspirations family and friends have been asked for their support. There was evidence of a service user being fully involved in developing their personal plan. Have Your Say comment cards received from staff told us that they have access to information that tells them how the service users wish to be supported. In developing the personal plans using a person centered approach the service has gathered information on how the service users make choices and what their goals and aspirations are. The plan tells the reader how the service user will make decisions and choices and how these are communicated. To support the service users with communication difficulties alternative communication tools are used, such as picture information boards and switches. The home also has access to an outside agency that holds communication workshops. The manager told us that the communication workshops have been very successful in Care Homes for Adults (18-65 years) Page 15 of 40 Evidence: supporting the service users to make decisions and grow in confidence to make choices about their everyday and future lives. Have Your Say comment cards received from some services users indicated that they are involved in making decisions about what they want to do during the week, in the evening and during the weekend. Observation on the day provided evidence that service users are made aware by staff of what choices and opportunities are available to them such as what to eat and activities to take part in. Areas where the personal plan identifies there is a need, a clear care plan has been produced to provide staff with guidance on how the service user wishes to be supported, including specific detail about how they like to be woken and assisted to get up. In addition there is an associated risk assessment. The risk assessments tells the reader what the activity is such as accessing the community, the level of risk to the service user and what steps the member of staff must take to minimise the risk. The manager has not included the risk to the service users using the ramp to the front of the home. At the time of the visit the ramp did not have railings to prevent service users from walking or rolling of the edge and potentially harming themselves. The inspector observed the potential risk when service users returned to the home and an accident nearly occurred. Personal plans provide information that where there is a risk of a service user becoming anxious, stressed or behaving inappropriately there are clear guidelines and risk assessments in place to minimise these. It was also observed that the feeding techniques carried out by staff place service users at risk of choking. The manager was made aware of the concerns and acted promptly to address the need for a reassessment and training for staff. Care Homes for Adults (18-65 years) Page 16 of 40 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 home ensures the people who use the service are supported to maintain an active lifestyle that suits their needs and individual interests. The home ensures the people who use the service maintain contact with family and friends and socially engage with their peers and the local community. The home ensures the people who use the service have their rights respected, are provided with opportunities to make decisions and develop individual living skills. The home ensures the people who use the service are provided with support and guidance to plan and prepare healthy meals. However up to date feeding assessments and training for staff must be provided to ensure associated risks such as choking are minimised. Evidence: Care Homes for Adults (18-65 years) Page 17 of 40 Evidence: The AQAA told us that the home does well to continue to support service users to access college courses of their choosing. Maintain contact with family and friends and involve families and service users in decision-making. The AQAA went onto tell us that they do well to ensure the service users maintain their health through well balanced diets, choice of menus and regular health care check ups. This was tested by viewing personal plans, daily activities, menu plans, observing practice and speaking with service users about their day. Each service users personal plan has an activity record that identifies the activities they enjoy and a record of activities they have been involved in each day. The plans include attending college, swimming, pamper sessions, shopping and accessing community based activities such as going out for a meal. Service users are encouraged to attend these and access their community. On the day of the visit all the service users were out attending college or school. On return from college discussion took place between service users and staff as to what other activities they would like to do. Some service users have limited or no verbal communication, the staff said they were able to gauge by gestures and facial expressions if service users are happy or not with the choices on offer. This was observed when a choice of what to eat was made at lunchtime. For service users with limited verbal communication a daily picture board is completed to inform them of what is happening throughout their day, which included attending college, in house activities and me time. Other communication aids were observed to be in use to assist service users to be independent, advocate for themselves and have an awareness of their life. These included labelling draws with pictures of where certain items of clothing are stored, access to media and pictures of family and friends. Picture board person centered plans are in the process of being developed of service users with limited verbal communication. These include pictures of the service user in everyday activities they enjoy and the people who are important in their lives. A service user told us that they had enjoyed their day at college and was looking