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Inspection on 04/09/08 for Fernhill Lodge Care Home

Also see our care home review for Fernhill Lodge Care Home for more information

This inspection was carried out on 4th September 2008.

CSCI found this care home to be providing an Good 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Fernhill Lodge Care Home 5 Fernhill Road New Milton Hampshire BH25 5JZ 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: Janette Everitt Date: 0 4 0 9 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. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 33 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 33 Information about the care home Name of care home: Address: Fernhill Lodge Care Home 5 Fernhill Road New Milton Hampshire BH25 5JZ 01425622390 01425622390 fernhill.lodge@craegmoor.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Park Care Homes (No 2) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 13 Number of places (if applicable): Under 65 Over 65 13 13 0 0 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following category/ies of service only: Care home only ? (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) Mental disorder, excluding learning disability or dementia (MD) The maximum number of service users to be accommodated is 13. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 33 A bit about the care home Fernhill Lodge is managed by Parkcare Homes No: 2, which is a trading subsidiary of Craegmoor Group Ltd, a national company providing residential and nursing care. The home is located in a residential area on the north side of New Milton, close to local amenities. Fernhill Lodge is registered to provide care and accommodation for 13 male/female residents with a learning disability and a mental disorder. Four of the residents are over the age of 65 years at the time of this visit. Accommodation is provided on two floors. The home does not have a lift and as part of the assessment process the manager ensures that only service users who are mobile are accommodated on the first floor. Care Homes for Adults (18-65 years) Page 5 of 33 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 Care Homes for Adults (18-65 years) Page 6 of 33 How we did our inspection: This is what the inspector did when they were at the care home The site inspection visit to Fernhill Lodge took place on the 4th September 2008. A senior carer and support worker along with residents assisted the inspector throughout the visit. The visit to the home formed part of the process of the inspection of the service to measure the service against the key national minimum standards. The home sent us their Annual Quality Assurance Assessment (AQAA) in August 2008 following a reminder letter to return it. The focus of this visit to the home was to support the information stated in the AQAA and other information received by the CSCI since the last inspection visit of 4th September 2006. A service annual review was undertaken in December 2007, where surveys were distributed to service users, staff, relatives and care managers. The outcome of this review was that the home continued to provide good outcomes for service users and in general there was a high level of satisfaction identified in the surveys returned to CSCI. Documents and records were examined and staff working practices was observed where this was possible. The inspector looked around the home and spoke with most of the residents who were at home Care Homes for Adults (18-65 years) Page 7 of 33 that day. Those spoken to expressed satisfaction about their home and were very satisfied and complimentary about the lives they live and were happy to show us their home. Surveys had been distributed to service users and staff, care managers, GP and other visiting professionals. Six staff surveys were returned to the CSCI and five from service users. The surveys returned from staff indicated that they have good training opportunities, but feel they have lacked support from the previous manager. Some people living in the home returned surveys that were completed with the help of staff; they all said they are Happy living in the home, where they have choices and autonomy over their lives. The fees quoted on the day of this visit as being 520 1065. The fees do not include personal items, outings and holidays. What the care home does well The home looked clean and homely and there was a good reaction between service users and staff. Service users told us they were happy living in the home. One comment from service user said the service has dedicated staff with the knowledge to provide the care that people need Care Homes for Adults (18-65 years) Page 8 of 33 Thorough assessments and information is in place for all service users detailing their needs and wishes. Detailed care plans and risk assessments are put in place and these are in pictorial format so that service users can contribute to the planning of their care. Service users say that they are supported and that their privacy is respected. The service users told us that the food is very good. The menus are well planned and wholesome nutritious meals are served. The communal areas and service users personal rooms are well decorated and their rooms are individualized with their person belongings. The home has a large secure garden surrounding the house which service users use in the better weather. Staff support the service users to voice any concerns and work with them to rectify any issue. What has got better from the last inspection The home has increased staffing levels to meet changing needs of the service users as they get older. A quarterly audit programme is in place to monitor standards. Care Homes for Adults (18-65 years) Page 9 of 33 The home has appointed a new manager for registration who is a qualified learning disability nurse and has many years experience in working with the client base. A staff supervision programme has