Inspection on 15/01/09 for Crest Lodge

This inspection was carried out on 15th January 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Crest Lodge 16/01/07

Crest Lodge 25/11/05

Crest Lodge 05/07/05

Crest Lodge 17/01/05

Crest Lodge 11/08/04

Crest Lodge 16/02/04

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

Prinsted

49 Glendale

The Springs Community

Crossways Community

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: Crest Lodge Churt Road Hindhead Surrey GU26 6PS     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: Suzanne Magnier     Date: 1 5 0 1 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 32 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 32 Information about the care home Name of care home: Address: Crest Lodge Churt Road Hindhead Surrey GU26 6PS 01428605577 01428609234 crestlodge@carehomesofdistinction.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr L Hasham care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence past or present drug dependence mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 33. The registered person may provide the following category/ies of service only: Care home with nursing - (N) 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) Past or present alcohol problem (A) Past or present drug problem (D). Date of last inspection Brief description of the care home Crest Lodge is a large detached property located in Hindhead, close to the amenities of Beacon Hill. The home is owned by Care Homes of Distinction and provides Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 0 0 33 33 33 Brief description of the care home accommodation and nursing care to up to 33 adults with mental health needs. The accommodation is arranged over two floors with the first floor being accessed by stairs or passenger lift. All bedrooms are single and all have en-suite facilities. There is a bathroom and separate shower room on the ground floor and a bathroom on the first floor. Communal facilities include a lounge, two dining rooms and a designated smoking room. The home has its own mini-bus to access the local and wider community and there is parking for several cars to the front of the property. A public bus stop is close by. There are gardens to the front and rear of the property, however they are not at present accessible to service users as neither are enclosed and they lead onto a busy main road. Care Homes for Adults (18-65 years) Page 5 of 32 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 Quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. This inspection of the care home was an unannounced Key Inspection and some additional standards were assessed and have been included within the report. Following the previous key inspection on the 25th November 2005 the service has met all the requirements made. Ms S Magnier Regulation Inspector carried out the inspection and the nurses in charge and the general manager represented the service as the registered manager was on annual leave. For the purpose of the report the individuals using the service are referred to as residents. Care Homes for Adults (18-65 years) Page 6 of 32 The home had submitted the Annual Quality Assurance Assessment AQAA prior to the inspection, which was brief yet well written to inform the commission about the service and some details of document have been added to the report. The inspector arrived at the service at 09.00 and was in the home for seven hours. It was a thorough look at how well the home is doing. It took into account detailed information provided by the home and any information that CSCI has received about the service since the last inspection. The commission received five staff written surveys and two surveys from health care professionals. Nine comment cards were received from residents which had been completed by staff at the home. The comments of which have been included within the report. The inspector spent time talking and observing the staff members and residents in order to gain their views and opinions about the service. The inspector looked at how well the service was meeting standards and has in this report made judgments about the standard of the service. Documents sampled prior and during the inspection included the homes Annual Quality Assurance Assessment AQAA, the homes Statement of Purpose and Service User Guide, care and person centred plans, risk assessments, medication procedures, staff files, a variety of training records, health and safety records and several of the organisations policies and procedures including the complaints and safeguarding procedures. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. During the inspection a concern was raised by the inspector regarding a safeguarding vulnerable adult in the home and this was promptly addressed by the general manager and a referral made to the local authority safeguarding team. One other safeguarding referral was being investigated by the local authority prior to the inspection and has been satisfactorily concluded. From the evidence seen by the inspector and comments received, the inspector considers that the home continues to be able to provide a service that meets the needs of people who have diverse religious, racial or cultural needs. The final part of the inspection was spent giving feedback to the service representatives about the findings of the visit. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 8 of 32 Residents rights to confidentiality and privacy must be maintained at all times. Arrangements regarding advising residents of the meals offered by the home must be strengthenned in order that residents are aware what meals are being offered and what choices are available to them. The communal bathrooms are not adequate in number to support the needs of the current resident group. The residents are not fully protected by the homes safeguarding adults procedures. Safe vetting practices concerning the recruitment of all staff to the home must be improved and maintained in order to ensure the safety and protection of residents in the home. All staff must attend induction and mandatory training to ensure that they are suitably trained and competent in their duties. Arrangements must be made for the robust management of staff supervision in order to ensure staff are supported and managed well. 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 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have up to date information about the homes services and facilities in order that they can make an informed choice about moving into the home. The admission and assessment procedures ensure that residents needs are appropriately identified. Evidence: The Statement of Purpose and Service User Guide were sampled and both the documents were written in plain English to describe the facilities and services offered by the home. The general manager comfirmed that each resident is given the documents in order that they have an informed choice about moving into the home and what the homes staff can offer them. Two care plans of individuals who had been recently admitted to the home were sampled and evidenced that a robust assessments had been made by a qualified person to ensure that the needs of the resident could be met by the homes staff. Comments received from residents regarding the admission procedures to the home included I wasnt asked if I wanted to move into the home and I didnt have enough information about the home. The place is better than where I was before.I was Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: asked if I wanted to move into the home and had enough information.I was given the option of a room here. I remember being shown round by the manager and thinking it would be a nice place to live. I like it here. Care Homes for Adults (18-65 years) Page 12 of 32 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. The support and personal care that people receive is based on their individual needs set out in their care plans. Monitoring of risk assessments is well managed to ensure the safety of individuals. Peoples rights to dignity and confidentiality must be maintained at all times. Evidence: Four care plans were sampled and it was evident that those individuals newly admitted to the home had had their care plan developed from the pre assessment documentation. The care plans were well written to allow the reader to gain an overview of the persons medical, emotional, social and lifestyle preferences. The homes staff had commenced to introduce person centred plans which evidenced that residents were involved in the content of the plans and had been encouraged to maintain an interest and where possible sign the plans. The AQAA advises that all residents have a Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: keyworker yet when speaking with some residents they were unsure of the name of their keyworker and it has been suggested that an improved system be put in place to assist residents to remember the name of their keyworker. The AQAA also advises that the home is endeavouring to involve a local advocacy agency to support residents of their rights to have their opinions and concerns listenned to. The care plans included comprehensive risk assessments which had been documented following assessments of hazards in individuals lives. The risk assessments were clear in detailing the hazards and the actions that staff or the individuals representative should take in order to minimise the risk and promote the individuals safety and wellbeing. Several residents spoken with confirmed that they are able to have choice and independence in their lives. It was observed that some residents left the home during the morning and where necessary risk assessments were in place to support individuals rights to independence and autonomy. The daily records maintained by staff were well documented and professionally written to detail the twenty four hour period in the persons life. It was noted that some records only contained the first name of the staff member writing the report and it was addressed during the inspection that the staff be reminded to write their full name on the records. Whilst touring the premises it was observed that in the homes office a large board displayed information regarding the residents full name, their healthcare needs and appointments. A shift plan book detailing some residents information had been left on a table by the visitors book and a staff members private address details had been displayed on one of the homes notice boards. It has been required that more robust arrangements must be made regarding the awareness of peoples rights to confidentiality of their information. When the shortfalls were brought to the nurse in charge attention the staff were prompt to remove all the dispayed items. Care Homes for Adults (18-65 years) Page 14 of 32 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. Individuals are able to exercise choice in their daily lives, maintain bonds with family and friends and take part in social, cultural, religious and recreational activities. Individuals are encouraged to be involved in the running of the home and maintaining their daily living skills. A choice of a healthy diet is provided yet arrangements regarding informing people about meals offered by the home needs to be strengthenned. Evidence: Throughout the inspection it was observed that residents were comfortable and settled in their surroundings and the staff on duty were attentive to the needs of each individual. One staff member had reported in sick on the day of the inspection which had been promptly addressed by the home and two members of staff volunteered to come in on the day shift to support the home. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: There was evidence in the home that planned activities take place and these include a music session, phyiscal exercise sessions, visits to the local amenities for example the post office and local shop, attend a variety of drop in centres in a local town and have access to the daily newspapers and magazines of interest. The nurse in charge advised that the home have regular church services within the home which residents enjoy attending. It was noted that some residents were free to leave the home in the morning and had their own keys to their bedrooms and the home. One resident was eager to go shopping at the local charity shop and when they returned showed the inspector the bargains they had bought. In general the residents showed limited interest in the activities provided by the home and it was evident that the staff work hard to encourage residents to widen their interests in their daily lives. The home have an activity plan which was displayed on the notice board. It was noted that the notice was not dated and the inspector was advised by a resident it was because the activities were the same each week. Another resident told the inspector that the home has its own transport and they dont like to mix with a lot of people. A notice board in one dining area demonstrated that some residents had been involved in art work which had been displayed and which gave the room a homely atmosphere. Written comments received from residents regarding the home stated I usually make decisions about what I do each day and staff usually listen and act on what I say. I choose to live at Crest Lodge and am happy where I am living. Carers ususally treat me well and sometimes listen and act on what I say. I have help making decisions and have choices about what I do. Some residents confirmed that they have support from their family and friends and they like to keep the contact. The AQAA advises that the homes staff are aware that they could improve in encouraging more contribution from residents family and friends in keeping in contact and the aim of the home is to promote the idea of a relatives support group which will hopefully improve connections between relatives and the residents. Records confirmed that regular residents and staff meetings are held in order to maintain the open management approach in the home and to encourage residents to be involved in the running of the home. Written comments received from healthcare professionals about the activities and the home in general stated Clients are encouraged to join activities and go out. Visitors are made to feel welcome.They provide a friendly, homely environment, know clients Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: needs in depth and are able to manage challenging behaviour effectively. The residents were asked if they knew what the meals were being offered on the day of the inspection and all of the six residents asked did not know what was on the menu or what week the menu displayed on the dining room wall related to. The nurse in charge was also asked what the midday meal was and they too advised they did not know. Several residents said that the print on the menu was also too small for them to see. The staff advised that the menu is generally written on the chalk board in the dining room yet this had not been done as a staff member told the inspector the chef was new. It has been required that arrangements regarding advising residents of the meals offered by the home are strenghenned in order that residents are aware what meals are being offered and what choices are available to them. The inspector observed residents within the homes dining areas being offered their breakfasts and midday meal. The dining areas were bright and spacious with small tables to seat up to four people. Staff were attentive and respectful in the serving of the meals and choices of the menu were observed. The person in charge explained that nutritional, eating and drinking risk assessments were kept within the persons care plans in order to ensure the well being and safety of individuals and which were sampled by the inspector. Care Homes for Adults (18-65 years) Page 17 of 32 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 care plans were up to date and the provision of personal care and support were well documented. Peoples health care needs are well met. Medication is administered in way that protects the individual and promotes their safety and well being. Evidence: The staff team consist of a multi racial mixed gender staff group and the person in charge advised that where possible gender based care is provided and staff are aware of residents individual preferences. It was observed that staff supported individuals in a sensitive way ensuring their privacy is respected when providing assistance with personal care and residents responded favourably to staff and the staff demonstrated a knowledge and understanding of the residents welfare and support needs. Four care plans and person centred plans were sampled. The care plans and health care reports have been well maintained and included records of attended health care appointments which included visits to the individuals general practitioner, care managers, and specialist health care personnel. The AQAA advises that the home are Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: seeking to improve access and response from the local community mental health teams regarding residents reviews and to encourage community dental services to visit the home to attend to the needs of people who are unable to travel to appointments. The daily records completed by staff were well written and contained good