Inspection on 04/02/09 for Dexters Ltd The

This inspection was carried out on 4th February 2009.

CSCI found this care home to be providing an Good 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

Dexters Ltd The 27/02/07

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

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: Dexters Ltd The 21 Penley`s Grove Street York YO31 7PW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Dawn Navesey     Date: 0 4 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 03000 616161 (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.cqc.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: Dexters Ltd The 21 Penley`s Grove Street York YO31 7PW 01904644675 01904628187 lynnedexter@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Dexters Limited Name of registered manager (if applicable) Mrs Lynne Dexter Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: Service users to include up to 16 (LD), up to 16 (LD(E)), up to 16 (MD) and up to 16 (MD(E)) up to a maximum of 16 service users. Date of last inspection Brief description of the care home The Dexters is a care home providing personal cares and accommodation for up to sixteen people with mental health needs and/or learning disabilities. The home is located close to the centre of York and its amenities and leisure facilities. The accommodation is provided in both single and double rooms and there are two selfcontained units and an attractive back garden area, which is used by people who live at the home. The Dexters Ltd took over the ownership of the home in October 2005. The current fees for the home as given by the registered provider range from 375 pounds to 650 pounds per week and do not include costs for hairdressing, chiropody and toiletries. Care Homes for Adults (18-65 years) Page 4 of 31 care home 16 Over 65 16 16 16 16 Brief description of the care home Current information about services provided at The Dexters in the form of a statement of purpose, service user guide and the most recent inspection report published by the Commission for Social Care Inspection are available by contacting the home. 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The Commission for Social Care Inspection (CSCI) inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.csci.org.uk This visit was unannounced and was carried out by one inspector who was at the home from 10:15am until 4:30pm 4 February 2009. For some part of the visit, the inspector Care Homes for Adults (18-65 years) Page 6 of 31 was joined by an expert by experience. An expert by experience is someone who has expert knowledge of care services through their own experience of using services. They join the inspector to help them get a good picture of the service from the viewpoint of the people who use it. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people living there. And also to monitor progress on the requirements and recommendations made at the last inspection. Before the inspection evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the visit. An AQAA (Annual Quality Assurance Assessment) was completed by the home manager before the visit to provide additional information. Survey forms were sent out to people living at the home, staff and health care professionals. A number of these have been returned and this information has also been used in the preparation of this report. During the visit a number of documents and records were looked at and some areas of the home used by the people living there were visited. Some time was spent with the people who live at the home, talking to them and interacting with them. Time was also spent talking to staff and the manager. Feedback at the end of the visit was given to the deputy manager. The last inspection of this home was on 25 February 2007. What the care home does well: What has improved since the last inspection? What they could do better: People who use the service should have detailed care plans and risk management plans, clearly outlining all their support needs. This should also include future aspirations and how people are to be supported to achieve greater independence. They should also be more involved in drawing up their support plans. This will make sure Care Homes for Adults (18-65 years) Page 8 of 31 that they receive person centred support that meets their needs fully. Views on activity in the home were mixed. The expert by experience said, Some residents seemed to get out very infrequently. One resident commented that there are no organised activities only board games, and that they would like more organised activities and outings. Others said they had plenty to do. The administration of creams and ointments must be recorded and clear directions for their use must also be recorded. This will make sure administration is safe. Guidelines for the administration of as and when required medication must be individual to the person they are prescribed for. This will make sure that practice is safe and needs are not missed or overlooked. Handwritten entries on MAR sheets should be checked and countersigned by a second person to make sure the information is correct and people receive the right medication. Paper towels must be provided so that people can dry their hands in a hygienic manner. This will prevent any spread of infection. The heating levels in the bedrooms must be monitored to make sure they are comfortable and warm enough for people. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –03000 616161. 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 are provided with good standards of pre-admission assesment which makes sure the service can fully meet peoples needs. Evidence: In the AQAA, the manager said, After the initial formal contact, prospective residents are invited for several social visits and meals (with a friend or relative if preferred) to make the experience as stress free and relaxed as possible. This enables all parties to assess realistically, if and how needs could be met. We looked at pre- admission assessments for some people. We saw that peoples needs are assessed before they move into the home so that staff can be told about any specific needs they might have and know what help and support to provide. We also discussed the procedures that are followed if periods of notice are to be given to anyone using the service. These seemed to be fair and flexible according to peoples Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: individual needs. People said they were happy living at the home. Comments included: I saw 4 homes and preferred the Dexters Very good home You wont find nowt wrong here Been here 8 years, its lovely Super home, super place to live 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. People are involved in decisions about their lives, but do not always play an active role in planning the care and suppport they receive. Evidence: In the AQAA, the manager said, We enable each resident to be instrumental in the planning of their care in the home. They may not feel