Inspection on 05/01/09 for Elisabeth House

This inspection was carried out on 5th 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elisabeth House 08/01/08

Elisabeth House 15/08/07

Elisabeth House 30/08/06

Elisabeth House 17/01/06

Elisabeth House 26/07/05

Elisabeth House 13/01/05

Elisabeth House 01/07/04

Elisabeth House 02/03/04

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 13/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Elisabeth House Rhosweil Weston Rhyn Oswestry Shropshire SY10 7TE     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: Becky Harrison     Date: 0 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 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Elisabeth House Rhosweil Weston Rhyn Oswestry Shropshire SY10 7TE 01691777563 01691680983 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Sonja Eckert-Hopkins Name of registered manager (if applicable) Susan Frances Mary Madden Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 9 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 9 Date of last inspection Brief description of the care home Elisabeth House is registered with the Commission for Social Care Inspection (CSCI) to provide accommodation and personal care for up to nine adults with a learning disability. The home is located in the hamlet of Rhosweil, some 8 miles north of Oswestry in North Shropshire, in a quiet area next to a canal but within easy reach of main roads and the local towns. Elisabeth House was originally converted from a row of four cottages and provides homely accommodation on two floors in 2 double and 5 single bedrooms. A large kitchen/diner and separate lounge and dining room are Care Homes for Adults (18-65 years) Page 4 of 31 care home 9 Over 65 0 9 Brief description of the care home provided. The home has pleasant and well-kept grounds and gardens. People who use the service and their representatives are able to gain some information about this service from the Statement of Purpose and Service User Guide. Inspection reports produced by CSCI can be obtained direct from the provider or are available on our website at www.csci.org.uk The range of fees charged were not stated in the Service User Guide, as required therefore the reader may wish to obtain this information direct from the service provider. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We were at Elisabeth House for 7 hours over 2 days, we did not tell people that we were coming. A range of evidence was used to make judgements about this service to include discussions held with six people who use the service, 3 staff and the manager. We looked at some parts of the home, reviewed the homes quality assurance processes and sampled a number of records to include complaints and protection, staff training, recruitment and health and safety records. Before we did our inspection we asked the manager to complete an Annual Quality Assurance Assessment (AQAA) document for us. The AQAA is a self-assessment and a Care Homes for Adults (18-65 years) Page 6 of 31 dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for them to share with us areas that they believe they are doing well. By law they must complete this and return it to us within a given timescale, which the manager did. Two people who live at the home were case tracked this involves establishing individuals experience of using this service, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked at the outcomes for people living at the home and information to produce this report was gathered from the findings on the day and also by review of information received by CSCI prior to the inspection date. What the care home does well: What has improved since the last inspection? What they could do better: People told us that they have had lots of different staff to support them. One person who lives at the home said Lots of the staff have left and we have new ones, I miss the staff another person said I dont always like new staff as it takes me a long time to get used to them. Managers need to look at how they can retain the staff to provide some stability and consistent care for the people living at Elisabeth House. People told us that they would like to get out more, particularly at weekends. An increase in staffing levels would provide more opportunities for this and would also provide a more individualised service. The manager needs to make sure that new staff employed are suitable to work with the people who live at the home by ensuring all checks are done before they start work. Staff should receive induction training and other training specific to the needs of the Care Homes for Adults (18-65 years) Page 8 of 31 people they support for example learning disability qualification, downs syndrome, mental health and communication to give them a better understanding of the needs of the people they support. Staff need to be provided with more opportunities to attend staff meetings and receive one to one meetings with their manager so that they receive the support they require to do their job. We asked the people who use the service what they thought the home could do better and one person said I would like to go out more often. Another person said The staff cant do any better as everything runs smoothly. Managers acknowledged the need to strive to improve the overall outcomes for the people living at Elisabeth House and appear committed to improvement. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the home is out of date so prospective residents may not be able to make an informed choice about whether they wanted to live at Elisabeth House. Evidence: The home provides prospective residents and their families with some information about the service. Both documents require further information and updating to help people understand the services that Elisabeth House provides, the managerial arrangements, the fee levels and any additional charges should be made available so that people know exactly what fees include. The guide should also be developed in an accessible format so that information is easier for people to understand. None of the people living at Elisabeth House had been admitted since our last inspection. Therefore we did not assess the homes admissions procedure on this occasion. Care Homes for Adults (18-65 years) Page 11 of 31 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. Staff have most of the information they need to support people so that their individual needs are met in a way that they prefer. Evidence: People receive the support they need because staff are working with them to develop new care records. These help staff understand their individual needs and how they wish to be supported. People we spoke with told us that they attend meetings held about them and invite people close to them, as evidenced on the files belonging to the people we case tracked. Person centred plans (PCPs) are also being developed with individuals. These include information about the individual, their likes, dislikes, important people in their life and their goals. We spoke with three staff and they demonstrated a good understanding of peoples needs and how they prefer them to be met. Peoples preferred communication styles are documented in their support plans. More Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: could be done to provide information in a format for people to understand for example menus, activities and the service user guide. The six people we spoke with told us that they could make choices about how they spend their time, their meals and activities and that they now partake in regular residents meetings to share their views and help make decisions. People living at the home are provided with some opportunities to lead the life they want whilst ensuring they can be as safe as possible. Risk assessments were available on the care files we looked at and staff had signed to say that they had read them and know how to support individuals with taking risks. We asked the manager to develop risk assessments further so that staff know exactly what to do when supporting individuals in the community, tasks in the house and how to recognise and support the mental health needs of one person to help avoid them becoming ill again. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Elisabeth House maintain contact with people close to them and are provided with some opportunities for personal development, so that they can lead their life in a chosen way. People are offered a healthy diet and enjoy their meals. Evidence: We spoke with six people about the things they do in the home and in the community. People told us that they attend different day services, that some of them go to a club on Sundays and that they have all enjoyed a holiday to Blackpool or Llandudno. One person said that she goes to church and that many events have been held at the home to include an Abba night, cheese and wine evening, Christmas party and Halloween night. We saw lots of photographs of these events which were also enjoyed by family and friends. Some of the people we spoke with said that they would like to go out more, particularly at weekends. When we visited we noticed that most people were in Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: their night clothes before 7 pm as there were no planned activities. Staff felt that opportunities for activities has improved but that an increase in staffing levels would provide people with a more active lifestyle. People are supported to maintain relationships that are important to them through regular visits, telephone calls and the day services that they attend. One person told us that she enjoys visiting a neighbour, who she is good friends with. Another person said that she spends the day with her sister every week. Peoples preferences in relation to choices, routines, likes and dislikes are documented so staff are aware of these. Staff are working with individuals to develop a person centred plan and these will include information that is important to individuals, their goals and aspirations so that they can lead their life in a way they want and maximise their potential. People told us that they help out with domestic tasks such as keeping their rooms tidy, emptying the dishwasher, dusting and polishing. People told us that they can choose when to go to bed and that on new years eve they were asked if they wanted to stay up and celebrate bringing in the new year. Discussions indicate routines are flexible and observations made evidence that people have access to all areas of the home and can choose when to spend time on their own or in the company of others. The home has a menu in place, which has been developed with the people who live at the home. It would be good if this could be produced in a pictorial format to assist people who have limited communication skills with choice and menu planning. Records indicate people are involved in basic meal preparation and that their dietary needs are catered for. When we visited the home of an evening we saw people being offered a cooked meal or choice of sandwiches, which were well presented. The dining table was nicely laid and the meal was a social occasion with people chatting about what they had done during the day. One person said The food is very good here, I go shopping and help with cooking and baking. Another person said The food here is lovely and Ive also been out today to the Poachers Pocket for a meal with the staff. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs, which are monitored and regularly reviewed ensuring their needs are met. Evidence: We looked at the care records held on behalf of two people and these stated how staff are to support individuals with their personal and healthcare needs to ensure their needs are met. Staff were prompt to offer personal care to individuals as needed and were seen to uphold the dignity of individuals supported. On both days that we visited the home people looked well presented and discussions held with a number of people evidence that they choose the clothes they wish to wear. One person said The staff are very good to us and look after us well. Evidence of a variety of health appointments and outcomes were clearly recorded on the care records seen and any concerns regarding a persons health and wellbeing are referred to the appropriate health professionals. Staff are currently working with people to develop an individualised plan about what the person should do in order to stay healthy. We advised the manager to further develop the care documentation for Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: an individual who has experienced some mental health difficulties; this will ensure staff know how to monitor the person and what to do in the event of a relapse. People who are prescribed medication are supported by staff who receive training to ensure they are competent to administer medication. The deputy manager is responsible for ensuring the procedure for the receipt, storage and administration of medication is implemented and staff have received training procedures are followed. People receive regular medication reviews to ensure they are on the correct medication and dosage required to maintain their health. The home has developed a procedure for when a person requires specific medication, as required (PRN). We advised the manager to make sure the procedure is individualised so that staff know when they should administer the medication, ensuring they are consistent in their practice and in peoples best interests. Since our last inspection there have been two occasions when four people did not have their prescribed medication. On one occasion medication had been signed for and not given. We discussed this with the managers and looked at the action taken by the home to prevent a reoccurrence. We were satisfied with the action taken by the home. Managers have developed assessments for staff to undertake to ensure they are competent to give people their medication, as required by our last inspection. People we spoke with said they were happy with how their medication is managed. Care Homes for Adults (18-65 years) Page 18 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. If people have concerns with their care, they or people close to them, know how to complain. Their concern would be looked into and action taken to put things right. The service safeguards people from abuse by ensuring staff are trained in adult protection so that they know what to do in the event of an allegation. Evidence: The home has a complaints procedure in place, which has been developed in an easy read version so that its easier for people to understand. All six people we spoke with had an understanding of what to do if they were unhappy with the care that they receive. One person said Id speak with Sue the manager or Sonja, the owner. We saw that the complaints procedure had also been discussed with people at a recent residents meeting held. We have not received any formal complaints about Elisabeth House since our last inspection but have received three concerns. Two were about the home intending to withdraw waking night staff, the risk that this action may pose on the people living at the home and issues regarding the conduct of the manager. We asked the provider to look into this, which they did and this has since been resolved and waking night cover continues to be in place. We spoke with three staff and six people who use the service and discussions held with them indicated they have no concerns with how the home is managed. Another concern that we received was about how the home managed some issues in relation to one person as they were unable to Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: meet the persons needs. We discussed this with the manager during our inspection and is was considered this was a communication breakdown between people supporting the person concerned however no further concerns have since been raised. The home has received a number of compliments since we last visited the home and these include: I always get a warm welcome and a nice cuppa. All the staff are friendly and very welcoming Great atmosphere and lovely to see the residents and staff having a lovely time Staff have access to information to follow and seven staff have received training in safeguarding so that they know how to recognise signs of abuse and report this so that the people living at the home can be safe. One member of staff told us that she would not hesitate to whistle blow if she observed any poor practice but that she had no worries at all. Eight staff have also received training in the management of actual or potential aggression, this helps them understand how to support people whose behaviours may challenge the service. We looked at how the home supports the two people we case tracked to manage their money and are satisfied with how this is done. People we spoke with told us that they are happy with how they are supported with their money. One person said My sister helps me with my money, I have my own bank account and I go with to the bank regularly to get my money. Both the manager and deputy manager have attended training in the Mental Capacity Act and Deprivation of Liberty so that they understand how this legislation could affect people living at the home and the need to assess a persons capacity if there is any doubt they may not have the capacity to make a decision. Care Homes for Adults (18-65 years) Page 20 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. People living at Elisabeth House are provided with a clean, safe and well decorated home that meets their needs. Evidence: All six people we spoke with told us that they like living at Elisabeth House. One person said I like it very much here and have lived here for a very long time. Another person said, I am happy living here, there is nothing I dislike. We had a look around the home and all areas were very clean, well maintained and decorated to a good standard. One person told us that the location of the home could