Inspection on 23/02/09 for Casa Mia

This inspection was carried out on 23rd February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Casa Mia 23/04/07

Casa Mia 13/06/06

Casa Mia 29/03/06

Casa Mia 08/09/05

Casa Mia 23/03/05

Casa Mia 27/07/04

Casa Mia 03/03/04

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Polesworth Group Pooley Heights

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10 Whitfield Avenue

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: Casa Mia Cleobury Road Far Forest Near Kidderminster Worcestershire DY14 9EH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Peter Dawson     Date: 2 3 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Casa Mia Cleobury Road Far Forest Near Kidderminster Worcestershire DY14 9EH 01299266317 01299266406 martin@casa-mia.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Martin James Winfield,Mrs Michelle Dawn Winfield care home 15 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 15. The registered person may provide the following category of service only: Care Home Only (Code PC) the service users of the following gender: Either Whose Primary care needs on admission to the home are within the following categories: Mental Disorder (MD) 15 Learning Disability (LD) 15 Date of last inspection Brief description of the care home Casa Mia is a detached building situated in a rural area of Far Forest. The home has been extended and adapted in order to provide accommodation for a maximum of 15 people who may have either a Learning Disability or Mental Disorder as their primary Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 0 15 15 Brief description of the care home need upon admission. The minimum age for admission is 50 years. The home is set back from the road and provides car parking at the front of the premises and a patio and an attractive garden at the rear. Thirteen of the service users are accommodated on the ground floor and two service users are accommodated on the first floor. There is one shared bedroom. A portable ramp provides access at the front entrance for good access and a ramp provides access to the rear garden. There is no mechanical means of access to the two bedrooms on the first floor. The fees ranged from #350.00 to #600.00 per week. Additional charges are made for hairdressing, holidays, transport, toiletries, newspapers, magazines, reflexology and massage. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service was on 23rd April 2007. A Thematic Inspection was carried out on 28th September 2007, which was a short, focused inspection that looked at the quality of care people with dementia experienced when living in care homes. This key unannounced inspection was carried out by one inspector on one day from 8.30 a.m. - 7.00 pm. An AQAA (Annual Quality Assurance Assessment) was received from the service on 12th September 2008. This is a self-assessment by the providers to evaluate the standards and levels of service provided. The AQAA gave us useful information about the service and comments from the AQAA are included in this report. Care Homes for Adults (18-65 years) Page 6 of 33 The inspection was carried out with assistance throughout the day from all staff on duty, the Registered Manager (also provider) and the other provider of the service. There were 15 people in residence and all were seen and most spoken with separately and together. All made positive comments about the service and support provided at Casa Mia, the commitment of staff and the very positive changes made to improve the environment. All staff on duty including two Senior staff provided very useful information about the service and were knowledgeable about the needs of the people living there. The service has changed registration and moved away from providing a service only to older people, to providing a service for people with a learning disability or mental health needs. The home was therefore inspected using the National Minimum Standards for Younger Adults as the basis for assessment. The atmosphere was very relaxed, people engaged openly and freely with us and also with staff throughout the day. There was an inspection of the environment including all communal areas and a small sample of bedrooms. Care planning information was readily available on the new computer system and easily provided the information we needed to inform the inspection process. There was an inspection of other paper records including personal planning information, staffing records, medication records, reports and other documents relating to the inspection process. No visitors were seen during this inspection and we were not able to obtain written feedback from people prior to the inspection. What the care home does well: What has improved since the last inspection? The environment has been improved vastly since the last key inspection. A new conservatory has been added giving needed additional communal space to the large lounge/dining area. This faces the rear garden providing bright, pleasant surroundings overlooking the decked patio area and large landscaped garden. A bathroom area has been upgraded and there is now a choice of bath or shower facility for people. Redecoration of some bedrooms and other communal areas has improved the general presentation of the home. One of two shared bedrooms has been converted into 2 single bedrooms with curtain screening for privacy in the remaining one. There have been improvements to the care planning information with more detailed information to ensure staff are able to meet peoples needs. A new computerised care planning system has been installed, improving the access to and presentation of care planning information. There are now photographs of all people to ensure correct identification particularly in an emergency. All requirements