Inspection on 12/02/09 for Chatterley House

This inspection was carried out on 12th February 2009.

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

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

Other inspections for this house

Chatterley House 03/05/07

Chatterley House 21/11/06

Chatterley House 02/05/06

Chatterley House 09/02/06

Chatterley House 24/05/05

Chatterley House 14/12/04

Chatterley House 02/08/04

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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 09/07/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Chatterley House Chatterley Road Tunstall Stoke on Trent Staffordshire ST6 4PX     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: Pam Grace     Date: 1 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Chatterley House Chatterley Road Tunstall Stoke on Trent Staffordshire ST6 4PX 01782834354 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Alice Clarke care home 11 Number of places (if applicable): Under 65 Over 65 0 0 learning disability mental disorder, excluding learning disability or dementia Additional conditions: 11 1 The maximum number of service users who can be accommodated is: 11 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD) 1 Learning disability (LD) 11 Date of last inspection Brief description of the care home Chatterley House is a care home registered for 11 people. The home can accept people over the age of 18 years and above that have a learning disability. They are registered for one place for a person who has a mental disorder that does not include a learning disability or dementia. Nine gentlemen and two ladies currently live at the home, which is a detached property set in its own grounds. The proprietors house is situated next door. The home is situated just outside Tunstall, which is one of the towns that make up the city of Stoke-on-Trent. It has good access by road, but although there is public transport from other areas to Tunstall itself, bus routes do not extend to the homes Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home location. The home has a mini bus to assist the people using the service to have access to community facilities. There are few local facilities in very close proximity to the home, although a pub is within walking distance which one or two people use. Tunstall, however, has the range of shops that you would expect of a small town. Chatterley House has been extended with the addition of two en suite bedrooms. This means that the home now has two en-suite bedrooms, five further single bedrooms that are not en-suite, and two double bedrooms. There are spacious communal rooms that are attractively furnished. All areas of the home are generally well maintained. The grounds have attractive gardens and adequate space for car parking. There are links with local colleges and day services to provide individuals with the opportunity for personal development. People using the service purchase their own items, such as personal toiletries, newspapers and magazines. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 inspection for this service was 3rd May 2007. This inspection visit was an unannounced key inspection and therefore covered the core standards. The inspection took place over eleven hours by one inspector who used the National Minimum Standards for Adults (18-65) as the basis for the inspection. Prior to the inspection, the care manager completed an Annual Quality Assurance Assessment for us. Four surveys were received from staff, and ten surveys were received from the people using the service. Comments in relation to those surveys are included in this report. Care Homes for Adults (18-65 years) Page 6 of 31 On the day of the inspection, the home was accommodating eleven people. We spoke with staff and people using the service. We also examined records, carried out indirect observation of three people who use the service, and two staff on duty. Two plans of care and three staff records were examined, we also directly observed daily events. We looked at three bedrooms, two communal lounge areas, the dining area, kitchen, and bathing facilities on all floors. We inspected the system of medication administration and storage. The fees charged for the service at Chatterley House are from 295 pounds per week. The fee information included in this report applied at the time of inspection, the reader may wish to obtain more up to date information from the care service. What the care home does well: What has improved since the last inspection? What they could do better: Where the registered manager proposes to be absent from the care home for a continuous period of 28 days or more the registered person shall give notice in writing to the Commission of the proposed absence. This is to ensure that the health, safety and welfare of people using the service are promoted and protected. The ethos of the home should include a clear sense of direction and leadership. This will ensure consistency and smooth day to day running of the service. Effective quality assurance and quality monitoring systems, should be based on seeking the views of people using the service, staff and stakeholders. This ensures that peoples views are listened to and acted upon, with outcomes fedback during meetings that are minuted and recorded. Records relating to care planning should be dated, shared with the individual and or their representative, and signed. This will evidence that individuals are involved in the care planning process. Care Homes for Adults (18-65 years) Page 8 of 31 Medication should be appropriately and securely stored. To ensure the safety of the people using the service. Staffing levels should be maintained in order to meet the individual needs of the people using the service. Staff