forward to a weekend trip to Paris. Pictures of service users on various holidays, pictures of family events, birthday celebrations and pamper sessions provided other example of activities service users are involved in. The manager told us that arrangements are in place to support one of the service users to address their dream, goal and aspiration to be a secretary. There was visual evidence that this goal was being addressed. Service users are supported to maintain contact with family and friends, this was evidenced in records held in their personal plan. The information tells the reader about relationships that are important to them and the contact they have with those people. Daily notes record if contact has been made with family and friends, which includes visiting the family home for the weekend or speaking with a family member on the Care Homes for Adults (18-65 years) Page 18 of 40 Evidence: phone. The manager told us that they have strong family involvement who play an important part in the daily lives of their relative, assisting with the development of personal plans and supporting their relative to make decisions. On behalf of a service user a family member told us in a Have Your Say comment card that their relative was very happy at Caroline House and the staff mix was well suited to meet their relatives needs. Through observation the staff showed us they treat service users with respect and uphold their dignity, privacy and individual choices. Information in personal files inform the reader, the name by which service users wish to be to known by, and what behaviours and non-verbal clues are telling staff about how they are feeling. A member of staff spoken with at the time of the visit was aware of their roles and responsibilities in respect of providing an individual approach and valuing service users for who they are. The member of staff went onto verbally demonstrate that they are aware of the homes aims and objectives which includes the importance of promoting freedom of choice and developing independent living skills. This shows us that the service takes seriously the importance of treating and respecting service users individuality and their diverse needs. Service users have access to their own bedrooms when they wish and have access to all communal areas of the home. For service users who require supervision for their safety, staff provide support to access areas such as the kitchen, garden and the community. The manager told us that mealtimes are led by service users and what they would like to eat. The manager said at times there could be several different meals being prepared at any one time. This includes service users being supported to plan, shop for and prepare meals. The manager went onto tell us that service users take turns to do the shopping and another likes to fax orders to the local grocer. The manager said that they support service users to make healthy options, offering advice when planning the menu to ensure they are considering foods such as fruit and veg. Fresh fruit and veg was well stocked in the home. A number of service users require some level of assistance to eat their meals and some have disabilities that affect the way in which they eat their meals. It was observed that risk assessments were in place for these service users but there was not a specific care plan that told the member of staff the correct way to help the person to eat. Observation at a mealtime provided evidence that poor techniques were being used to help the person eat and in a way that could potentially cause harm to the service user. This was addressed immediately with the manager who admitted it had been sometime since a re assessment of eating and swallowing had taken place. The manager made arrangements at the time of the visit for a speech and language Care Homes for Adults (18-65 years) Page 19 of 40 Evidence: specialist to visit and undertake an assessment. The manager was informed that staff must receive further training following the assessment to ensure they are following correct safe procedures. Care Homes for Adults (18-65 years) Page 20 of 40 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 home does well in some areas to ensure the people who use the service receive the appropriate support with their personal care, health care and medication in the way in which they require and prefer. However the people who use the service who have complex physical disabilities must be regularly reviewed to ensure the current plan of care and procedures meet their changing needs. Evidence: The AQAA told us that service users have a choice of when they like to get up and go to bed, they have access to a GP and other professionals when required and all staff receive training in the safe administration of medication. This was tested by viewing personal plans, Have your Say comment cards and medication records and speaking with the manager and staff. The personal plans provide detail on how service users wish to spend their day Care Homes for Adults (18-65 years) Page 21 of 40 Evidence: including what time they like to get up, go to bed, when they like to bathe and how to support them with their personal grooming. A member of staff said they were aware of service users individual support needs as all staff are encouraged to read the plans, be involved as a keyworker to support service users with their everyday needs and be involved in reviewing their personal plans with them. There was evidence of reviews taking place and service users being involved. The manager told us the service has good links with primary care and specialist health care teams. Service users personal plans provide evidence that their health care needs are monitored and reviewed. The plans also provide information on specific health care needs, what action is required and how staff must support them with these needs such as keeping limbs and joints