Inspection on 11/11/08 for Francis House

This inspection was carried out on 11th November 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Francis House 22/01/07

Francis House 26/01/06

Francis House 16/11/05

Francis House 11/03/05

Francis House 02/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Francis House Cofield Road Boldmere Sutton Coldfield West Midlands B73 5SD     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: Kerry Coulter     Date: 1 1 1 1 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 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: Francis House Cofield Road Boldmere Sutton Coldfield West Midlands B73 5SD 01213547772 01213547772 kate@lisieuxtrust.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Lisieux Trust care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The establishment may provide personal care to residents under the age of 65 years. The home may provide care for 9 service users with learning disabilities. Date of last inspection Brief description of the care home Francis House is a purpose built modern property in the style of a large residential dwelling and is owned by the Lisieux Trust, a local voluntary organisation. The home is registered to provide accommodation and support for nine people with learning disabilities. All nine single bedrooms are situated on the first floor of the house, as is the Managers office. The home is furnished and maintained to a high standard and residents have helped in choosing how both their individual rooms and shared areas have been decorated. Downstairs is a comfortable lounge, with an additional room next to it that is used for a range of activities. The kitchen is roomy and open plan, and includes the main dining area. There is no lift facility within the home, so it would not be suitable for people with significant mobility problems. There is an attractive private and enclosed garden to the rear of the property, with a patio and seating area. The house is situated close to Boldmere village, and offers easy access to local amenities Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 9 Brief description of the care home including shops, pubs, restaurants, and Sutton town centre is a short drive away. The area is well served by public transport. There is sufficient off road parking at the front of the house for five cars, including the services own vehicle. Information regarding fees was included in the statement of purpose for the home but the manger told us fees had since increased. Therefore the reader is advised to contact the home for information about the current levels of fees charged. Copies of our inspection reports are available for people to read in the home, on request. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out over one day, the home did not know we were going to visit. This was the homes key inspection for the inspection year 2008 to 2009. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and the Annual Quality Assurance Assessment (AQAA) completed by the manager. This provides information about the home and how Care Homes for Adults (18-65 years) Page 6 of 31 they think it meets the needs of the people living there. We also received surveys from five people who live at the home. Two of the people living in the home were case tracked. This involves establishing individuals experience of living in the care home by meeting or observing them, 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 parts of the home, and a sample of care, staff and health and safety records were looked at. All of the people living there were spoken to and asked their views on living in the home. The manager and staff on duty at the time were spoken with. We also spoke with two health care professionals and some of their comments are included in this report. What the care home does well: What has improved since the last inspection? The home has implemented a feedback sheet for people so they can comment on the admission process. Each person now has their own move on programme so that people are supported to develop new skills. A new format for health action planning has been introduced to help ensure peoples health neeeds are well planned for. Staff have received training about dementia so they know how to meet the needs of Care Homes for Adults (18-65 years) Page 8 of 31 people who have dementia. Reports are available to show that the home is visited regularly by the providers representative to make sure it is being well managed. The fire alarms are now tested regularly to make sure they are working and people are alerted quickly should a fire ocurr. What they could do better: 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information is available to help people make a decision about whether or not to use this service. Peoples support needs are properly assessed, so that they know the home is able to meet their needs. Evidence: The statement of purpose of the home was dated June 2005. This included the relevant and required information such as fees so that it was clear what the home provides. The manager said that fees had been increased since. It is recommended that this document is reviewed annually to ensure all the information is up to date. It is good that there is a DVD available about the home, this enables people who are thinking of moving there to see what it is like. Discussion with the manager shows that no new people have moved into the home for four years. The home currently has no vacancies. Admission procedures were included in the statement of purpose. These indicated that before any new person moves into the home an assessment would be completed of their needs to ensure that the home is Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: able to meet these and support the person to achieve their goals. The homes annual quality assurance assessment recorded that they have implemented a feedback sheet for people so they can comment on the admission process. Surveys from people who live at the home show they were asked if they wanted to move there and were given enough information about the home. 