training should be kept up to date, and a comprehensive up to date training matrix should reflect all of the courses undertaken. Care staff should receive formal and regular supervision, as per the National Minimum Standard. Consideration should be given of additional heating for the conservatory, to enable all year round use by the people using the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their representatives have the information needed to choose a home that will meet their needs. They have their needs assessed, and a contract which clearly tells them about the service they will receive. Evidence: The Annual Quality Assurance Assessment (AQAA) completed by the care manager told us we provide a comfortable clean and safe home, and assist our residents to live their lives in a way which suits the individual. Assist our residents to make informed choices. Assist our residents to build on their existing skills and to learn new skills. We ensure that everyone has a holiday, days out and evenings out. Surveys received from people using the service told us that they had received enough information prior to making a decision to move into the home. Comments included the client came for visits before deciding, she also stayed overnight to see if they would settle in a strange place.I liked it when I visited.My sister helped me to decide. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: The service has a pictorial statement of purpose which is readily available to prospective people and their representatives. An attempt had been made by the service to personalise the service user guide to suit each individual, some of these were very brief and didnt contain enough information about the service provided. This was highlighted and discussed with the care manager at the time. Two care plans were examined. These showed that appropriate pre admission assessments had been undertaken. The care manager confirmed that all people using the service had been assessed, had been invited to visit the home with their family and or representative, and had the opportunity to spend time at the home prior to making the decision to move. The home does not admit people in an emergency. Local Authority Contracts, Terms and Conditions of Service were evident in care plans seen. We were assured by the care manager that these are reviewed annually alongside of annual reviews of care for people using the service. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are involved in decisions about their lives, and play an active role in planning the care and support they receive. Evidence: The Annual Quality Assurance Assessment (AQAA) completed by the care manager told us We have always put residents needs and choices first, as long as they dont conflict with others. We then find a happy medium. We are now putting in place Person Centred Planning, which should make residents preferences much clearer. Also their needs may be more defined from a more personal outlook. Surveys received from the people using the service confirmed that they always receive the support and care they need. Comments included They are very patient with me, I do not like having the bathroom door locked, just in case I have a fit, but staff know that, and keep an eye on me.Staff surveys confirmed that they have the right support, experience and knowledge to meet the different needs of individuals using the Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: service. We looked at two care plans. Both care plans had been regularly reviewed and updated. Appropriate risk assessments were in place, and the care plan had been generated from the original pre admission assessment. Person Centred Practice (PCP) care plans had been introduced for all people using the service, however, we were told that due to staff shortages, these were still in the process of being changed over for some people. Some records seen within care plans were not dated or signed, this was highlighted and discussed with the care manager at the time. There was also little evidence that individuals and their representatives had been involved in the homes review of their care plan, for example, that this had been shared with them, and signed by the individual concerned. People using the service told us that they make choices every day, what to eat, what to wear, when to go on holiday, and whether they take part in activities or not. One person said I go to the pub up the road, and have a beer, I can go out with staff if I want to. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use services are able to make choices about their lifestyle, and are supported to develop life skills. Social, educational, cultural and recreational activities meet individuals expectations according to their age and abilities. Evidence: The Annual Quality Assurance Assessment (AQAA) completed by the care manager told us We ensure that family links are maintained. We try to ensure that friendships are maintained, but some have been lost through closure of the day services. To encourage residents to go out into the community shopping, going to the pub, circus, cinema etc. We encourage residents to make choices for food but ensure a balanced diet. There is variety as well as choice. We ensure that all Doctors, Dentists, Chiropody, Optician and other professional appointments are kept. We have two residents that go out to work, our other residents cannot achieve this, but we are Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: looking at appropriate activities for others. Surveys received and people spoken with confirmed that there are activities arranged by the home that people can take part in. Comments included the staff are very considerate all the time, we have table games sometimes, we go out shopping and to the pub, we go out for