autonomous and in control of important aspects of their lives so staff endeavour to empower and encourage involvement in every decision that is made. We looked at care plan and risk assessment records for some people who live at the home. We found them, in the main, to be person centred and individual to each person. Some plans had clear and detailed instruction on how the needs of people who use the service are to be met. They had some good information about how people should be supported with personal care, communication, social and health needs. There is less emphasis on furthering peoples independence and involving them in the Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: daily life of the home though. The expert by experience said, There was no evidence that people are encouraged to look after themselves as much as possible to maintain their own independence, such as being able to make their own drinks, but the residents we spoke to did not seem concerned about this. People who use the service said they had not been involved in the development of their plans so were unable to say if their needs were being met according to their care plans. One person told the expert by experience that they would like to be more involved in developing their care plans and would like a copy of them. They did however say their needs were well met. Some peoples care plans were from previous placements. Some were undated or signed which means it was difficult to say if they were current. This could lead to peoples needs being missed. For example, someone at risk from aggressive behaviour and suicidal tendencies had no risk assessments completed by the home, just the previous placement. People who use the service told us they always make decisions about what they do each day and that they can decide to do what they want. They said, I go home every day, Can do what you want, when you want to and Have meetings now and then to discuss things. We looked at minutes of these meetings and saw that a variety of aspects of the running of the home are discussed. However, it was not clear how requests or suggestions are acted upon or actioned by the home. Most staff said, they felt there was enough information in peoples care plans to enable them to meet peoples needs properly. One said, Support clients with care needs to individual care plans and needs. Another said, It is a caring and supportive environment where the residents needs and choices are always respected. Staff were familiar with what was written in peoples care plans and could talk confidently about the support they give. They had very good knowledge of peoples individual support needs and could describe peoples routines well. Care plans are reviewed and evaluated regularly to make sure they are still relevant for people. 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 the service are, in the main, able to make choices about their lifestyle. Social, educational, cultural and recreational activities meet peoples expectations. They also benefit from a good, healthy and varied diet. Evidence: In the AQAA, the manager said, We recognise that lifestyle preferences differ from person to person and we support and encourage each resident in their choices unless it is detrimental to their mental or physical health. We have always celebrated equality and diversity and endeavour to champion residents who struggle to be heard. We identify who seems to be less forthcoming voicing their views and pursue with them other means of communication. She also said she was planning to make improvements to the service, saying, Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: Continue to explore further social and occupational activities that may be of interest to our client group. Continue to encourage residents active involvement in the home ie. the running of the home, health and safety issues etc. As mentioned in the Individual Needs and Choices section of this report, we found little evidence of how people who use the service are involved in the daily life of the home and supported to develop their independence. A number of people said it was their choice to allow staff to cook and clean for them and didnt want to get involved. Staff told us that some people are particularly unmotivated in trying to develop their independence skills. Most people said they had plenty to do. One person said, I do voluntary work and go to college. Sometimes the staff go for a coffee etc with the residents. Others said, Plenty to keep me busy, dominoes, games I set tables, wash up, make my own drinks Dont do much here Sometimes play bingo and board games and sometimes go to the Theatre Goes on day trips to Whitby and likes it I always stay in the home and do not want to go out I go to the drop in centre down the street The expert by experience said, Some residents seemed to get out very infrequently. One resident commented that there are no organised activities only board games, and that they would like more organised activities and outings. One resident said that they do not want the home to organise activities and that they are happy browsing in shops. They also said, One resident said that the home would help if somebody wanted a day trip organising and that he is going out for the day in April. One resident said that the home was organising a holiday to either Blackpool or Skegness for certain residents. One resident stated that he was 70 in a few weeks and that the home is organising a party and his sister is coming to take him out. Staff said that, in the main, they felt they had enough staff to support people with their activities. One said, Residents have lots of opportunities to get involved in social activities and have support from staff if they need it. We noticed that people who were able to go out into the community on their own had more choice of activity than those who need staffs support to do this. Most people who live at the home tended to congregate in the kitchen/dining area talking and chatting to staff. There was plenty of social interaction between the staff and people who use the service. It was clear that staff and people who use the service get on well. People are also supported to keep in contact with family and friends. They said, My Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: Mother comes to visit me and Visitors come now and again. We looked at menus at the home. These are planned around peoples likes and dislikes. People who live at the home said they enjoy the food, they said, The food is fine, healthy, I am diabetic they keep an eye on what I eat Always something else to have if you dont like whats on They always say its your choice, we will cook you what you want A staff member said, The choice and variety of meals are always excellent. Better records are now being kept of what people eat. This means peoples nutritional needs can be monitored. The expert by experience spoke to people about food and mealtimes in the home. They said, When asked if they are allowed to go in the kitchen to do things for themselves, the residents said no, they were not allowed. The manager clarified this by saying, Residents are allowed in the kitchen to make drinks and planned meals but not when staff are cooking as the Health and Safety risks identified in the risk assessments make it an unsafe environment. People also said they can have food and drink when they want and have different choices to choose from on the meal menu. The expert by experience said, One resident said that they liked the food and another commented that the food is good. 