and recommendations made in relation to medication have been met improving the safety of the system in use. This is confirmed on a recent visit by the Care Homes for Adults (18-65 years) Page 8 of 33 PCT (Primary Care Trust) Pharmacist who found no shortfalls after a lengthy review of the medication system. The decking to the rear of the home has been fitted with non-slip material to avoid potential falls. A new roof window/ventilation system has been fitted in the kitchen area for the comfort and safety of those using this area. Recruitment procedures have been strengthened for staff ensuring the necessary checks and references are in place prior to employment to protect people in the home. There has been an extensive programme of staff training in core areas relating to the changed direction and registration of the service. All free-standing wardrobes are now fixed to walls to ensure the safety of people in their bedrooms. The staff duty rota now includes names and designated positions of all staff and the hours worked. This ensures an accurate record of staff on duty at all times. More flexible and additional staffing hours are provided to meet needs at peak times and to promote the philosophy of greater community access. What they could do better: The Statement of Purpose and Service Users Guide should be revised. The Service Users Guide should be condensed into an easily readable document and must include a revised copy of the complaints procedure. The service should consider a pictorially based Guide which would be more easily understood by people using the service. The complaints procedure must be updated with current information, and should be condensed to provide a concise easily read document. It would be helpful to present this also in pictorial form. The service must obtain a copy of the Safeguarding Vulnerable Adults procedures produced by the local authority. All staff should have updated training relating to Safeguarding to ensure they are aware of the current procedures and actions that need to be taken if abuse is suspected. It is important that the service resume questionnaires to a range of people involved in the service, as a means of securing feedback about the quality of care and service provided. This information should be used to inform practice and make changes to service delivery and must be included in the Service Users Guide. The service must ensure that staff are not allowed to be nominated agents to receive information/payments in relation to peoples benefit. Relatives or others should be nominated for this purpose. Moving and Handling training must be updated for all staff and ensure, by whatever means that there is a safe system for moving people using the service. Care Homes for Adults (18-65 years) Page 9 of 33 Additional training for staff is required in relation to mental disorder. Training has been limited to schizophrenia. This should be more extensive to include specific diagnoses for people already using the service. Examples are Korsakoffs Syndrome, Depression and Bipolar Disorder. Care plans should include stated goals for people. These should be clear and achievable objectives which can then be measured and reviewed. Peoples hopes, wishes, desires and aspirations should be known and plans set to achieve them where possible. A risk assessment must be put into place in relation to a person smoking in a bedroom. Control measures should be in place to reduce the risk. Staff recruitment practices should include a reference from the last employer. Any reasons for not obtaining this should be recorded. The service should consider ways of greater empowerment and participation for people in the routines and daily running of the home. Practical domestic tasks should be part of skill enhancement to maximise potential and independence. Ways of extended choice in the daily living situation were discussed with staff during the inspection and these and other options pursued. It is important that a Care Management Assessment is obtained from the Social Worker prior to admission to ensure that all needs are known and can be met. 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 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the home could be improved to ensure people have all the information they need to make a decision about the suitability of the home for them. Evidence: The Statement of Purpose and Service Users Guide is presently a lengthy and complicated combined document. This needs to be revised and a shorter, more userfriendly Service Users Guide, possibly pictorial to allow people considering admission an easy-read but informative document, to assess the suitability of the home. The AQAA states there will be a new brochure to include the service users guide. Two people have been admitted to the home since the last inspection and both within the past 2 months. In one instance a person lived in Scotland but a visit was made by staff to assess the person there, taking information about the home including photographs to enable the person to make a judgment out the suitability of a placement. In the other instance the person was invited to visit prior to admission and a needs assessment carried out in the persons current placement. In both instances the homes pre admission assessment was carried out correctly and in detail but in one Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: instance a Care Management assessment by the Social Worker had not been obtained. It is important to obtain this to ensure all needs are known and can be met. Since the last inspection the home have moved from providing a service to older people to a service for younger adults. A variation of registration was approved and allowed admission of people with dementia and mental health needs to be admitted over the age