a meal, I go to football matches when I can, and watch football on the television. Surveys and people spoken with during our visit confirmed that they like the meals at the home. Comments included I like the food, the food is very good, I can choose what I want to eat. Staff surveys showed a concern that there was sometimes not enough staff on duty to meet the needs of individuals, particularly in regard to activities, which would be affected by staffing levels. Day service provision ceased for some individuals a year ago. The care manager confirmed that this had caused them distress, because the people affected had no choice in that decision, which was made for them by the Local Authority. The people affected missed their friends and the networks that they had built up over the years. She said that it had been almost impossible for the home to replace that network, and despite a lot of encouragement, it had also been difficult for people to maintain some of their friendships. Inevitably some friendships had been lost. The majority of people living at the home are able to engage in meaningful activities. Other people have made the choice not to attend any further education or training opportunities. One person, who is of retirement age, prefers to stay at home, apart from going to his local pub independently for a drink on some lunch-times. All people using the service access the local community. The home does not have shops nearby. The local town of Tunstall and shops are within walking distance, however, some people are unable to walk that distance. Those individuals have access to public transport and or taxis. The home also has its own mini bus that staff drive, to ensure everyone can make visits to places that they choose. Individuals are taken on holiday each year, and are supported by staff. Community participation is encouraged, and individuals confirmed their relatives can visit any time, and that they have a choice of their pattern for the day, therefore what time to get up and go to bed, choices of meals on offer, some people have a key to their own bedroom, others had chosen to not to. We discussed the need for staff to resource the area and local Colleges for activities and further education opportunities. The care manager confirmed that she is waiting Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: for information from a College in regard to this. More could also be done in regard to staff encouraging and working with individuals who wish to shop, prepare and cook meals. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: The Annual Quality Assurance Assessment (AQAA) completed by the care manager told us We ensure that each person within the home has as much control over their lives as is possible. That everyone is treated with dignity, privacy and respect. That all service users health needs are met. Medication is given appropriately. That those who self medicate are monitored and risk assessments are in place. Surveys received from people using the service and staff, told us that individuals receive the medical support they need. Comments included the staff are considerate all of the time, they have their dietary needs met, they attend every appointment that comes in, unless there is a good reason why they cannot. The home ensures that the healthcare needs of the people using the service are met. They do this by supporting people to access their General Practitioner (GP), and other Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: healthcare professionals, and by ensuring that health appointments are kept. We examined two care plans, records were kept of all health visits and their outcomes. There was also evidence that a CPN (Community Psychiatric Nurse) was involved in the care of a person, and that the staff were completing a behavioural chart at his/her request. There were good records of Care Programme Approach meetings, and that all appointments with the psychiatrist had been kept and advice followed. There were clear records available of the medication received, administered and leaving the home. A current MAR (Medication Administration Chart) was available for each individual and had been completed in full in each case. Medication, eye drops and cream, had been left out on a worktop in the staff room, which was locked at all times. This was highlighted and discussed with the care manager at the time and rectified. We discussed the need to have a signed permission pro forma in each persons record to permit the home to administer medication. We also discussed self medication, in view of one person who self medicates, and needs medication to be administered weekly by the pharmacist, rather than monthly. We recommended that this is to be discussed with the pharmacist concerned. The homes medication policy had not been reviewed. We also discussed the need to ensure that staff training records reflect the medication updates that had been undertaken. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. Evidence: The Annual Quality Assurance Assessment (AQAA) completed by the care manager told us We have a clear and easy complaints procedure in place. The guidelines are in keeping with the care standards. We ensure service users are safe from any forms of abuse or harm. Surveys received from staff and people using the service confirmed that they knew how to make a complaint, and who to speak to if they were not happy. Comments included this client does not speak, but communicates in a way that staff understand if she is not happy, I like being happy, I would go to the staff, I would go to the staff that were on duty at the time. Staff spoken with were concerned about not having security lighting outside the home to deter local youths from entering the grounds of the home. This had been a problem during the past few months. During our visit, we noted that additional security lighting was in the process of being installed to rectify this situation, which ensures the safety of staff and individuals using the service. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: No formal complaints, and no Safeguarding referrals had been made or received by the home or by us, since the previous inspection. The complaints procedure is clearly displayed on the wall in the entrance hall of the home, and is also contained within the Statement of Purpose, however, our address needed to be updated, and the procedure needed adding to the individual Service User Guide. We discussed ways in which both of these documents could be more pictorial, helping people to better understand them. Staff records showed that the necessary security checks had been undertaken prior to staff being employed at the home, and staff spoken with confirmed that they had received Protection of Vulnerable Adult training within the past two years. A spot check of peoples finances showed that amounts tallied with records kept. Receipts were also evident in those records, ensuring an auditable trail for the monies spent on behalf of and by individuals. We discussed the need for the care manager to inform us of any event that affects the service that people receive. This was in regard to her not informing us (under Regulation 37), when she was off sick at the end of 2008. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. Evidence: The Annual Quality Assurance Assessment (AQAA) completed by the care manager told us Our premises are suitable for the stated purpose. They are accessible safe and well maintained. They meet the residents individual needs. Our home is clean, comfortable and in keeping with national care standards. We are clean and free from odours. We have systems in place to control the spread of infection and cover legislation. Surveys received from staff and people using the service confirmed that the home is always clean and comfortable. Comments included no problems, its cleaned morning, afternoons, after tea and the again after supper. Staff spoken with were of the opinion that there is too much cleaning and not enough time spent with the people using the service. People said that they were generally very happy with their bedrooms, and the decor of those rooms. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: Chatterley House provides spacious accommodation for eleven people in a domestic setting with comfortable furniture and fittings and good decor. There is a spacious lounge, separate dining room, with a large conservatory off, well equipped kitchen and sufficient bathrooms. two additional single bedrooms with en suite facilities had been recently provided to enable the sister home to close. All areas are safely accessible on the ground floor of the home, however, the upstairs bedrooms would only be suitable for people who are fully mobile. Although there is a Parker bath available for use, people prefer to use the shower room, located on the ground floor. The kitchen had been refurbished in the past two years, this was mostly of steel construction with a larger than usual cooker. Giving the appearance of a kitchen that would be more suited to a school or larger premises. We discussed this in view of the fact that some people using the service would need to prepare and cook food as part of their chosen lifestyle. It was reported that people can and do use the kitchen facilities already, without difficulty. The large conservatory was not in use because it was cold, and there was only one radiator heating it, this was also highlighted and discussed. Other forms of heating should be considered, to enable all year round use. Good practice recommendations which had been made previously in regard to infection control, and the way in which the service laundered soiled items of clothing had been met. A noisy tumble dryer will be replaced as soon as possible. Paper towels and anti bacterial hand wash was also available across the home. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home should be trained, skilled and in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. Evidence: The Annual Quality Assurance Assessment (AQAA) completed by the care manager told us All our staff have NVQ 2, two have NVQ 3, one is starting NVQ 3, two are going to do NVQ 3 later in the year. Mandatory training is done, and updates are done as and when needed. We are looking to extra training, relevant to our service users. Surveys completed by staff and people using the service told us that staff are always available when needed, staff listen and act on what people say, and people receive the support and care they need. Comments included staff find time for me. Staff spoken with confirmed that they were really tired, had not being given training which keeps them up to date. Records seen were out of date, disjointed, and not uniformly kept. Staff also said We are at the end of our tether, staffing levels had not been maintained, and in a small staff team the pressure is then on the remaining staff to cover for those absences. One staff member said that they do so much cleaning and Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: laundry at the home, that they do not have time to spend with people using the service. These issues were highlighted and discussed with the care manager, who confirmed that staffing levels had been barely maintained, with the care manager covering on shifts, this had meant that for some months managerial tasks had to be postphoned, and or neglected. The care manager had recently been off sick for seven weeks, and had not been able to appoint a senior to oversee the management of the home, as there is no senior in post. The provider was