sometimes be isolating because it is not within walking distance of the town. People are provided with a range of spaces to share with others to include a large kitchen and dining area, a dining room and a lounge. The flooring in the lounge and dining room have been replaced since we last visited and the bath and shower rooms have been redecorated to provide people with fresh and comfortable areas to bath or shower. People told us that they are happy with their bedrooms, some of these have been redecorated with people choosing their own colour schemes and soft furnishings. The home provides one bedroom on the ground floor, which is for one person who has difficulties with their mobility and four bedrooms are located on the first floor. Some Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: people have to share their room with others but discussions held with three of the four people evidence that they are happy to share their room. One person was unable to tell us if he was happy with this because of his limited communication needs but we were told he has shared his room for a long time and gets on well with the person he shares with. People have been supported to personalise their own space with pictures, photographs, ornaments, their own electrical equipment such as televisions and music systems. The rooms of the people we case tracked were furnished appropriate to their needs and they told us that they like their bedrooms. Care Homes for Adults (18-65 years) Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff work positively with the people they care for but should be provided with training to support their skills and knowledge about the individual needs of the people living at the home. Not all recruitment checks have been undertaken to check if new staff employed are suitable to work with the people living at the home, potential placing them at risk of harm. Evidence: Discussions with six people who use the service evidence that staff treat them well and that they are happy with the care and support they receive. One person said We always have a good time with the staff, they are good to us. Another person said I like the staff, they are nice. We observed staff working well with the people they support and discussions with them indicated they have an understanding of the needs of the people they support. We were told that seven staff have obtained a care qualification known as NVQ at level 2 and above and one person is a nurse, this exceeds the National Minimum Standards. The rota told us that the current staffing ratio is two members of staff to nine people in Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: addition to the manager. Discussions with people who use the service and staff indicate that an increase in staffing levels, particularly over the weekend, would provide opportunities to offer people living at the home a more individualised service. The home currently has three staff vacancies and permanent staff are covering these hours until the posts are filled. There has been a high turnover of staff since our last inspection. One person who lives at the home said Lots of the staff have left and we have new ones, I miss the staff another person said I dont always like new staff as it takes me a long time to get used to them. Managers need to look at how they can retain the staff to provide some stability and consistent care. Discussions held and records seen indicate that there has been some conflict in the team over recent months but people considered that has not impacted on people who use the service and that morale has improved. One person said Morale is a lot better and I now feel relaxed about coming to work. I feel more positive about my job and get the support I need from my manager, everyone is brilliant. Another member of staff said The staff are reliable, morale is brilliant, there are no issues with the staff now and we get on well. We looked at the files of five staff employed since our last inspection to make sure that checks are undertaken so staff are suitable to work with vulnerable adults. The files were generally well presented and evidenced that a Criminal Records Bureau check and PoVA check had been undertaken. All files contained references however not all of these were written references and some references had not been obtained from the applicants previous employer as required. None of the files contained a photograph of the staff member. The manager fully acknowledged the shortfalls and our concerns about the homes recruitment procedures and committed to improve these to ensure that people who use the service can have confidence that staff are suitable to work with them. Since our last visit to the home the manager has developed a training matrix, which identifies the type of training and date that staff have undertaken this. This helps the manager to identify any gaps in training. We looked at the matrix, certificates of training completed and also spoke with staff about the training that they have received. Records seen and discussions held evidence that people receive the necessary mandatory training such as fire, food hygiene, moving and handling, infection control, medication so that people are kept safe. Three staff have also done dementia care. A training plan identified staff training needs and these cover autism, learning disability, dementia, learning disability qualification (LDQ) and record keeping. Although there was evidence that staff have received in-house induction new staff need to complete the LDQ as part of their induction to demonstrate that they have met the requirements of the Common Inductions Standards. This will provide them with the skills and knowledge to undertake their role and effectively support the needs of the Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: people living at the home. We saw evidence that staff receive formal supervision and that staff meetings are in place but not at the required frequency. Given the turnover of staff and recent conflict within the team it is important that staff receive dedicated time so that they feel supported, understand their role, identity training needs and have the opportunity to discuss any changing needs of the people they support. This was identified in the AQAA as an area requiring improvement. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has an understanding of the areas in which the service needs to improve in the best interests of the people living at Elisabeth House. Evidence: The manager has a number of years experience in working in the care sector and is now registered with us. The manager has NVQ at level 4 in Care and has attended courses appropriate to her role and has started the Leadership and Management for Care Services Award. Completion of this award will equip her with the qualifications required of a registered manager. Since the last inspection a deputy manager has been employed to assist the manager with her role. Both the manager and deputy assisted with the inspection and discussions with them indicate that they are aware of what is required to improve the service in the best interests of people living at the home. People told us that they like the manager and are happy with the how the home is managed. One person stated The home is managed quite well, the manager is approachable and good at her job Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: People told us that they now have meetings to share ideas around activities, meals and events, which is good because it allows their views and things important to them to be listened to and acted upon. There is also a need to obtain the views of others such as staff, relatives and stakeholders through satisfaction surveys and develop an overall report based on the findings. This will help assess how the service is currently performing, evaluate outcomes for people and aid future planning. Although the provider visits the home on a regular basis she needs to do a report of her findings, which will assist with the how the home is performing. People said that they feel safe living at Elisabeth House. We looked at a variety of health and safety records and the checks that staff do to prevent people from being placed at risk of harm. We found that checks are undertaken at the required frequency to ensure that the equipment is safe and in full working order although we advised that emergency lighting be tested at least monthly. Water temperature checks are recorded which assists in the prevention of people accidentally scalding themselves. Service certificates were available and found to be satisfactory. The manager reported that window restrictors have been sourced and will be fitted shortly to all first floor windows, as we have previously expressed concerns regarding the potential risk to people. Staff have received training in safe working practices for example food hygiene, fire, infection control and moving and handling which helps to keep people safe. The fire officer has recently inspected the homes fire safety arrangements and has asked for some work to be done on the fire risk assessment and policy, which has yet to be completed. Since our last visit the provider has commissioned an independent organisation to ensure the home has the necessary paperwork in place concerning health and safety and all staff have now been issued with an employee safety handbook. The organisation also carried out a health and safety inspection in November 2008 and no significant shortfalls were identified. The Environmental Health Officer has also visited the home to review food safety procedures and the home has done the minor thing that they were asked to do. 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 34 19 All pre-recruitment checks must be undertaken on new employees before they commence direct work. This will ensure people living at Elisabeth House are protected by the homes recruitment policy and practice. 01/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose and Service User Guide should be updated to make sure it contains the information required so people know about what the service provides, the management arrangements and details about the fees and what they cover. The guide should be developed in a format that is easy for people to understand. Greater opportunities should be provided for people to be supported to take part in valued and fulfilling activities of an evening and weekend that meet their needs Staffing levels should be reviewed to ensure staffing is appropriate to the needs of the people using the service Page 29 of 31 2 14 3 33 Care Homes for Adults (18-65 years) and provides them with opportunities to lead the lifestyles they choose. 4 35 Staff should receive training specific to the needs of the people they support for example downs syndrome, mental health, communication, ageing to give them a better understanding of the needs of the people they support. New staff should complete the LDQ as part of their induction to demonstrate that they have met the requirements of the Common Inductions Standards. This will provide them with the skills and knowledge to undertake their role. Staff should receive a minimum of six supervisions and attend regular staff meetings so that they receive the support they require to do their job. Quality assurance systems based on seeking the views of people living at the home, their relatives, staff and stakeholders should be implemented and reports as required under Regulation 26 undertaken to assess how the service is currently performing, evaluate outcomes for people and aid future planning. Recommendations made by the fire officer should be complied with at the earliest opportunity to ensure people are not placed at risk of harm in the event of a fire. A falls risk assessment should be completed for the person who has been prone to recent falls to ensure they receive the appropriate support and monitoring. 5 35 6 36 7 39 8 42 9 42 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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