of 50 years, this was agreed with the providers. It was found that a person below that age had been recently admitted and there was some doubt about whether a further variation to include people below the age of 50 had been agreed. This matter will be clarified and followed up by the Regional Registration Team. Care Homes for Adults (18-65 years) Page 13 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good care planning processes ensure that peoples needs are met. Greater participation in daily decision making will further empower people. Evidence: A new computerised care planning system has very recently been installed. All staff have had training in its use and are undoubtedly keen to ensure its success, in fact the programme used is an extremely user-friendly and easy to operate system and provides the required information taken from assessments and previous manual records. There has been considerable time invested in setting up the new system and transferring all existing information. Shortfalls have been identified in some areas of records and the providers of the system are in the process of making the required changes. Some shortfalls were identified in discussions during this inspection and changes will be made. These areas include: providing goals/aims which are quantifyable and achievable, providing a chronological record of all health interventions, and a record of all activities undertaken. Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: This is a positive move and when completed will provide a comprehensive, easily accessible and clear record of how peoples needs can be met. There was evidence that people had been involved in compiling the new care plans and the system is secure with access only by password. The AQAA states All service users are involved in the creation of their initial assessment and continued care planning . All care plans are reviewed on a monthly basis. The AQAA also stated The service users are involved in making decision in the environment in which they live. There was some evidence of this but greater empowerment and decision making could be extended in some areas. An example of increased choice is to provide serving dishes at mealtimes allowing individual choices of type and quantity of food. This could be extended into other areas of daily living. There was little evidence of people being involved in daily domestic tasks such as preparing drinks and snacks, laundry and other simple daily tasks. This is a means of maximising skills and independence. This is increasingly important in providing a service to younger adults. Finances held on behalf of people in the home were not inspected on this visit, although we were told that monies given to people were signed by them and two members of staff. We found that in relation to one person a member of staff had been nominated to receive correspondence and benefit payments. It was agreed that this should be passed to a relative who has now moved into the area. Risk assessments were in place in relation to many daily living activities. These could be extended particularly where some restrictions are in place. Some people only going out escorted although they have the physical ability to do so but this is not agreed and recorded. Again this will apply to some younger people where agreements are reached in discussions and agreement and these must be recorded. Confidentiality is important and people know that information about them is handled appropriately in accordance with written procedures and the Data Protection legislation. The computerised records are password protected and paper information stored securely. Previously the office area was located in a corner of the dining area. A new office has been made available, although on this visit the new computer system had been deliberately located in this area to allow staff the opportunity for staff to readily access the new system. Nevertheless this inspection involved use of the computer near the dining area and we were concerned about the discussion of Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: confidential information close to people in the lounge area. The Manager intends to resolve this swiftly once staff have become fully orientated to the new computer system. Care Homes for Adults (18-65 years) Page 16 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Options to be involved in personal development, community links and other social activities would further improve peoples quality of life. Evidence: As stated in the last outcome area further opportunities should be given for people to maintain and develop social and independent living skills. Opportunities to learn and use practical life skills are important particularly for young adults. These are the stated aims of the home the AQAA states continue to train staff to move further away from institutionalised practice. In relation to a younger person recently admitted the home are pursuing the question of engaging in external activities including work placement or voluntary work outside the home. It is important also to provide opportunities for people to continue their education and training or be involved in further education and learning. Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: There are a range of external activities to provide people with opportunities to extend social inclusion. The local village shop is nearby and people make regular visits there, alone or escorted depending upon their individual needs. Visits to the cinema, local restaurants have taken place quite recently. People have had holidays/short breaks during the past year in smaller groups, escorted by staff. A previous recommendation to provide additional staff at peak times has been actioned. With more external activities flexibility of staffing was evidence when people go out swimming or for meals in the evenings or at weekends. The AQAA states We encourage staff to support clients to live fulfilled lives outside as well as inside the home These opportunities have been taken more extensively since the last inspection. The home now has a vehicle to take small groups on external visits. People have made contributions toward this under the mobility scheme. A range of internal activities are provided. We saw people being encouraged to paint, colour and draw and staff sitting individually with people playing games or simply engaging in ongoing conversations. One person still attends a local day centre and transported by staff, another decided he no longer wishes to attend and now involved in internal and some external daily activities. Leisure activities are being pursued for someone who wishes to be involved in motor sports and other sporting activities. People using the service were all highly satisfied with the food provided. Daily menus include a choice of 3 main courses and 2 desserts and a range of alternatives for breakfast and tea. Drinks are available throughout the day and night. Fresh fruit delivered twice weekly was readily available in the lounge areas. We saw good quality and quantity meals served at lunch time, people eating heartily and saying that they love the food. It was disappointing to see that a recommendation of the last report had not been actioned to provide serving dishes on tables to give people choice of food type and quantity. This was discussed with the Manager who felt that this option should be tried. This could be extended to other areas of daily living, examples were discussed with staff present during the inspection. They seemed receptive to attempting to involve people more in daily domestic activity to extend their skills, competence and confidence. Two people spoken with did say that they would like to go to church. This was mentioned to the Manager who will pursue this at the next residents meeting. The church is nearby and people could either go alone or with staff initially if they need support. The options of further social involvement in church or other activity could also Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: be pursued. Care Homes for Adults (18-65 years) Page 19 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples healthcare needs are known and met and there is a safe system of medication to ensure the well-being and protection of people using the service. Evidence: Personal support is given sensitively and respecting privacy and dignity. This was confirmed in discussions with people and from observations during the inspection. Health care needs were generally recorded, there were clear diagnosed conditions. This information has been transferred to the new computerised recording system. Some recording was difficult to find. A recently admitted person had 2 weekly depot injections by the CPN (Community Psychiatric Nurse), these were traced to daily notes but it was not possible to identify the recording of one injection although said to have been given. It is recommended that a chronological health care record sheet should be established recording interventions by all healthcare professionals. This would ensure records are clearly identified and provide required information in case of emergency or admission to hospital. Staff training shortfalls identified in the last key inspection report have been Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: addressed. The home has changed registration to admit people with dementia care and mental health needs. All staff have received training in these areas, although it was surprising to see that mental health training had been limited to schizophrenia. It is important for staff to have training in other areas of mental health needs for example depression and neurosis. It is strongly recommended that training is arranged swiftly in relation to Korsakoffs syndrome (alcohol abuse) - two people including a recently admitted person have this diagnosis and staff need to understand the cause, effect and support needed for people with this condition. Another person has a bi-polar diagnosis and training covering this specific condition would be helpful to staff in supporting his needs. Health care needs were being met by a range of healthcare professionals including visiting District Nurses, CPNs, Optical, Dental and other specialists as required. The GP provides a good service to the home who visits every 6 weeks and carries out medical and medication reviews. Whilst this is a good service and there are still people in the age range 80 - 95, it is also important that younger people able to attend the local surgery/health centre are encouraged to do so. The medication system is provided by Boots Chemists in monitored dose form (blister packs). Since the last inspection all staff administering medication have had accredited training in the safe use of medicines. There is now a fridge for medication required to be stored at required temperatures. Handwritten entries on MAR (Medication Administration Records) sheets are now signed by 2 staff members to ensure accuracy. The medication system was inspected. All records had been completed accurately and there were no omissions. The Pharmacist from the Primary Care Trust had carried out an audit of the system few weeks prior to this inspection, her report was available and there had been no errors or omissions following a lengthly review of each persons medication and the system in use. She had complimented the home on the standards and accuracy of the medication system. Care Homes for Adults (18-65 years) Page 21 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A clearer complaints procedure and greater awareness of Safeguarding