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. Arrangements are in place so that staff have most of the information they need to support people to meet their needs safely and enable them to make choices about their day- to -day lives. Evidence: The care provided to two people who live at the home was case tracked. Each person had a care plan that was centred on the person and was up to date. Care plans covered areas such as health, eating, personal care, communication, mobility and social needs. In addition to required reviews, a system is in place where individuals key workers complete a monthly review sheet. These cover all their support needs and seek to ensure that issues are monitored frequently and regularly, so as to keep plans current and up to date. Care plans detailed peoples wishes and goals for the future, for example one person wanted to improve their travel skills and also to attend a Christmas show. Records Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: were kept of progress made towards achieving their goals. Due to one persons change in mobility needs they are having to spend all their time in their bedroom as they cannot use the stairs. The home recognizes that the person needs to move to another home that has the facilities to meet this persons needs. Records show that health professionals and the social worker have been involved in assessing this person and it is intended that they will be moving to another more suitable home soon. People are fully supported to make decisions about their lives. It is good that regular care reviews are held, records sampled showed that the person is fully involved in their review. During the course of the visit, members of the care team were directly observed offering people choices about what they wanted to do, supporting them to make decisions appropriately, and encouraging them to do things for themselves, so as to promote personal independence. Meetings are held monthly with people who live at the home so they can have a say on how it is run. It is good that these meetings are chaired by a volunteer, this means that people can be more confident in raising things they want to talk about. It is good that people who live at the home were helped to fill in our survey by a student social worker rather than a staff member. This shows that the home wants people to feel confident about sharing their views of the home. Liseux Trust has also recently set up a steering group to represent people who live across its homes. Elections were held for people to be on the group. The manager told us that no one at Francis House had wanted to stand for election but that the group was there for them to use. The group meets four times a year to discuss any points raised by people and puts any issues forward to the Liseausx Trust board. Conversations with the manager indicate a positive attitude to supporting people to take risks responsibly, and that this is seen in the context of providing opportunities for learning and personal growth. Risk assessments had been completed for areas such as road safety, money, self medication, bathing, accessing the community without staff support, pressure care and using the hoist. One person at the home has recently had a bed with rails fitted to help prevent them falling out. A risk assessment had been completed for their use but this needed improvement. The rails had not been fitted with covers and the assessment did not assess the risks of this. Shortly after the key inspection the manager sent evidence that this had now been assessed and covers for the rails had been ordered. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home enjoy opportunities to take part in valued activities and to be part of the local community. People who live at the home enjoy their food. Evidence: People living at Francis House enjoy a wide range of opportunities for social, education and leisure activities. The home places importance on people being able to develop skills and each person has their own move on programme. This records peoples progress in areas such as money, travel and cooking skills. A noticeboard in the home has information for people about what is on offer in the local area. Several people attend local centres and colleges for structured activities during the day. The home is well placed for accessing local amenities and people make full use of these, in groups and individually, with support as required. Records and Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: discussions with people show that they regularly take part in activities such as food shopping, meals out, library, cooking, keyboard lessons and in house activities such as jigsaws. One person attends a work experience placement where they help to serve drinks to older people at a local centre. One person who lives at the home told us do not get bored, I do things, I go out during the day and the evening. One person at the home has been unwell and has had to spend their time in their bedroom. We saw that staff spent quality time with the person to reduce the risk of them becoming socially isolated. Staff told us that they also encourage people who live at the home to spend time chatting with them. The manager advised that most peoples relatives have well established links with the home, and the majority regularly spend time visiting their families and staying for weekends. One person told us that their mother was visiting the home and that they would be doing some cooking together in the kitchen. Records showed that contact with peoples friends is also encouraged, for example one person has visits from a friend who lives in another care home. We saw at breakfast time that people are encouraged to help themselves to food in the kitchen and prepare their own breakfasts. People looked at home in the kitchen and this was obviously part of their normal routine. We saw that people were involved in planning the menu and completing food shopping lists, it was good that each person was supported to write their own list of foods they wanted. Some people went out with staff later in the day to do the food shopping.People who live at the home told us meals are good and food is nice. The record of meals taken showed that people have access to a diet that is sufficiently balanced, varied and nutritious. Food stocks were plentiful and included fresh produce. One person at the home has to have food that is of a softer texture due to a risk of choking. We saw that their evening meal was of a consistency as recommended by the speech and language therapist. 