flexible. These did not include a service user requiring specific feeding techniques, and observation provided evidence that further support and training for staff was required. The manager dealt with this concern on the day of the visit. But is reminded of the importance of regularly monitoring, reviewing and ensuring the staff have the skills to carry out specific techniques. A comment card from a specialist nurse told us The service is very good at promoting continence and all consultations with service users are undertaken in the privacy of their own rooms The manager told us that it has been one of the homes successes to promote independence and self control with continence for some service users. The service has systems in place for the administration of medication. The home uses a monitored dosage system (MDS) supplied by a local pharmacy. Medications are received, recorded and disposed of using systems as recommended in the Royal Pharmaceutical Guidelines. It was noted that the medication cupboard was clean, tidy and organised. Each service user has a list of medications, which have been prescribed by their doctor, which includes regular and as required medication. As required medications are supported by care plans that detail when the medication needs to be given, such as when a service user has a seizure. The manager told us that only staff who have undertaken medication training are responsible for ensuring service users receive their medication. A member of staff confirmed that they receive training from the service, which covered such areas as storage, procedures for giving medications and side effects. The manager told us that the training is being reviewed and staff will be receiving further training in the near future. The manager went onto tell us that she views the medications and medication records daily to ensure all medications have been given and signed for, this is good practice. Care Homes for Adults (18-65 years) Page 22 of 40 Evidence: Care Homes for Adults (18-65 years) Page 23 of 40 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home ensures it listens to and acts upon the concerns raised by the people who use the service. The home ensures the people who use the service are safeguarded from potential risk of abuse. Evidence: The AQAA told us that they do well to ensure all service users have a copy of the complaints procedure in widget (Widget is a specific set of pictures used for people with communication difficulties) and photos in their individual personal plans and staff receive training. This was tested by viewing the homes current complaints procedure, the complaints log book, a service users behaviour support plan, management of service users personal monies, Have Your Say comment cards and speaking with staff. The complaints procedure details how service users can make a complaint and what action must be taken to resolve it. There is an accessible format for service users who have limited verbal communication, this has been produced by service users for service users with the support of an outside agency. The complaints procedure has been produced using photographs of the service users and staff acting out a scenario of a complaint, using speech bubbles to describe what is happening. All comment cards Care Homes for Adults (18-65 years) Page 24 of 40 Evidence: received from service users and staff indicated that they know who to speak to if they have a concern or what to do if someone makes a complaint. The AQAA tells us that the home has not received any complaints in the last year. The service has a complaints log where if the service receives a complaint it will record the nature of the complaint and what action was taken by the service to resolve it. The manager said the home holds regular group and individual meetings with service users and encourages them to tell them of any concerns they may have. The manager spoke of how a service user has been supported to write to the responsible individual to complain about how long it has taken for a minor maintenance issue to be mended. The manager told us that staff are provided with safeguarding of vulnerable adults training, which provides them with the knowledge to identify various types of abuse and how to report these. A member of staff spoken with at the time of visit confirmed that they had received training and was aware of their roles and responsibilities in maintaining service users health and wellbeing and reporting incidents of concern. Some service users have complex needs and present with behaviours that challenge. There are detailed intervention plans in place and the home monitors the wellbeing of service users on a regular basis. When required support is sought from specialist health care teams who are skilled in managing challenging behaviours. The manager told us that staff have received training in managing behaviour that is challenging and all staff are confident to support service users when their behaviour is challenging. This was supported by a member of staff who was spoken with at the time of the visit. Service users are supported with the management of their money. The home has systems in place for the safe management and monitoring of service users spending, and supports them to develop their personal skills in managing their own money. Care Homes for Adults (18-65 years) Page 25 of 40 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 ensures the people who use the service live in a comfortable, clean and spacious environment that meets their physical and social needs, however it does not respond to areas of maintenance that require an efficient and appropriate response. The home ensures its staff receive appropriate training to minimise the risk of cross infection, however it must ensure laundry facilities meet the required levels of hygiene to prevent potential risks of cross infection. Evidence: The AQAA told us, The