procedures would ensure better protection for people using the service. Evidence: The complaints procedure is too lengthy (2 A4 pages) difficult to understand and dated. It was clear that people using the service did not understand the procedures. A more concise, user friendly and informative procedure must be provided. It is also important to consider provision of a pictorial complaints procedure given the changes of categories of people who can be admitted to the home. A copy of the procedure should be given to all people in the home and made available for all visitors in the reception area. No complaints have been received by the home or by us since the last inspection. Requirements and recommendations were made at the time of the last inspection relating to the procedures for reporting abuse. On this visits the Manager and staff were unaware of the term Safeguarding which has replaced the Vulnerable Adults procedures. Some staff have previously had distance learning training in the Protection of Vulnerable Adults. The home does not have a copy of the current Safeguarding Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: Procedures provided the relevant Local Authority (Worcestershire). It is important that staff are provided with updated training in this important area and whilst distance learning is acceptable it is recommended that senior staff attend local Safeguarding of Adults training to ensure they are conversant with the local procedures and able to discuss/clarify areas of concern. It is also important that the home obtains a copy of the multi-disciplinary Safeguarding procedures relevant to the area which clearly state the procedures to be followed in the event of suspected or actual abuse. Care Homes for Adults (18-65 years) Page 23 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the premises mean that people live in a homely comfortable and safe environment. Evidence: Many aspects of the environment required improvement and upgrading and were detailed in 4 requirements and 6 recommendations of the last report and some from previous reports. It was pleasing to see that the necessary, considerable improvements had been made in all the areas previously identified. The AQAA (dated September 2008) listed the following improvements New conservatory area to lounge. Programme of decoration throughout. Large ventilation window fitted into kitchen roof. Fixed screening in shared bedrooms. Removed temporary office from lounge into separate room. Most of decking now covered with nonslip Verde matting. Ground floor bathroom completed. Grab rail fitted to ground floor toilet. Tiles on front door step replaced. new security coding system for doors been installed. All corridors and some bedrooms have been decorated. New fire escape doors fitted to lounge. New dining tables and chairs. New lounge chairs. New 40 plasma TV. The above list was verified during the inspection and additionally the double bedroom Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: at the front of the property has been converted to 2 single bedrooms following planning permission. The ground floor bathroom has been refurbished following 2 previous requirements but now provides a suitable bathing facility. There are options for bath or shower facilities. The former smoking room has been converted to office accommodation. People now smoke in the immediate decked area at the rear of the home. A large hot-tub has recently been installed in the decked patio area. This has not been used, some people said they would not wish to use this but improved weather and encouragement could mean they may enjoy this new facility. The improvements made to the property were clear. It was suggested that an annual improvement plan/maintenance programme would record the planned and actual improvements made on an annual basis. People spoken with commented about the changes made and were clearly enjoying the improvements and additional communal space available. All areas of the home were clean and comfortable providing a homely environment. The rear garden of Casa Mia is spacious, pleasant, well planned and private, providing a large area where people can sit, lounge, relax or walk during the summer months. Greater involvement of people in planting and growing plants during the coming months is planned. Planning permission is presently being sought to link Casa Mia with the adjoining property in the ownership of the providers. This would increase the number of places and communal space and facilities. Care Homes for Adults (18-65 years) Page 25 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improved recruitment procedures and staff training ensure people receive support from well trained staff appropriately checked prior to employment. Evidence: Three requirements and 4 recommendations were made at the time of the last inspection relating to staffing. These related to recruitment checks and procedures and additional staffing at peak times. Sixteen staff are employed to provide care and support. Fourteen provide direct care and support to people. There are 3 staff on duty at peak times and there is flexibility to provide additional staff to support people outside the home and at times suitable to them - evening and weekend external visits are increasing and staffing provided to facilitate this. At night time there is one waking night carer and member of staff (senior) sleeping in and on call. The number of NVQ trained staff exceeds the target of 50 minimum. Staff are involved in Learning Disability Qualification training. There has been training in the following areas since the last inspection: Medicating, Food Hygiene, Management of aggression, Health & Safety, Infection Control, Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: Schizophrenia, person centered