evidence of the care and emotional support provided by staff and the monitoring of health related concerns. Through sampling care plans and observation it was evident that the home maintains good working partnerships with health care professionals. Written comments received from healthcare professionals included the homes staff will phone the surgery if they need advice or are concerned about an individuals health needs. They work closely with the general practice and mental health services.Generally all aspects of residents care and needs are met in most cases because of residents physical and mental condition they have little scope for choice. The home has a clincal room and the medication cupboard is located in a safe and secure area within the home and a monitored dosage system remains in place. Procedures regarding the safe handling, administration and disposal of medicines have been maintained. The homes medication policy and procedure was robust and medication administration charts were well recorded and demonstrated the way the person preferred to take their medicines, the side effects, purpose of the medicine and the individuals photo and any known allergies were available within the records sampled. Records of controlled medicines were sampled and demonstrated that robust checks are maintained and all medicines were accounted for. The nurse in charge confirmed that individuals have the right to refuse to take their medicines and the procedures for reporting of the event, they also confirmed that where possible, and following the completion of a robust risk assessemnt, individuals rights to independence regarding taking their own medication would be promoted. The inspector observed the person in charge administering medicines. The procedures were unrushed and methodical to ensure the safety of the individuals receiving their prescribed medicines. Care Homes for Adults (18-65 years) Page 19 of 32 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. The homes complaints procedure is an accurate document for individuals to express any concerns or complaints. Individuals are not fully protected from abuse and harm by the homes policies and procedures. Evidence: The home has a clear complaints policy and procedure which is available within the home for residents or any person associated to the home to see in order that their views, opinions and complaints are recognised and acted upon. It was suggested that the complaints procedure be set in larger writing as some residents stated they could not read the policy very clearly. This sugesstion was acted upon promptly by the homes administrator. The general manager confirmed that no complaints have been received by the home and no complainant has contacted the commission with information concerning a complaint made to the service since the last inspection. Comments received from residents regarding how to make a complaint stated I would speak to the manager if I was unhappy and have never had a complaint. Everyone treats me extremely well. I would talk to a relative or a member of staff if I was not happy. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: The person in charge demonstrated that they were aware of the local authorities multi agency procedures for safeguarding adults and one referral had been recently concluded by the local authority. During the inspection it was observed that a member of the staff team acted inappropriatly towards a resident on two occassions. A senior member of staff reprimanded the staff member and the general manager in the presence of the inspector reported the incident to the local authority safeguarding team. Following the inspection the commission have been contacted to be advised that a planning meeting has been arranged. The home has a whistle blowing policy and procedure, which is available to staff in order to safeguard individuals in their care. The home have the current multi agency safeguarding protocols within the home. It was also observed,by the inspector that a resident gave a staff member an amount of money in order that the staff member could purchase an item on behalf of the resident. This incident was brought to the general managers attention and it was confirmed that the home did not have a policy regarding staff accepting money from residents in order to purchase items on their behalf. The administrator and general manager were prompt to develop a policy which was shown to the inspector and the staff member and resident were made aware that the incident could potentially put either party at risk. Records confirmed that all care staff had received safeguarding vulnerable adults training yet two ancilary staff files sampled by the inspector confirmed they had not received the training. The shortfall was raised with the general manager at the time of the inspection and the registered manager following the inspection. It has been required that all staff must attend safeguarding vulnerable adults training to ensure that individuals living at the home are protected from harm and abuse. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All areas of the home are clean. The bathing facilities within the home must be improved in order to provide residents with suitable bathing facilities that comply with the homes stated purpose to promote the safety and well being of residents. Improvements with regard to the designated smoking area for the residents must be considered. Evidence: During the tour of the premises the inspector observed that the home was well maintained. The home has an ongoing decoration programme which ensures that individuals bedrooms and communal areas have been or will be planned to be decorated with the inclusion of the individuals choice and preferences. Some areas of the homes decor looked tired and this was discussed with the general manager who advised this detail would be passed onto the providers to be included within the homes redecoration programme. A large number of residents smoke and the homes staff have, since the new legislation regarding smoking, arranged for a designated smoking room within the home. The room has been recently decorated yet it was observed to be institutional in nature for example the use of old sweet tins for ash trays and old chairs. It has been Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: suggested that the area be made more homely as the activity of people smoking is meaningful to the individual and having an improved setting reflects the value of the person and may increase their enjoyment. The home was clean and orderly throughout and no malodour was detected. One written comment received stated the decor could be improved. It was noted that the shaft lift in the home was not working and an engineer had been called and was repairing the lift in order that residents had access to all areas within the home. Whilst speaking with several residents they confirmed that they thought there were insufficient bathroom facilities in the home and this was confirmed when speaking with staff members. It was noted that two residents used the bath facilities and the other twenty two residents used the shower facilities. This shortfall was discussed with the general manager and the registered manager following the inspection. It has been required that the service provides residents with bathing facilities which include disability equipment or environmental adaptations, where necessary, to meet the residents assessed needs and meets the homes stated purpose. The directors have advised the commission following the inspection that the home are arranging for one bathroom within the home to be changed to a walk in shower room which will be more beneficial and meet the current needs of the residents. The front and back gardens are accessible for individuals to use and new seating has been provided. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes staff provides twenty four hour support to the individuals living at the home. The homes recruitment practices, induction, mandatory training and supervision of staff is not consistent to ensure that residents needs are appropriately and safely met and staff have equal opportunities. Evidence: The homes staff are currently supporting twenty nine residents and there is a stable staff team. The level of staffing was discussed with the nurse in charge who confirmed that there is ongoing monitoring of the residents needs and staff resources would be maintained and action taken to address any shortfalls should residents needs change. On the day of the inspection the homes staff were observed as skilled in supporting residents in their care and were knowledgeable regarding the specific needs of individuals to ensure their safety, well being and offer reassurance. Written comments received by residents regarding the staff stated a good thing here is that there is always someone to talk to. The staff are very good people. Other comments received stated They are experienced and caring staff. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: The home has a recruitment and selection policy, which incorporates equal opportunities. The inspector sampled four staff files which included care and ancillary staff. The care staff records were well recorded and contained application forms, with two references, evidence that face to face interviews had taken place and the job description in order that the staff member was clear about their roles and responsibilities. There was documented evidence that a CRB clearance had been obtained. The care staff mandatory and induction training records evidenced that staff had received updated training and had also undertaken specialised training in order to support the needs of the residents. The AQAA identifies that over 50 per cent of staff have achieved their National Vocational Qualification in Care awards. The care staff records evidenced that they are formally supervised by the registered manager and staff confirmed that they felt supported by the manager on a day to day basis. One newly appointed ancillary staff members application form was not robustly completed and did not reflect that the staff member had received any induction programme to the home. There was no evidence that they had been supported to receive language tuition by the organisation and there was no evidence available within the home or documented on the training matrix that they had received any mandatory training. There was no evidence found during the inspection that the two ancillary staff members had received formal documented supervision of their work. It was not evident how the two staff were supported to comply with the homes policies and procedures and also training with regard to legislation affecting their role and responsibilies for example control of substances hazardous to health, safeguarding procedures and health and safety. It has been required that all staff employed at the home must receive training appropriate to their work and have supervision of thier work in order to ensure the safety and welfare of all persons in the home. Staff written comments received by the commission included my duties are to formulate a care plan when a resident is admitted together with them or relatives and try to write up a care plan which is person centred. I was inducted very well and also went on mandatory training.My manager does supervision individually with me and we have staff meetings as well. He will call meetings at any other time to discuss any work related issues. We treat all our residents with dignity, privacy and respect and try to keep the home clean and tidy. How the home could