environment meets the needs of the service users, but we could do better to provide blinds for the conservatory and individual service users bedrooms. This was tested by walking around the home. Viewing maintenance records and Have Your Say comment cards. Caroline House is a large house, which has been purpose built to meet the physical and social needs of the service users and each service user has a bedroom of their own. Some of which have en-suite facilities. The bedrooms are personalised to reflect the service users interests and personality. Care Homes for Adults (18-65 years) Page 26 of 40 Evidence: The bedrooms viewed at the time of the visit were observed to be clean, tidy, comfortable and tastefully decorated. The bathing facilities have been designed to meet the physical needs of the service users with handrails, hoisting equipment and walk in shower and wet rooms. It was noted that some bathrooms were in need of attention such as a broken shower door, water leaking from a shower room onto the carpet of the service users bedroom and a wooden radiator cover that had been damaged by water from the shower. The radiator cover was unsightly and despite it being brought to the attention of the provider in May 2007 and letters have been sent from the service user concerned and from next of kin it remained in need of repair. Since visiting the home the provider has contacted the Commission for Social Care Inspection to say what action he was going to take to immediately deal with the concerns. The home has a large communal conservatory that is used as the main focal point of the home where service users meet. The conservatory does not have any blinds or curtains to reflect light and reduce heat in the summer and to provide warmth in the winter and to offer privacy to the service users and staff. The home is overlooked by other homes in the neighbourhood. The maintenance logbook provided evidence that the service users have waited over a year to have blinds fitted. The provider confirmed following the visit that blinds would be fitted in the conservatory. The manager informed us that service users are involved in choosing how they would like their bedrooms to be decorated and are responsible with the support of staff to keep their rooms clean and tidy and where possible assist with their personal laundry. There was evidence that the service has taken into account the physical, sensory and diagnosed learning disabilities when supporting them to design and furnish their rooms. The home has a large enclosed garden where there is room for relaxation and fun. The AQAA told us that the majority of the staff have received infection control training. Training information and staff who were spoken with at the time of the visit confirmed this. There is evidence that the service provides staff with detergents, equipment and protective clothing to minimise the risk of cross infection. The home has a separate laundry facility with a washing machine that can wash at high temperatures and has a sluice facility. Although the laundry room was observed to be clean and tidy the flooring was laminated and had been damaged when the washing machine had leaked. The flooring has lifted and there are gaps where soiled debris could collect and cause a source of contamination. It was brought to the attention of the manager who must consider an alternative floor covering. The provider has since informed us that the flooring will be replaced. Care Homes for Adults (18-65 years) Page 27 of 40 Evidence: Care Homes for Adults (18-65 years) Page 28 of 40 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 . The home ensures the people who use the service are supported by staff who have been appropriately recruited in such numbers that meets their individual needs. In some instances the home can demonstrate that the skills of its staff meet the needs of the people who use the service, however further attention is required to ensure specific techniques such as feeding are carried out correctly. Evidence: The AQAA told us that the service does well to maintain and retain a good staff team, ensure all staff have or are undertaking a national vocational qualification (NVQ) and they follow stringent recruitment procedures. The AQAA told us that they feel they could do better to involve the service users in the recruitment process. This was tested by viewing staffing levels, the duty rota and observing practice on the day, viewing training data, recruitment records, Have Your Say comment cards and speaking with service users and staff. At the time of the visit all service users were being supported to undertake activities in the community, some of whom returned at lunchtime and were supported with their meals. The staff appeared organised and well informed of what was going on for each service user. The manager stated the staffs routine includes a handover at every shift where Care Homes for Adults (18-65 years) Page 29 of 40 Evidence: the health, wellbeing and activity of each service user is discussed. A service user said: The staff are very nice and I like them a lot, they help me with things I like to do. A relative completing Have Your Say comment card of behalf of a service user said: The staff are all lovely and care very much for the young ladies they look after. Comments made by staff in respect of staffing levels and team working, were on the whole positive and included: We have a good staff ratio in our home and communicate well to ensure the service users always come first and their needs are met. Another said: Usually there is enough staff but if someone takes time off as sick or annual leave we dont get cover, so it can be a bit difficult to give the girls attention and do all of the work, which needs to be done. The manager confirmed that she will cover shifts and work hands on when there are staff shortages. She told us that as far as feasibly possible