care, dementia care and the Mental Capacity Act. 7 staff have completed full first aid training. Two managers have completed LDQ level 3. These were checked against the staff training matrix. Shortfalls identified at this inspection in relation to staff training are: More extensive training in mental health needs, including Korsakoffs Syndrome, Depression and Bipolar disorder, Safeguarding training and moving and handling training. We found that moving and handling training had been provided by means of distance learning in some instances but there were gaps. It is important that this training is provided on a service-specific basis relating to the needs of people and the environment. It is recommended that either one member of staff attends a Moving & Handling Trainers Course (to train all staff) or staff attend courses for individual training. A sample of two staff files were seen. These indicated improvements in the recruitment checks and procedures identified in the last report, although in one instance a reference from a previous employer (care provider) had not been obtained. This should always be done. Throughout the inspection we spoke to people in the home often with staff present and we observed interactions between them. There was evidence of good engagement with people. Relaxed and spontaneous exchanges indicated a committed staff group receptive to the needs of the people they support and evidenced in good communication. Care Homes for Adults (18-65 years) Page 27 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run in the interests of the people there. Feedback about the service should be sought from people receiving the service and other stakeholders, this will inform practice and identify areas for improvement. Evidence: Seven requirements and 2 recommendations were made at the last key inspection relating to these outcome areas. The majority have been actioned, some have not. The AQAA stated We send out questionnaires to residents, relatives and stakeholders for feedback. Questionnaires have bee sent to these people but the last seen were dated 2006. It is important to request feedback from the people mentioned to inform practice and review the standards of care provided by the home. The Manager will ensure that feedback forms are resumed for this purpose. Feedback should be given to people using the service and should also be included in the Service Users Guide. Quality Assurance in the form of seeking the views of people in the service and others should Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: be in place in order to measure success in achieving aims. Regular meetings are held with people using the service and written minutes provided (not seen on this visit). There is no forum for feedback from relatives apart from individual visits to the home and they should be included in the feedback requests. The Manager has the required qualifications (Registered Managers Award) and experience to run the home. He has a hands-on role in the daily running of the home and gives direct support and care to people who live there. He takes a positive lead in the management and running of the home and there appears an open and inclusive atmosphere. Record keeping is improving with the introduction of a new computerised system including care planning. Confidentiality and security of the system does need further review. A lot of work has been done by staff in transferring and updating information into the new system, which has the potential for a clear and well recorded system of care planning. Shortfalls identified in the last report relating to safe working practices have been addressed. Risk assessments have been extended to include more general aspects of daily living. In relation to a person recently admitted there was evidence that she had been smoking in her bedroom. This is generally discouraged but a risk assessment had not been established to asses this situation and reduce the risks involved. This should be done. Fire records evidenced regular checking of alarms and equipment. Moving & Handling training updates are required for all staff and must be arranged. Care Homes for Adults (18-65 years) Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 23 6 A copy of the local Safeguarding procedures must be made available in the home and all staff must have updated training in Safeguarding Adults This will ensure people are protected where there is suspected or actual abuse. 30/04/2009 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 Care Management assessments must always be obtained prior to people being admitted to the home. This will ensure their needs are known and met. It is important that care plans involve people in setting achievable aims and goals which are quantified and reviewed. Greater involvement in decision making and participation in the daily running of the home will further empower people. Further opportunities for people to be involved in daily living tasks, social, recreational and educational activities Page 31 of 33 2 6 3 4 7 11 Care Homes for Adults (18-65 years) 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 will continue to improve quality of life. 5 19 It is recommended that staff have training in more general mental health care needs and specifically Korsakoffs Syndrome and other person specific conditions which exist in the home. Moving & Handling training should be provided for all staff to ensure they have the knowledge and skills relevant to the service group and that people are moved and handled safely. The service must maintain a system for reviewing and improving the quality of care including consultation with people using the service and their representatives. 6 33 7 39 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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