commenced since the new manager has been in post. What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 10 of 33 If you want to speak to the inspector please contact Janette Everitt 33 Greycoat Street London SW1P 2QF 02079792000 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 11 of 33 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 12 of 33 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 . Service users are assessed prior to their admission to the home to ensure all their needs can be met. Evidence: Pre-admission assessments are undertaken by the manager following a referral from a care manager or family, if the service user has been living at home. A copy of the format of these was found to be comprehensive and covered all potential care needs. We were unable to access the pre-admission assessments for the current service users owing to them being stored in a locked drawer, and to which we could not get access. The support worker accompanying us with the inspection told us that service users are assessed by the manager, this, together with the needs assessment, which is sent to the home from care managers, forms the basis for the care planning process. Service users spoken with and indication from the surveys returned to CSCI say that service users were informed about the home and had the opportunity to visit the home Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: before they moved in. One service user said she was very happy living in the home and that is was much better than the two previous homes she had lived in. Service users do visit the home and stay for short periods before they move in to enable them to be introduced to the environment and other service users. Care Homes for Adults (18-65 years) Page 14 of 33 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 . There are clear and effective care planning and risk assessment systems in place to promote service users independence and provide staff with the information they need to meet service users needs. Service users are enabled to make decisions and the staff provide them with support. Evidence: A sample of three service users care planning documentation was viewed. These demonstrated that risk assessments are undertaken and care plans are put in place to show how care needs would be met and risks managed. The care plans were very detailed in content and person centred and contained a range of information to inform practice. Each resident has a designated key worker who documents in the care plans and reviews them monthly. One of the service users spoken to was aware of who her key worker was and said she was very happy with her. Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: Surveys returned from the service users say: I am happy here all of the time. I go to the staff if I am not happy. My key worker supports me to do what I like. From speaking to the service users and observation of practices in the home, would suggest that the care workers support the residents to undertake various outside interests whilst encouraging indepenance. The care plans document the choices and routines that are preferred by the resident. One resident prefers to stay in bed longer in the morning and this was respected. Service users were observed to be coming and going as they please. One resident being able to go to the local amenities each day on his own. The care plans document that residents are supported to take risks within their daily lives within a risk assessment framework. The home had accessed an advocate for one service user who was in dispute with the family. This was resolved with the residents wishes being respected by the family. Care Homes for Adults (18-65 years) Page 16 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The meals are wholesome and nutritious and service users are given choice in every aspect of their daily living. Service users are supported to take part in a variety of activities to suit their needs and choices. Service users feel they are treated with respect and their autonomy and choices are respected. Evidence: Six of the eight service users were spoken with and we observed the routines and practices throughout the day. There was evidence that service users are well supported to take part in the variety of activities available to them. One service user has a particular interest in jigsaw puzzles Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: and his finished products had been framed and hung on walls around the home. His room was large and gave evidence that he has been supplied with a large table and area to enable him to continue with his hobby. Care plans demonstrated an individual weekly programme of activities for each service user is recorded. They showed what activities the resident have the opportunity of participating in. One gentleman goes to town each day or some days he chooses to go on bus rides. On the day of this visit he informed us that he was going on a bus ride after lunch and became very animated when talking about his forthcoming trip. The support workers told us that he was able to do this independently. Programmes also showed periods of one to one activity with residents. Service users have the opportunity to engage in adult literacy, which is supported by an external visitor fortnightly. The activities room was viewed and this had become an area for storage. The room was large and there was still adequate room for the service users to use it they chose but the support worker told us that they do not use it that often. The support worker told us that there are plans for the rubbish to be disposed of and the room to be re organised and made more available to service users for activities. The home has a vehicle available to them but there are no qualified drivers currently employed. The vehicle is used to take service users out into the community and to the local shops. The support worker said that the carer who was their regular driver