Inspection on 16/12/08 for Eastbank

This inspection was carried out on 16th December 2008.

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

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

Other inspections for this house

Eastbank 18/12/07

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Eastbank 26 Ledbury Road Hereford Herefordshire HR1 2SY     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: Jean Littler     Date: 1 6 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect 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 34 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 34 Information about the care home Name of care home: Address: Eastbank 26 Ledbury Road Hereford Herefordshire HR1 2SY 01432266177 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Russell Vance James Type of registration: Number of places registered: Mr Russell Vance James care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 6. The registered person may provide care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Learning Disabilites (LD) 6 Date of last inspection Brief description of the care home Eastbank is registered to provide personal care for up to six adults with learning disabilities. The Home is situated in a residential road in Hereford within walking distance of the city centre. The house is four storeys with a garden and comprises of six single bedrooms, staff facilities, a kitchen, laundry, bathrooms, a lounge and a dining room. Information about the Home is available from the provider on request. The weekly fees are currently 367 pounds per week. The residents are expected to pay for personal services such as haircuts and chiropody and personal items such as clothes and some toiletries. They also have to pay for holidays, transport costs and social activities. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 6 Care Homes for Adults (18-65 years) Page 5 of 34 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: We, the Commission, carried out this inspection over four hours. The owner, Mr James, came in to help. We looked around the house and met all the residents. We spoke with three in private. Some records were looked at such as care plans, medication and money. The owner sent information about the Home to the inspector before the visit. Care Homes for Adults (18-65 years) Page 6 of 34 Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Carry out the plans to make the house more homely. Have a system to make sure people are not cold in their bedrooms. Have a system to make sure people always have good quality mattresses and bedding. Staff could be offered further training and enabled to gain the Learning Disability Care Homes for Adults (18-65 years) Page 8 of 34 Qualification. The way the residents are supported with their money can be improved. Develop ways of checking the quality of the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 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 34 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. Prospective residents would be given information about the service and have their needs assessed. They would be enabled to visit the service, and if suitable, move in on a trial basis. Evidence: There is a Statement of Purpose and Service Users Guide. The Guide has been developed into a more accessible format for people with a learning disability since the last inspection. The information is written clearly in plain English with visual prompts. Mr James has issued each person with one of these and a Residency Agreement relevant to his ownership of the Home. There have not been any vacancies for over three years. Mr James has an admissions procedure that lays out how any prospective residents would have their support needs assessed. If judged to be suitable they would be enabled to visit and spend time with the residents and staff. If a place is offered the person would move in on a trial three month period and they, their representatives and the other residents would be Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: consulted before the placement became permanent. Care Homes for Adults (18-65 years) Page 12 of 34 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 can be confident that their needs are being kept under review. They are involved in planning their support and developing their care plans. They are being better supported to make choices about their lives and take reasonable risks as part of living a fulfilling life. Evidence: Mr James has now reviewed each persons support needs and written new care plans. The residents have been consulted about the content. One really enjoyed the process and he has a copy of his plan on his laptop. The plans are person centred in style and include information such as personal history, family religion, preferred routines, leisure choices, assistance needed and relationships. People have been supported to develop personal goals for the year ahead. Risk assessments have been completed for areas such as road crossing and accessing the kitchen. Some areas were identified as needing risk assessments such as night time arrangements for monitoring epilepsy and going into the community alone. Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: Specific behaviour guidance is in place to help staff support people in a consistent manner. Mr James has developed this himself after talking to staff and observing situations. The example seen directed staff to calm the person down verbally and to debrief them afterwards. Staff safety has also been considered, for example making sure they do not get trapped in the office when the person becomes angry. Mr James has not yet involved any of the professionals based at the local Learning Disability Community Team such as the psychologist or speech therapist. He is considering involving a private speech therapist to assess one mans communication needs. Links with the local team should be developed to support the residents and help ensure the team are kept aware of residents needs. Daily records are made in a handover log and in individual care plans for more specific information. The level of recording about support has increased greatly under Mr James management and this helps monitor and protect residents. Incidents and accidents are being recorded and monitored. Care reviews have been held with the residents and the representative they wished to attend. Mr James has arranged for some meetings to be at offices of day services to enable other professionals to attend. This has built on efforts Mr James has made to strengthen communications with staff at the day services people attend. The member of staff spoken with felt that the needs of the residents were well known and staff were working consistently to support them. She felt people were being enabled to be more independent and although one man had found this challenging all are benefiting from the new approach. The residents gave positive feedback about how they are being supported and enabled to make choices. Mr James said he is consulting them about their daily routines and lifestyles. Information is being explained to help people make informed choices, for example one man signed up for a five day a week activity whilst at a seminar when he already had commitments on three days. He is now partaking two days a week and enjoying the new activity. Restrictions the last provider had in place have been lifted such as not taking drinks into the lounge and recently people have become more relaxed about eating meals at times that suit them rather than always having to sit as a large group. This has enabled one man to accept overtime at work when it is offered to him. Choice is being promoted each day and through residents meetings. For example all chose to go on a group holiday despite Mr James encouraging people to try more personalised breaks. It is positive that people are now taking turns to chair the meetings and one is typing the minutes on his laptop. Care Homes for Adults (18-65 years) Page 14 of 34 Care Homes for Adults (18-65 years) Page 15 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a good quality of life and take part in valued activities. They integrate with the local community and are supported to maintain links with their families and friends. They are provided with a balanced diet and they enjoy their mealtimes. Evidence: People have their own front door keys and obviously feel relaxed at home. Unless they are unwell all the residents go out each weekday. They continue to have busy personalised routine and these include day centre sessions, part and fulltime employment and work experience. One man continues to work at a garage and hopes to start an NVQ award. Two men share a newspaper round. One is still enjoying gardening work and helps in a voluntary group that carries out garden maintenance work on graveyards in the area. The people spoken with were positive about their lifestyle and said they can choose how to spend their time. People all go out alone and Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: the location of the home helps them develop these skills, as it is so convenient for town facilities and transport links. Some take part in leisure activities such as swimming and social clubs, and two play for a local football team. Several had invitations to Christmas meals and parties. A car has been provided by Mr James and he drives people to some activities and health appointments. Some people are now spending less money on taxis as they have increased their use of public transport. At home people get involved in daily tasks such as setting the table, drying up and tidying their own bedrooms. People have developed their life skills over the last year, for example one man has achieved a goal and now does his own washing at the weekends. Relationships are supported between family, friends and partners. Mr James said two residents have been to the house of mutual friends for a meal and they plan to return the invitation. Mealtimes are now more flexible, for example, people no longer all get up early at weekends to breakfast together. More are involved in food shopping and food preparation. The meals are prepared fresh by staff on a daily basis. The residents spoken with confirmed that they like the meals and make suggestions for the menu. People are being encouraged to choose their own packed lunch contents. Each persons preferences are known and a record of what people eat is kept. Mr James reported in the AQAA that the service does the following things well. Support and encourage residents to take part in day and evening activities of their choice. Change activities which are not meeting the individuals needs or wishes. Residents no longer have to participate in all group activities but are given opportunity to select activities which they wish to participate in only. Individual activities now include a wider range including activities such as both individual shopping and shopping for he home, attending church, attending social clubs, going to local pubs, going out for meals, attending a wide range of local events and much more. Support for residents to keep in contact with family members. Encourage residents to take pride in their home, rotas are in place for bed changing and washing drying up. Support residents to become more independent by changing their own bed, cleaning their own bedrooms and helping to keep communal areas tidy. Offer residents healthy diets and choice. Meal times are relaxed and a social event. Encouragement of residents to communicate using a method preferable to them. Future plans include. Develop the recording systems. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: Develop the choice making for individuals and the range of activities on offer for residents. Taking into account their limited experience in this area and the consequences of offering too much choice, allowing residents to develop in this area at their own pace. To continue to develop residents pride in their own home and understanding and appreciation of each other including respect for each others wishes, needs, abilities and feelings. Care Homes for Adults (18-65 years) Page 18 of 34 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. Suitable arrangements are in place to meet the health needs of the residents and they receive personal care in the way they prefer. Medication is being safely managed. Evidence: The residents are supported with their personal care needs in different ways, as they all need varying levels of support. The only female resident has the top floor bedroom, which helps provide her with some privacy. People spoken with confirmed that they are able to follow their preferred routines and make choices about who assists them. Mr James reported in the AQAA that the residents are supported in they way they prefer and this information is now included in their care plans. He also said that everyone has a health checklist completed as part of their care plan and they have been offered a health assessment with the practice nurse. Mr James reported that each person has had a well man or well woman check in the last year. He agreed to ensure people are offered a cholesterol test as part of the process. Regular check ups are in place such as dental and chiropody. People are being encouraged to be more physically active. Specialist health care needs are being met Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: through specialist and staff are being trained so they are aware about specific conditions. A resident with epilepsy has an alarm to press for staff assistance at night and he has been offered the opportunity to have a mattress alarm but has declined this at the moment. Mr James agreed to make a record of this and review the decision periodically. A purpose built cabinet has been purchased to store the medication in. The key is held securely. A relatively small amount of medication is held. The records were clear and up to date showing that medication doses had been checked on arrival and given as prescribed. The supplying pharmacy has completed an audit and a returns book is in use. Mr James reported that he has developed the medication policy and has attended accredited medication training in October 2007. Other staff have been provided with brief training on the monitored dose system, had in house instruction and been observed to show they are competent. They should all also attend an accredited course to meet the standard. Mr James should keep peoples ability to manage their own medication, with support, under review as they may be able to become more independent in this area. Care Homes for Adults (18-65 years) Page 20 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents views are listened to and concerns they raise are taken seriously. They feel safe at Home and are being protected from abuse. Evidence: Mr James reported in the AQAA that they have done the following to support people to make complaints and raise concerns. Listen to complaints made by residents and take action. Development of a user friendly system where residents feel that they understand and are able to make a complaint. Held Residents meetings where they are able to talk about concerns. Residents meet and talk to manager and other staff members. Involve family members, whenever possible. Kept records of financial transfers of residents funds. Involvement the residents in the decision making around their funds. Identification of risk situations with residents. Management of incidents to ensure that residents are protected. Mr James said he is consulting with the residents informally when he works regular shifts with them and more formally at care reviews and weekly Residents meetings. Minor concerns have been resolved at meetings such as doors being slammed. People were observed to interact comfortably with Mr James and those spoken with said they can tell him or the staff if they have a complaint or concern. Information about making a complaint is included in the Service Users Guide. The procedure includes information about who to contact with a complaint but the social work team details could be added Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: to this as a local independent agency. No complaints have been received by the service, or by us, since the change of ownership. One person did tell Mr James that he wanted to live somewhere else. Mr James supported him to meet with a social worker. After this process he chose not to pursue the option to move. Mr James has attended safeguarding training provided for managers by the local authority. A protection policy is in place and Mr James is aware of the need to report any protection matters immediately. Adult protection training has been provided for all staff. The worker spoken with confirmed she had attended this and was aware of her duty to report any concerns. No adult protection issues have been reported since the change of ownership. The residents all have regular contact with friends and staff in other places where they could raise concerns. Mr James believes the residents look out for each others welfare and would raise concerns on each others behalf if needed. Care Homes for Adults (18-65 years) Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents live in a clean and comfortable Home that is reasonably well maintained. They have personalised single bedrooms. Evidence: The Home is situated on a busy road in easy walking distance of the city centre. The rooms are spread over four floors. The staff facilities are located in the basement and the communal rooms are on the ground floor. These include the kitchen, laundry, lounge and dining room. The communal areas are large enough and the furnishings and fittings are of good quality and domestic in style. The six single bedrooms are spread between the ground and first floor and one person has an attic room. People have personalised their bedrooms over the years and they are being supported to keep them clean. Mr James has been involving people in decisions, for example one man chose a desk and chair for his room when he purchased a lap top. Mr James plans to offer people the opportunity to decorate their bedrooms in the year ahead and get involved in