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. Overall, peoples general healthcare needs are well met and based upon their individual needs. Evidence: In the AQAA, the manager said, We are respectful towards residents who struggle to manage personal care for themselves. We have a keyworker system so that residents can be matched to the staff they feel most at ease with and a personalised working care plan can be formulated over a period of time as knowledge of all the residents needs and wishes become more apparent. Staff had good knowledge of peoples personal support needs. Staff were thoughtful, discreet and respectful of peoples dignity when attending to any needs. People who live at the home looked well cared for, well dressed and groomed. People said they felt well looked after . One person said, I was feeling low last week, they looked after me A1, got me through it. Another said, They understand my Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: problems. Good records are kept of health appointments and their outcomes. Staff make sure that people are given support to attend appointments to meet their health needs. People are referred to health professionals when needed. Staff have identified and monitored health needs well. Better records are now being kept of peoples weights. This means their health needs are properly monitored. Staff said they had received some training on meeting the specialist health needs of people who use the service such as Hearing Voices and working with psychiatrists and community nurses on the effects of peoples mental health diagnoses. This means they are well equipped to support people on an individual basis with their health needs. Health professionals told us they were satisfied with the service provided by the home. One said, Most things they work hard to do for a very vulnerable group of patients. Another said the home usually meets peoples health care needs. The home uses a monitored dosage pre-packed system for medicines. There are good ordering and checking systems in place. We checked some medication administration records (MAR) sheets. These were found to be in reasonable order. However, some people were prescribed creams and ointments and the records for these did not at times give directions for their use or show they had been administered. The deputy manager was advised that a seperate MAR sheet could be used and kept with the creams in the persons room to make sure they are properly administered and recorded. We also noticed that some entries on the MAR sheets had been handwritten. It is good practice to make sure these entries are checked and countersigned by a second person to make sure the information is correct and people receive the right medication. Some people are prescribed as and when required medication. Guidelines for the administration of these medications were not individual to the person they were prescribed for. This could lead to needs being missed or overlooked. The deputy manager agreed to make sure these were in place. 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, in the main, able to express their concerns and are protected from abuse. Evidence: In the AQAA, the manager said, We believe that daily opportunities for group and individual discussion between staff and residents ensure that staff become aware of potential problems arising. Staff regularly review and attend N.A.P.P.I courses on the protection of vulnerable adults. We have a complaints procedure and new residents are given a copy with their contract. We talk through the procedure to make sure everyone understands and are fully aware of their rights. We ensure that opportunities arise for residents to discuss how they feel and to feel comfortable talking to staff they know they can trust. Most people who use the service said they knew how to complain and said they would talk to the manager or staff if they were unhappy about anything. However, the expert by experience said, Some people said they did not feel confident raising complaints and many did not have access to independent advocacy or frequent visits from family who would be able to pick up issues on their behalf. One resident stated I darent Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: complain for fear of residents getting their own back. Other peoples comments were mixed, they said, Waste of time complaining, although I have nothing to complain about No complaints but if I had would tell the staff or manager Feel that people listen to our complaints. Staff have received training in safeguarding adults. They were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They were also able to describe the different types of abuse. They were familiar with the whistle blowing procedure and said they would have no hesitation in using it if they thought they needed to raise concerns outside of the home or organisation. Records are kept of the finances of people who live at the home and their monies are kept safe. 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 environment is homely, comfortable and in the main, safe for people who live at the home. Evidence: In the AQAA the manager said,We have created a homely and welcoming environment. Residents are encouraged to choose the decor of their bedrooms and to keep their bedrooms clean (staff will help if required) People who use the service said they were happy with the standards of cleanliness in the home. They said the home is always clean and fresh. One person also said, encouraged to look after our rooms and The rooms are immaculate. Some people said their rooms were cold and that their radiaters did not work properly. We found some rooms to be very cold and due to the radiators having covers on we could not see if people were able to adjust the temperature of them themselves. One person said they would like to stay in their room to read or listen to music but their room was too cold to do so. Another said they were happy with their room but that it is, A bit chilly when its cold weather. The heating levels in the bedrooms must be monitored to make sure they are comfortable and warm enough for people. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: A tour of the home was carried out. Communal areas, bathrooms and bedrooms were visited. The expert by experience said, The home itself is well cared for in appearance. First impressions on entering the home were good. It smelt clean and fresh and had a homely feel. It did not appear to be formal or institutional. The decoration was modern, and the carpets were of good quality and clean. The furnishings and fittings were in good condition. However, they also said, The towel in the first floor toilet was extremely dirty, and there were no paper towels available. Paper towels must be provided so that people can dry their hands in a hygienic manner and prevent any spread of infection. In the AQAA, the manager told us of improvements made to the environment. These included, We have refurbished the kitchen and dining area. We have added a shower cubicle in the top floor bathroom. We have bought a wide screen television for the conservatory wall and a Nintendo Wii. Clinical waste is properly managed. Staff have received training in infection control as part of their induction and were able to say what infection control measures are in place. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are trained, skilled and in sufficient numbers to support people who use the service. Evidence: In the AQAA, the manager said, We have a very settled, experienced and committed staff team. All staff have clear job descriptions and contracts and have regular supervision sessions to identify training needs and talk through personal performance and competency. The majority of the staff team has completed NVQ training with four members of staff achieving their NVQ level 2 awards this year. Training is specific to current health needs of individual residents to increase staff knowledge and performance. We have an excellent staff team who understand the many problems faced by residents and offer support if prejudice and discrimination is encountered in their everyday lives. Most people who live at the home said they liked staff and got on well with them. The expert by experience said, Residents seemed to really appreciate the staff, they liked the staff as they are kind. Another stated that the staff members are excellent. Other comments included: Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: Staff are alright Staff are good but one can be bad tempered. The expert by experience also said, Two people commented that the staff had been there for years, and therefore it would appear that the staff are dedicated to their role and there is not a high turnover of staff, which greatly benefits the residents. We looked at the rota and this is arranged flexibly to meet the needs of the people who live at the home. There are usually 3 or 4 staff on the morning shift, 3 in the evenings and 2 staff work until 11pm to allow people to go out for the evening. One member of staff is available at night and there is a manager on call. We looked at recruitment records. These showed that recruitment is properly managed by the home; interviews are held, references and CRB (Criminal Record Bureau) checks are obtained before staff start work and checks are made to make sure staff are eligible for work. Induction training is based on the Skills for Care common induction standards. Staff said their induction had been good and prepared them well for their job. We also looked at training records and these showed that most staffs training was up to date or if updates were needed, they were planned. Staff spoke highly of their training. Comments included: Regular updates given The training is good Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed, the interests of the people who use the service are seen as important to the manager and staff and are properly safeguarded. Evidence: In the AQAA, the manager said, We have an open door management style and staff, residents and relatives know that their views and opinions will be listened to and acted upon if necessary. She also said that the service had been improved, saying, We have created a Deputy Manager post and have recruited a trained Learning Disabilities Nurse with mental health experience for the position. The manager of the service is a registered nurse and has many years experience of managing the home. She also has the registered managers award making her suitably qualified to run and manage the home. Staff and people who use the service spoke highly of the manager. Their comments included: Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: Happy with the manager She is very kind, very generous Like the manager She is very supportive Records we looked at showed that regular health and safety checks are carried out. In the AQAA the manager said relevant health and safety policies and procedures were in place, she did not however say when these had last been reviewed. She also said equipment has been serviced or tested as recommended by the manufacturer or regulatory body. Records showed that certificates on gas and electrical safety were up to date. The organisation provides a comprehensive manual of policies and procedures for staff to refer to. We looked at accident reporting and spoke to staff about this. Staff were clear on their responsibilites and how to report and record accidents or incidents. The AQAA was fairly well completed by the manager and gave us most of the information we asked for. However,it didnt highlight what the home could do better or how it had improved or any plans for improvement in a number of outcome areas. We discussed how the manager gives people an opportunity to comment on the service provided. She said they have an annual satisfaction survey for people who use the service and act on an individual basis with people as issues are brought up. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 The administration of creams and ointments must be recorded and clear directions for their use must also be recorded. This will make sure administration is safe. 31/03/2009 2 20 13 Guidelines for the 31/03/2009 administration of as and when required medication must be individual to the person they are prescribed for. This will make sure that practice is safe and needs are not missed or overlooked. 3 24 23 The heating levels in the bedrooms must be monitored to make sure they are comfortable and warm enough for people. 31/03/2009 Care Homes for Adults (18-65 years) Page 29 of 31 4 30 16 Paper towels must be 31/03/2009 provided so that people can dry their hands in a hygienic manner. This will prevent any spread of infection. 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 People who use the service should have detailed care plans and risk management plans, clearly outlining all their support needs. This should also include future aspirations and how people are to be supported to achieve greater independence. This will ensure that they receive person centred support that meets their needs fully. People who use the service should be given more opportunities to develop their skills of independence. This will make sure their needs are more fully met. Handwritten entries on MAR sheets should be checked and countersigned by a second person to make sure the information is correct and people receive the right medication. 2 11 3 20 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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