would be returning from extended leave imminently and outings would be more available. The surveys returned by staff make comment on the need for transport to be available by having more drivers available to enable those who are less mobile to go on outings. A service user spoken to said she would like to go out on more outings. A service user told us that she enjoys going on the picnics to the local duck pond and this is in walking distance from the home and this outing takes place as much as possible in the better weather as transport is not needed. Observations throughout the day demonstrated that the service users have good relationships with each other and the staff. One service user, due to the nature of his disability is not able to communicate well with others and likes visiting the kitchen frequently throughout the day. This has been identified as a risk and measure put in place to limit the risk. He was observed to interacted well with members of staff and did follow their instructions to ensure his safety and those of other service users. The AQAA stated that the home supports the service users to access the community and maintain contact with family and friends. There was evidence that this does take place but some service users do not have family to visit them.Service users spoken with and the response in the surveys returned to CSCI indicate that service users consider their choices are respected and that they are able to take responsibility for Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: their choices in their daily routines. Meals are taken in two dining rooms and all service users come to the dining table to eat together. On the day of this visit all service users were taking their lunch together, but they do have choice of where they wish to eat. The meal observed was a very social occasion for the service users, at which time they chatted to each other and staff. The kitchen was visited and was clean and well organised. The cook has been in post for some years and is very familiar with service users likes and dislikes. Observation of the lunchtime meal being served demonstrated that the food was well presented and was wholesome and nutritious with a choice given at every meal. The service users said they enjoyed the food and the cook makes cakes most days for their tea. One service user has been assessed as nutritionally at risk, being very underweight. A plan was in place of how this could be managed and regular weights are recorded. These records demonstrated a gradual gain in weight since her admission to the home. Care Homes for Adults (18-65 years) Page 19 of 33 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 . Service users receive personal and healthcare support appropriately. Medication is well managed but needs to be reviewed more regularly to reflect the current medication needs of the service users. Evidence: The AQAA states that all service users health care is monitored regularly with reviews and health checks. Service users spoken with confirmed they have access to healthcare. They are registered with the local GP and are able to attend the surgery if they wish to have consultation with the doctor or the GP will visit the home if requested. Service users have access to the chiropodist, attend the dentist in the community and an optician visits the home. The community learning disability team do support the service users, who will visit the home when requested. The home is accommodating one service user whose mobility is deteriorating and who now needs a wheelchair for transfers. The home has no lifting equipment and the wheelchair does not go down the corridor of one area of the home. He cannot get access to the bathrooms because of the width of the doorway will not allow a Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: wheelchair to pass through. The consequence of this is that he is unable to have the choice of having a bath or shower. This was discussed with the senior carer who told us that this is acknowledged and that at times this is a difficult situation. The home has had occupational therapy input and that currently his care is being reviewed by the multi agency team as to the suitability of the home to meet his needs. The AQAA stated that the home anticipates that service users will deteriorate with age and is planning to provide a more diverse service to include nursing in a purpose built unit in the near future. Service users spoken to and surveys returned from them indicate that they feel well supported with their healthcare needs and general well being. Observations through out the day demonstrated that the staff are very familiar with the service users healthcare needs and were communicating about doctors appointments and general health issues with service users. Care plans also document the healthcare needs and risk assessments were in place in relation to their healthcare. The medication procedures were viewed. There were no service users choosing to selfmedicate their medicines. Risk assessments are in place for all service users to support this decision.The staff have received medication training and certificates were in place to evidence this. Two staff administer the medication at all times to avoid errors. The medication is stored securely in clean well organised cupboards. The medication administration records (MAR) sheets were viewed. These had been recorded appropriately. There were a number of service users medication administration records (MAR) sheets that recorded some medication, that had been prescribed on a regular basis, was only being given as and when needed. Some medication was still being prescribed that had not been needed for some considerable time. The records demonstrated that service users medication needs to be reviewed by the GP and medications prescribed appropriately to avoid unnecessary ordering and delivery. The senior carer told us that the medication ordering is monitored and recorded