they avoid using agency staff as this disrupts the continuity of care for the service users and in some cases causes them upset. She went onto say that she has a very committed staff team who will step in when shifts need covering. Staff are encouraged undertake a national vocational qualification (NVQ) and will support them to undertake NVQ levels 2, 3 and in some cases level 4. Currently the home has more than 50 of its permanent staff trained or working to wards a NVQ. The recruitment files for three members of staff were viewed and it was established that the service users robust procedures when recruiting staff. A member of staff talked through the process of how she was recruited, which included completing an application, attending an interview, providing names of two referees and personal information so a Criminal Record Bureau (CRB), Protection of Vulnerable Adult (POVA) and Protection of Children Act (POCA) checks could be carried out. The member of staff confirmed that she did not start working in the home until all the checks were in place. This was further confirmed by recruitment checks in place Staff undergo an induction into the home where they are supported by a named member of staff to become familiar with the needs of the service users, the ethos of the home and the way in which the service works day to day. The AQAA told us that they have implemented a new staff induction pack and home orientation pack for new staff members. Care Homes for Adults (18-65 years) Page 30 of 40 Evidence: Three staffs individual training records were viewed and provided evidence that staff receive regular updated training in areas that are mandatory such as health and safety, food hygiene and fire safety and areas which are specific to the needs of the service users such as epilepsy, medication and managing challenging behaviour. It was noted that some staff records were not up to date. The manager confirmed that she was aware that some staff records needed completing, the manager must ensure an audit trail can be viewed of what training staff have received and when. The staff have been issued with a Continuing Professional Development (CPD), portfolio. The CPD includes areas where staff can record what training they have received, training they feel they require, induction plan, the homes orientation booklet and supervision time table. (This is not an exhaustive list). Three CPDs were viewed and found to be in various stages of completion, the manager stated that staff had recently received them and it is staffs responsibility to complete them. It was discussed at length with the manager to ensure where specific care techniques are used to support service users specialist training must be provided. Observation of a service user receiving a meal provided evidence that the member of staff did not have the necessary skills to feed the service user correctly. This could potentially place the service user at risk. The manager made arrangements at the time of the inspection for a speech and language specialist to review the service user eating and swallowing abilities and provide training for staff. The manager was made aware of her responsibility to ensure correct procedures are carried out and staff are fully competent to carry out such delicate techniques. Care Homes for Adults (18-65 years) Page 31 of 40 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 . A competent manager manages the home with a staff team who ensure the home is run in the best interests of the people who use the service. However the home does not take prompt or appropriate action to ensure the people who use the service are kept safe. Evidence: The AQAA told us that the home does well to manage and review policies and procedures, value all staff and service users and monitor quality assurance on a regular basis. This was tested by spending time with and speaking with the manager, speaking with staff and service users regarding quality, looking around the building and viewing documents in respect of health and safety. The registered manager (Ann Philips) has been registered with the Commission for Care Homes for Adults (18-65 years) Page 32 of 40 Evidence: Social Care Inspection under the Care Standards Act 2000 since the home was opened in 2005. Through the registration process she demonstrated that she has the required knowledge and skills to ensure the people who use the service receive good outcomes. Ann demonstrated through the course of the visit that she has an awareness of her roles and responsibilities in respect of meeting the needs of the service users, staff and legal responsibilities in managing and running the home. Staff were complementary of the support they receive from the manager. Staff Have Your Say comment cards told us: My manager does regular supervisory sheets, where she states what I can do better and I can state what concerns me, or we can just discuss what concerns us in private at anytime. Our manager is very supportive and meets with us regularly. When a service user was asked to give their thoughts on of the manager we were told: Ann is really nice, I like Ann. Another said: She lets me help her in the office. The service user went onto say that the manager had worked with her to help her to develop her person centered plan and is now helping her to achieve her goals. The manager provided evidence that the service has a number of tools to measure the quality of the service and seek the views of the service users. These include weekly meetings with the service users, which is titled What shall we do at the weekend? This asks the service users to consider the things they would like to do with their leisure time, what they would like to eat and who is going to take responsibility to organise what it is they want to do. Some of the service user have complex communication needs and express their needs and wishes using alternative forms of