improve is to listen to staff and not always the service user. Both sides should be able to get together to try and solve any problems. They are employing too many staff who cannot speak English which makes it difficult when working with service users and stressfull for staff. Service users get frustrated and angry when staff dont understand them. We always Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: get full information about the needs of the residents. I attended a five day induction course which was held at Head Office. My manager is keen to send us for all relevant courses and I have meetings with my manager. There are always enough staff on each shift. The care plans are kept up to date. The induction was helpful and we have nmadatory training each year. We have staff supervision with the manager on a regular basis. I think we have a very good level of care for the service users. It would be better if it were possible to arrange more outings or something similar for the service users for example the cinema. I think the service could improve by offering service users more entertainment. Following the inspection the general manager was informed of the shortfalls and it has been required that arrangements must be made to ensure that all staff employed by the home are suitably vetted, receive appropriate training and are supervised in order that the welfare, protection and safety of residents is promoted. Care Homes for Adults (18-65 years) Page 26 of 32 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 needs to be strengthenned. The home continues to be run in the best interests of the residents and their views and opinions and those of others associated with the home are sought. Individuals welfare is promoted through monitoring of health and safety in the home. Evidence: As documented within the report it was evident through observation that the pace of the home continues to be designed to meet the needs of the residents and the care staff present during the inspection had a good knowledge about individuals in the home to ensure their safety and well being. The home has a registered manager who has been in post for several years. Staff confirmed that the manager conducted the home in the best interests of the residents and offered an open and inclusive style of management. The home was represented by a registered nurse who undertook their duties in a professional and calm manner and was very knowledgeable about the running of the home to benefit the residents. Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: The management of files and related documents were well established and orderly. Accident and incident records were sampled and demonstrated that the homes staff are prompt in giving notice to the commission without delay regarding any event, which affects the safety and welfare of the supported people. Financial records of three residents were sampled and it was noted that two indicated minor errors. The shortfall was brought to the general managers attention at the time of the inspection. It has been recommended that all records relating to residents finance are more robustly managed in order to protect the individual from potential financial abuse. Hand washing facilities remain available throughout the home and clinical waste disposal is appropriately managed. Records indicated that servicing of fire equipment had taken place and health and safety checks had been undertaken and recorded. A current insurance indemnity, gas and electric certification was sampled and the current certificate of registration of the home dispalyed. Confirmation was seen that the home continues to seek residents and their representatives views and opinions about the service through the Quality Assurance procedures. All substances which are hazardous were stored in compliance with the control of substances hazardous to health legislation in order to ensure the safety and welfare of residents. The shortfalls identified throughout the inspection report highlight that some areas within the homes management need to be strengthenned which include the homes recruitment procedures, staff training and induction, improved awareness of safeguarding issues including financial procedures and consitent promotion of peoples rights to confidentiality, dignity and respect at all times. Care Homes for Adults (18-65 years) Page 28 of 32 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 29 of 32 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 10 12 Arrangements must be made that the home is conducted in a manner that respects peoples rights to confidentiality and privacy. To ensure peoples rights are promoted 20/04/2009 2 15 17 Arrangements regarding informing people about meals offered by the homes needs to be strenghenned. In order that people know what is on the menu and can make informed choices. 20/04/2009 3 23 13 Arrangements must be made that all staff receive training with regard to safeguarding vulnerable adults and policies and safeguarding procedures within the home are strenghtenned. 20/04/2009 Care Homes for Adults (18-65 years) Page 30 of 32 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 To ensure all persons in the home are protected from harm or abuse 4 34 19 Arrangements must be 18/05/2009 made to ensure that all staff employed by the home are suitably vetted, receive appropriate training and are supervised. In order that the welfare, protection and safety of residents is promoted. The management and administration of the home needs to be strengthenned. In order to ensure consistent practice to promote the welfare and well being of all persons in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 5 42 13 20/04/2009 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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