choosing paint and helping if they wish to. Two of the bedrooms seen were found to be very cold as windows were ajar. If it is the practice to air the rooms in the morning, arrangements should be reviewed as at 6.30pm one man was preparing to bath and he could not reach the open window to Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: shut it. There was still a draught from one window even when shut. Some bedrooms had net curtains that look old and one was ripped. One mans mattress felt like it needs replacing. The mattress was plastic coated but there was no under blanket just a worn cotton sheet. Mr James agreed to check everyones mattresses and review the level of support people are given with bed making. There are no ensuite facilities but there are two bathrooms and a separate toilet. As there is only one female resident one bathroom is used mainly by her. Mr James consulted the residents about changing one bathroom into a shower room but people did not want this to happen. He has therefore agreed to keep it as it is with the shower over the bath but does plan to refurbish the room to make it more homely. The separate mens toilet has already been refurbished. It is positive that the hot taps are now fitted with thermostatic temperature control devices. This has enabled people to bath independently as it has reduced the risk of scalds. The laundry is situated in an area adjoining the kitchen and is only accessible through the kitchen or from an external door. This is obviously not ideal but very little soiled laundry is managed, however, there are proceedures in place to manage infection control. Mr James reported in the AQAA that in the last year he has improved the following. Developed Health and Safety Policy and checks. Fire Safety checks have been completed in line with legislation. Thermostats placed on bathroom taps. A new and effective heating system has been fitted. No dates were given in the AQAA for servicing of equipment, however this appears to be an oversight as the fire records confirmed the system had been serviced during 2008. Care Homes for Adults (18-65 years) Page 24 of 34 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 residents are being supported by a committed group of staff who they like and who are reasonably well trained. The recruitment procedures are helping to protect the residents. Evidence: The residents spoken with said they like all the staff. They were all observed to interact positively with the worker on duty. The team is made up of five part time workers. One worker left in the last year so the residents have had a fairly settled period to get used to the new provider and his wife. Usually only one worker is on duty at any one time to support the residents. This is judged to be sufficient as people are independent in many areas. During the week the shifts are a 3pm start, sleep-in duty and morning shift until 9am. Mr James and a longstanding worker take turns to be on call while the Home is empty in case one of the residents needs to return from their day activity. At the weekends the shifts can be much longer. Mr James has reduced these from over four days i.e. Friday afternoon to Monday morning, to three days. It is positive that a change in staff hours in January will reduce the longest shift to two days. Two staff are now being rostered on duty on occasions. Recent examples included a Western night and a pending Christmas party. Mr James has discovered that where he had thought people may want staff to support them to activities often Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: they prefer to go unaccompanied. The recruitment records for the newest worker were seen. These showed that appropriate checks including a CRB had been carried out before the person started work. The residents are enabled to meet and give their views about applicants. Mr James confirmed that both staff who have started since the change of ownership have completed the Common Induction Standards. Core training has been provided as part of this in food hygiene, adult protection, fire, basic first aid, infection control, record keeping, epilepsy and medication. The medication training is a basic level and an accredited course should be arranged. One of the residents has Autism so it would be helpful for staff if training in this area were provided. Mr James has been helping staff learn Makaton in the quarterly team meetings and has been discussing training during the regular supervision meetings he is having with each worker. He aims to help staff develop professionally through keyworking. One worker has already been helping with the care review meetings. This is positive and should be given priority as residents have not had the benefit of having keyworkers in the past. Three of the team have NVQ awards and it is positive that both new workers are enrolled on an award. These workers have not been supported to gain the Learning Disability Qualification. This is part of the National Minimum Standards for staff working in this sector so Mr James should consider introducing this. The worker spoken with has been in post for five years. She reported that Mr James has been very supportive and is always available for advice if needed. She reported that her role had changed, as the focus was now much more on enabling people to be as independent as possible. She felt that the communication book and handover records were effective in keeping the team informed. Mr James reported that in the last year the following improvements have been made. Developed recruitment policy. Developed Induction and Training for staff members. Completed formal supervision and team meetings. Supported staff to complete training. Improved communication systems for the home. Recruitment of new staff to increase the staffing team. Shortened length of time that staff work alone through reorganisation of the rota pattern. Plans for the year ahead include. To offer further training to staff members. To further review the rota pattern to ensure that staff do not work very long stretches. To develop a staff handbook