thoroughly and that the home does not receive medications that is not needed and if they do so, they are returned to the pharmacy. The home has not yet acquired a controlled drugs cupboard that is a requirement of the Misuse of Drugs (Safe Custody) Regulations 1973. A recent change in the law means that all care homes must now keep all Controlled Drugs in a Controlled Drugs cupboard. Although the home was not currently administering controlled drugs, the home must be prepared for those occasions when they may be needed. Care Homes for Adults (18-65 years) Page 21 of 33 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 . Service users have access to a complaints procedure and are confident that they will be listened to. Staff have a good understanding of the protection of vulnerable adults and the reporting process. Evidence: The home has a complaints procedure available to all the service users and is available in graphic format if requested. Service users spoken to and surveys returned say that the service users know who to go to if they have concerns. Most of the surveys indicated that they would go to their key worker or staff if they did have concerns. The comments from the surveys and from service users spoken to say that they are very happy with living in the home. Service user meetings are held regularly and it is at this time that any issues or suggestions about the home are discussed. New chairs have been purchased recently as a result of management listening to the service users suggestions. All complaints are logged with action outcomes recorded. One complaint has been received from a service user regarding the washing machine being out of order. A new machine was acquired promptly. The home has a comment box on the front hallway Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: for service users to make any comments. The AQQA states that service users are encouraged and supported to speak out and have the right to complain and to put their points of view forward. The home encourages the service users to attend the quarterly forum Your Voice, which is a national forum set up by Graegmoor. Meetings are held quarterly at an arranged venue and are attended by representatives locally and nationally, and it is at this forum that service users have a say in the running of the organisation and voice their wishes to the committee. The home has a safeguarding vulnerable adults procedure to follow should there be any allegations or incidences of abuse. Staff spoken to were aware of what constitutes abuse and were knowledgeable about what action they should take should any incident occur. Staff surveys returned demonstrated that staff understood what constitutes abuse and their responsibility to report any incidence immediately to the manager or senior person. Staff training files evidenced that staff have received training on the prevention of vulnerable adults and safeguarding. Care Homes for Adults (18-65 years) Page 23 of 33 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 . Service users live in a warm homely environment that is well maintained, clean and hygienic. Evidence: We looked around the home and visited most bedrooms and communal areas. There are two bathrooms, one with assisted bath aid and one shower room. The house provides a warm, homely atmosphere for the service users to live in. All areas of the home were clean and hygienic and no offensive odours detected. Service users have single rooms decorated to their choice and each having a key, which is documented in line with their care plans. It was evident that service users are supported to personalise their rooms with their belongings and in some cases told us that they had been involved with choosing the colours of the walls. One service user, who was observed to hold her own key, invited us in to see her room and it was obvious that bedrooms are highly personalised and adequately furnished to meet their needs. Comments from surveys say I like the home better now the furniture has been Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: changed.I am happy here all of the time. The home provides various communal areas for the service users to choose to be in. The lounge is large and overlooks a large surrounding garden, which service users enjoy in the finer weather. The garden was in need of some attention. The home has a maintenance man that call every two weeks to undertake any repairs or redecoration. Gloves and aprons were available for staff to use as appropriate. There was evidence in staff training files that staff had received training in infection control. Care Homes for Adults (18-65 years) Page 25 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home has an appropriate staff training programme in place that ensures the service users are protected and that the staff have the skills to meet their needs. Evidence: Observation, speaking to staff and viewing records indicated that the home has a dedicated, effective and well trained staff group in sufficient numbers to meet the current needs of the service users living in the home. At the time of the visit there were three care staff and a cook on duty. Rotas indicated that this is the normal staffing level during the waking hours. The home has one waking and one sleeping staff member on duty at night. The AQAA states that the organisation anticipates that in the coming year they will increase staffing levels and review the skill mix and diversity of the team. The organisation has recruited a new manager, who commenced her role the week of this visit. She has experience with managing a home within the group in another area. At the time of this visit the personnel recruitment files were not available for the senior support worker to produce for inspection as the new manager was away from the area for the day and could not attend the home to make them available. Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: The manager stated in the completed AQAA that all necessary checks such as Criminal Records Bureau and Prevention of Vulnerable Adults are check before employment commenced and robut recruitment procedures were in place. A subsequent phone call to the new manager ensured, that in future all personnel documents will be made available for inspection in her abscence. The home has a training programme in place and the AQQA states that when the current staff have completed their NVQ level 2 training, the numbers will represent 66 of staff that will have achieved the NVQ level 2 and above. There is an induction programme for all new staff which is based on the Skills for Care Induction Standards spread over a six month period, one of these was seen by us but had not been fully completed to date. Training files and records were viewed for three staff members. Certificates evidenced that recent and appropriate training has been provided for staff to undertake. Staff told us in the surveys and speaking to staff at the time of this visit, told us that there are good training opportunities for them with the organisation. An improved programme of staff supervision was a requirement of the previous report. Some staff had subsequently received supervision with the previous manager. Owing to the recent change in management, the senior carers told us that the new manager has staff supervision high on the agenda, which she will address immediately and has commenced a programme of supervision for staff. The new manager did complete the AQAA comprehensively and acknowledged that a programme of yearly appraisals needs to be implemented. The staff surveys returned indicate that the staff have felt unsupported with the previous management and since they have been without a manager they comment they have had full support from the area manager and the manager from another home in the group. Staff spoken with at the time of this visit have high expectations of the new manager to give them support and regular supervision. Care Homes for Adults (18-65 years) Page 27 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home has appointed a new manager who is qualified and experienced to manage a home. The home has an effective quality assurance and monitoring system in place to ensure the home is run in the best interests of the service users. The health and safety of the service users and staff are promoted and protected. Evidence: The organisation has appointed a new manager from a home in the organisation in another geographical area. Having moved from another home she has experience in management and is a qualified learning disability nurse with extensive experience of working with learning disabilities and autism. She has not yet applied for registration. The manager commenced her duties very recently and unfortunately was not available on the day of the visit owing to being at a meeting out of the area and unable to return to the home to assist with the visit. The manager did complete the AQAA and acknowledges that she needs to build new relationships with staff and service users and increase communication through the period of change. Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: The home has a quality assurance system in place that was viewed. Audits for each area of the home in relation to care plans, medication records, administration and finances, housekeeping, kitchen, food and customer satisfaction with a quarterly report written and returned with an overview of the results and identified areas for improvement. A food safety audit was done in June 2008 and this was evidenced. Regulation 26 visit reports are documented by the operational manager who frequently visits the home. Service users views are sought through the one-to-one meetings on a monthly basis where the running of the home and their care needs are discussed. Residents meetings are held regularly where suggestions and issues are discussed, the minutes of these meetings are recorded and were seen by us. The AQAA states that with the quality assurance programme all objectives have been achieved in the last year. The Environmental Health Officer had visited the home in April 2008 and two recommendations were made from this visit, both have been complied with. The fire log was viewed and all records are well maintained and recorded at appropriate intervals, A service user was asked what she would do if the fire alarm sounded and she directed me to the meeting point. A sample of servicing certificates for the fire system, nurse call bell system, gas boilers and bath lift were viewed and seen to be current. Thermostats have been fitted to all hot water taps in the home. Evidence of records for the mandatory health and safety training for staff were evidenced in records. Care Homes for Adults (18-65 years) Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes  No  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 30 of 33 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 Description 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 Description Timescale for action 1 20 12 The registered person must make proper provision for the health and welfare of service users. 31/01/2009 The registered person must ensure that a controlled drugs cupboard, that is a requirement of the Misuse of Drugs (Safe Custody) Regulations 1973. be installed in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 It is recommended that the prescribed medication be reviewed by the doctor regularly to ensure that times and dose of medication is being administered as per doctors instructions. It is recommended that the manager ensures that all records be made available for inspection when she is not in Page 31 of 33 2 34 Care Homes for Adults (18-65 years) the home. Care Homes for Adults (18-65 years) Page 32 of 33 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 © (2008) 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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