also on holiday during that time. It is a priority for the care manager to recruit to those vacant posts, and to appoint a senior to be in charge of the home in her absence. This will ensure the well-being, safety and welfare of the people using the service. The care manager confirmed that she had recently advertised and subsequently appointed one carer, who is now awaiting security checks before commencement. One more carer still needs to be appointed. The care manager has identified a member of staff who may be able to take on the role of senior carer. Staff reported that they are not receiving supervision, or appraisals, and that staff meetings are taking place about twice yearly. This means that staff do not feel valued, or updated in their training, and that communication is not as good as it could be. Staff also said that the manager should have enough time to fulfil her role and responsibilities, and to keep records up to date. Training and development are linked to the homes service aims and to meeting individual needs and care plans. People using the service need to feel confident that staffing levels are being maintained, and that staff have the necessary skills, knowledge and experience to meet their needs. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home should be based on openness and respect, there should be an effective quality assurance system which is then fedback through staff meetings, and meetings for people using the service. Evidence: The Annual Quality Assurance Assessment (AQAA) completed by the care manager told us Care Manager has Level 4 NVQ and Registered Care Manager Certificates, has nine years experience within the home. We are establishing a quality assurance system, and monitoring is done. Policies and Procedures are in place. Surveys completed by staff and people using the service told us there always seems to be staff problems (sort of) for the manager to be able to complete all that is necessary with the staff. People living at the home have clearly been protected and cared for, and had not noticed any change in the quality of their service, we can say this because their comments have not acknowledged any change. The care manager had been covering for the lack of staff, and not completing her own role and Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: responsibilities as manager. This has led to a lack of consistency in regard to the smooth running of the home, poor record keeping, a low staff morale with a staff team who are tired because of poor staffing levels, and the high expectation that they will still keep the home clean and the laundry done. The care manager had a period of absence due to sickness at the end of 2008, and the provider was on holiday at that time. The care manager did not inform us of this. There was no senior carer in post to oversee the running of the service during that time. The care manager said that she had been able to spend small amounts of time in the home, even though she was actually off sick. However, staff became stressed and tired during this time. We discussed this in depth, and strongly recommended that she appoint more staff so that she can take up the proper management of the home, that she appoint a senior carer to manage the home in her absence, that she ensures that staff receive supervision and appraisals, which will value the staff as individuals, and identify the training required for staff according to their role and responsibilities. Record keeping had fallen behind, particularly in regard to staff training, the updating of Person Centred Planning care plans, the reviewing of policies and procedures. The Annual Quality Assurance Assessment was adequately completed, but did not reflect what we heard from staff, read in surveys, and found on the day of the inspection. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 42 38 Where the registered 07/03/2009 manager proposes to be absent from the care home for a continuous period of 28 days or more the registered person shall give notice in writing to the Commission of the proposed absence. This is to ensure that the health, safety and welfare of people using the service are promoted and protected. 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 Records relating to care planning should be dated, shared with the individual and or their representative, and signed. This will evidence that individuals are involved in the care planning process. Medication should be appropriately and securely stored. To ensure the safety of the people using the service. Staffing levels should be maintained in order to meet the individual needs of the people using the service. 2 3 20 33 Care Homes for Adults (18-65 years) Page 29 of 31 4 35 Staff training should be kept up to date, and a comprehensive up to date training matrix should reflect all of the courses undertaken. Staff supervision and appraisals should be kept up to date. These will identify future training for staff according to their role and responsibilities. The ethos of the home should include a clear sense of direction and leadership. This will ensure consistency and smooth day to day running of the service. Effective quality assurance and quality monitoring systems, should be based on seeking the views of people using the service, staff and stakeholders. This ensures that peoples views are listened to and acted upon, with outcomes fedback during meetings that are minuted and recorded. The homes written policies and procedures should be kept up to date, signed, reviewed, monitored and amended where necessary. Staff should receive training and updates to meet the specification on all safe working practices. 5 36 6 38 7 39 8 40 9 42 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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