and further develop human resource policies. Care Homes for Adults (18-65 years) Page 26 of 34 Care Homes for Adults (18-65 years) Page 27 of 34 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 residents are benefiting from a home that is being run in their best interests and promotes their safety and welfare. The management framework is now more robust which will help safeguard their best interests. The provider is aware of the areas that still need further development and he is seeking peoples views as changes are introduced. Evidence: Mr James has worked regularly in the Home since taking over the ownership in July 2007. It is his only care home and he also manages the service. He has relevant experience but has not been a registered manager or provider before. He hold an NVQ 4 in Care and the Registered Managers Award. He now knows the residents well and they seem relaxed and confident in his company. Those spoken with said they liked him and his wife and they could voice their views. The findings of this inspection indicate that Mr James is implementing positive changes in a paced manner. The residents have been involved in decision making where Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: possible. Staff have been supported to accept changes that affect their working practices such as improved record keeping and promoting greater independence. The AQAA was returned on time and contained clear information. The evidence needs to be more detailed in future to better demonstrate the outcomes for residents from the way the service is being operated. The management reported to have been improved in the last year include. The managers qualifications. Health and Safety Policy. Care Reviews. Residents meeting minutes. Risk Assessments completed. Complaints and representations policy User friendly guides to living within the home Areas to develop in the year ahead are. Introduction of a robust Quality monitoring system. Further develop person centred plans for individuals. Further development of policies for the home. Full review of communication systems to ensure that communication opportunities are fully maximised. Further develop roles and responsibilities for staff within the home. Quality assurance processes currently include consulting the residents during the regular meetings, their care reviews and through questionnaires. Mr James is considering developing a questionnaire to get feedback for other stakeholders such as families and social care or health professionals. It is positive that he plans to introduce a robust quality monitoring system, as this is an important part of the process of improving the quality rating for the service. Record keeping has been improved across the board. Staffing records would be more accurate if Mr James records all the hours he is in the home. A sample of residents financial records were seen. Mr James is appointee for the majority of the residents. People only have savings accounts so he has arranged for their benefits to be paid into a central Eastbank account. Their personal allowance cash is then brought into the Home for them to have access to. He confirmed that the account is separate from the business accounts of the Home. Records showed that each persons funds were being carefully recorded and kept up to date. The records for the Christmas fund that people pay into weekly were at Mr James home. All records should be available for inspection, however, this is an institutional practice and people should ideally be supported to save in a personal way that suits them. Mr James has not managed to progress the plans for each resident to have a current account of their own. He reported that the residents are reluctant to get more involved with their finances although some do go to the bank and one has decided to hold his own savings book. This is an area that should be revisited as people do have the capacity to have their own accounts. Perhaps linking with other service users in local Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: services who have their own accounts may help create an interest in this important area of independence. No health and safety hazards were noted during the inspection. Safety policies are now in place along with routine servicing and checking systems. The staff are trained in safety areas. Risk assessments have been developed, although some more are needed. First aid arrangements still need to be improved as staff have not yet become fully qualified by completing the four day course. Care Homes for Adults (18-65 years) Page 30 of 34 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 31 of 34 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 6 19 Residents should be able to have the benefits of a keyworking system. Arrange for people to be offered a cholesterol test and well man or woman checks as part of the health assessment process. All staff who administer medication should attend an accredited training course. Check bedroom windows are well fitting to avoid drafts. Have a system to ensure bedrooms are not cold due to windows being open that people cannot close themselves. Review bed making arrangements, replace worn bedding and mattresses. Have a system in place to check when mattresses need replacing. Carry out plans to refurbish the bath and shower facilities. Consider if staff can be supported to gain the Learning Disability Qualification. Provide staff with training on Autism. Have a qualified first aider on duty each day unless a risk assessment shows that this is not needed. 3 4 20 25 5 25 6 7 8 27 32 35 Care Homes for Adults (18-65 years) Page 32 of 34 9 10 39 41 Implement the plan to set up a robust quality assurance system. Support each person to open a bank account so the institutional financial practices can end. Review the practice of each person paying into a communal saving system held by the provider that they do not gain any interest from. Care Homes for Adults (18-65 years) Page 33 of 34 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. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!