communication, such as gestures, pictures and switches. The home has also introduced a communication workshop, which is run by an outside agency. These workshops assist the service users to express themselves and empower them to make decisions. The manager informed us that the workshops are working very well. Meetings are held with staff, although it was evidenced that these are not held on a regular basis. Information on a notice board told us that the manager was intending a hold a meeting soon and was requesting all staff to attend. Dolphin Homes Ltd have appointed a service manager who is not in day to day Care Homes for Adults (18-65 years) Page 33 of 40 Evidence: operation of Caroline House to carry out unannounced quality audits of the home, these are know as regulation 26 visits. Evidence at the time of the visit told us that these visits were not being carried out on a monthly basis as required. The last dated report was August 2008. The report provided information on actions that the manager and service must carry out. There was evidence that some of these actions had not been addressed, such as the blinds for the conservatory and fire risk assessments. There are systems in place for fire safety and it was evidenced that staff receive regular fire safety training, although the manager must ensure staff names are recorded and not all staff attended this is to ensure that a clear audit trail of fire safety training is available. Regular checks are made on fire safety equipment and on the day emergency lighting was being checked. A fire risk assessment has been carried out for each service users but components of the homes fire risk assessment as required by the Fire Safety service had not been completed. The manager said she was waiting on guidance especially in relation to evacuation of service users who have a disability and have a bedroom on the first floor. The manager was informed that she must address this as a priority. Substances that may be hazardous to health are securely locked away and there are notices discreetly displayed around the home. This is to remind staff to test and record hot water temperatures and follow good hygiene practices. Records seen provided evidence that all utilities such as gas and electrical systems and small electrical appliances are regularly checked to ensure they are in good working order. The manager and the service has a responsibility to ensure all areas of the home are maintained and free from hazards to the health and safety of the service users. It was noted on leaving the service that the ramp to the front of the house did not have a safety guard to prevent service users from walking or self-propelling off the edge. A near miss was observed whilst a service user was using the ramp. An immediate requirement was issued at the time. The responsible Individual Mr Heather has since been in touch with the Commission to tell us that safety railings would be in place within seven days of the visit taking place. The manager was immediately required to ensure all service users were risk assessed using the ramp and action taken to minimise the risk. Care Homes for Adults (18-65 years) Page 34 of 40 Evidence: Care Homes for Adults (18-65 years) Page 35 of 40 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 36 of 40 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 1 42 13 The home must ensure the ramp to the front of the home is safe to use at all times. The people who use the service and who mobilise with walking and mobility aids must be protected from the risk of falls and injury. 08/11/2008 2 42 13 The home must ensure the people who use the service and who mobilise independently with mobility aids must have risk assessments in place for using the ramp at the front of the home. The people who use the service who mobilise with walking and mobility aids must be protected from the risk of falls and injury. 08/11/2008 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 24 23 The people who use the service must live in a home 31/12/2008 Care Homes for Adults (18-65 years) Page 37 of 40 that is well maintained internally and externally. To ensure the people who use the service are provided with a comfortable, safe environment at all times. 2 35 18 The service must ensure the staff receive training that is specific to the needs of the service users such as feeding. The people who use the service must be assured that they will be assisted to feed in a way that prevents a risk to their health and welfare and is an enjoyable experience. 3 39 26 The registered provider must 08/12/2008 ensure the home is visited at least once a month unannounced to effectively quality assure and monitor the home and outcomes for the people who use the service. To ensure the people who use the service are confident that their views are listened to, monitored, reviewed and those views inform the development of the home and quality of the service provided. 4 42 23 The service must ensure all areas of the home that require maintenance are dealt with promptly to prevent potential risk to the service users and staff. The people who use the service must expect to live in Care Homes for Adults (18-65 years) Page 38 of 40 05/12/2008 08/12/2008 a home that is well maintained and protects them from potential risk of harm. 5 42 23 As recommended by the Fire 06/12/2008 Safety Authority and the regulation 26 visit in August 2008, the home must ensure fire risk assessments for service users situated on the first floor are completed without delay. The people who use the service must be assured that they will be protected in the event of a fire in the home. 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 Care Homes for Adults (18-65 years) Page 39 of 40 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 © (2008) 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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