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 needs of the people living there are met so ensuring their well being. Evidence: We saw that interactions between people and staff were warm and friendly, and that both are clearly at ease in each others company. It is quite clear that people have a good rapport with staff and are comfortable approaching them with any issues, and this was directly observed throughout the inspection visit. Staff were also seen to be appropriately respectful. Most people are fairly independent with their personal grooming skills, although some do need verbal prompting and one person needs a high level of support from staff. Peoples personal grooming and attire was individual in style and provided evidence that they receive a good standard of basic personal care. We looked at the health records for two people and discussed peoples healthcare needs with staff and the manager. Records show that people are assisted to access Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: primary and specialist healthcare support (including GP, dentist, optician, chiropodist), in accordance with their needs. One person has had a significant change to their needs and records showed that the home had sought input from health professionals to include the community nurse, speech and language therapist, occupational therapist, physiotherapist and district nurse. Their records show that they have had some sore areas of skin (pressure sores) and risk assessments and care plans had been put in place for this, these had been regularly updated as the persons needs changed. The home had kept turning charts when the person was restricted to being in bed but now that the person was spending time in a chair during the day staff had stopped this. During our visit we did see that the person was being repositioned in line with their plan. As this person still has some sore skin it is recommend that re-positioning records are kept so that staff can be sure and the home can evidence that care is always provided in line with the care plan. Whilst staff have yet to receive training regarding pressure care they told us they had received lots of information and advice and from the district nurses. Staff spoken with showed satisfactory knowledge regarding pressure care, re how to reduce the risk of sores occurring and how to prevent them becoming worse should they occur. District nurses were providing support to the home regarding pressure care. We spoke with one district nurse who told us that there were no concerns about the care the home was providing and that the sore areas were getting better and that staff were following instructions. We spoke with another health professional who told us that the staff have done everything asked of them and always get the district nurse to visit if there are any concerns regarding pressure care. They said home has done fantastic job given the circumstances. We looked at the homes system for administering medication. Medication was stored securely. Training records showed that staff who administer medication have received training to do so. It is good that where people are able they are given the opportunity to administer their own medication and this is supported by a risk assessment to make sure they are safe to do so. Since the last inspection the home notified us of two medication errors. Discussion with the manager indicates that following the errors appropriate action was taken to ensure people were not at risk of ill health. Action was also taken to reduce the risk of errors happening again. This included a discussion with staff about the errors and safe procedures that should be followed as part of a staff meeting. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: We looked at some of the medication administration records. It was good that photographs of people were kept with their records, this ensures that any staff new to the home will not get confused about who the person is. Medication administration records had generally been well completed. We saw that there was one gap on one persons chart where their medication had not been given, however it had not been recorded why. The manager thought this was because they were not at home when the medication was due. Discussion with the manager indicates that the home does not have an internal auditing system for medication. An internal auditing system should be introduced so that small errors like this are picked up and action can be taken to rectify them. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place to ensure that the views of the people living in the home are listened to and acted on and people are safeguarded from abuse. Evidence: The home has a satisfactory complaints procedure and this is on display in the home. There is also a system whereby people have postcards they can send to alert the organisation to the fact that there is a problem, which can then be followed up independently. As recorded earlier in this report, efforts are also made to consult with people through independently facilitated group meetings. Surveys from people who live at the home show that they know how to make a complaint. We have not received any complaints about this home in the last twelve months. The complaint log book showed that the home had received one complaint from someone who lives at the home. This was about the behaviour of someone they lived with. Information showed that their complaint had been listened to and action taken to resolve it. The log did not record the date the complaint had been received, the manager needs to make sure this is done so that complaints can be effectively tracked. Training records and discussions with staff show that all but two of the staff have received training on safeguarding adults from abuse. Staff told us that refresher Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: training is booked soon so that all staff will have done this. One staff told us that they would feel confident in raising any concerns they had with the manager. Records relating to peoples personal money was sample checked. The amounts held matched their record, and receipts were available to support records of purchases made. Financial risk assessments were in place on sampled files. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy living in accommodation that is homely, comfortable and welcoming. Evidence: We looked at all of the communal areas of the home and three bedrooms. As indicated in previous inspection reports, the standards of furnishing and decoration are good. Discussion with the manager indicates that new carpets were being installed in some communal areas the following week. The home has ample communal space for the number of people living at the home, this includes a large kitchen diner, lounge and activity room. With the exception of the activity room all areas of the home were warm and of a comfortable temperature. The activity room, which is an extension to the home was a little cold but was not being used by people during our visit. Everyone has their own bedroom and these were personalised with peoples own things and reflected their age, culture and gender. Two people we spoke with were generally happy with their rooms. As stated earlier in this report one person has had to spend their time in their bedroom. The manager had recently arranged for the person to have what was the homes office as their bedroom as it was much larger in size than their previous bedroom. This has meant the person has more space for their bed, hoist and armchair and staff can assist them to move more easily. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: The home has two shower rooms and a bathroom. One shower is a walk in type that is suitable for people with mobility difficulties. During our visit one person who lives at the home told us that they were having problems with the hot water to their sink. Staff told us that there had been problems with the water but that the manager was sorting it out. We tested the hot water temperature at the bath and found that the water was cold. Water temperature records indicated that this had been a problem for the last couple of weeks. The manager told us that she had spoken with the Representative of the landlord and had been waiting for them to provide contact details of a plumber. The manager said that she would speak to them again and contact a plumber herself if they did not have the details. Most people who live at the home do not have any mobility difficulties. One person over the last year has developed mobility difficulties and we saw that some adaptations have been made to the home to include installation of grab rails in the shower room. A stair lift had also previously been fitted although the manager advised that it was now assessed as being unsuitable for the person to use. Staff told us that they had all the equipment they needed for this person and we saw they had a hoist, pressure care mattress and special armchair. The home is kept clean and tidy, and good standards of hygiene were seen to be maintained throughout. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are generally sufficient to ensure that an effective, competent and supervised staff team who can meet individuals needs support them. The people living there are protected by the homes recruitment practices. Evidence: Training records and discussion with the manager indicates that all of the care team have the appropriate National Vocational Qualifications, so ensuring that care staff have the skills and knowledge to meet the needs of the people living there. Staff spoken with showed they had good knowledge of the needs of people who lived at the home. Many staff have worked at the home for several years so that the people who live there know them well. Surveys from people who live at the home indicate that they are usually treated well by staff and listened to. Discussions with the manager and sampling of the staff rota show that during the day Monday to Friday there are usually three staff on duty and two at weekends. At night there is one staff who sleeps in. There was one occasion on the rota that for one hour during the day there had been only one staff on duty. In recent months the needs of one person at the home have increased and they need Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: the support of two staff with personal care and when being transferred from bed to chair and vice versa. It is not clear that there are always enough staff on duty to meet the needs of people at the home. The manager said that extra funding had been requested from social services to provide extra staffing but as yet this had not been provided. The records of two of the staff that work there were looked at. These included the required information including evidence that a satisfactory Criminal Records Bureau (CRB) check had been completed. This ensures that suitable people are employed to work with the people living there. Staff said that they had an induction when they first started working at the home so they knew how to support the people living there. Staff records sampled showed and staff said that they receive the training they need so they know how to meet the needs of the people living there and keep them safe. Most staff have recently received training in dementia care as one person at the home has been diagnosed as having this. As stated earlier in this report staff told us they had received some information from district nurses about pressure care. Records show that staff meetings and supervision are regular so that staff receive the support they need. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that the home is run in the best interests of the people living there. Evidence: The manager is qualified to NVQ level 4 and has now been in post for a number of years. Training records show that the manager undertakes regular training to keep herself up to date with good practice. Her management style is open and inclusive. We received the homes annual quality assurance assessment when we asked for it and this provided generally accurate information on the service provided. One staff told us manager always has an open door, respects confidentiality, we trust her. One person who lives at the home said manager is nice. Reports were available to show that a representative of the provider visits the home monthly to make sure it is being well run. Reports of these visits showed that they include consultation with people who live there and staff. As indicated earlier in this Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: report, the views of people are also actively sought through regular meetings and key worker reviews. Satisfaction questionnaires are also sent on an annual basis to relatives, professionals, staff and people at the home. The results of the surveys are then collated into one report to show how people think the home is performing. Safety records were sample checked. A health and safety audit had been completed in August and no concerns had been identified. The gas safety certificate and the electrical hard wiring certificate were both in date and showed that appliances were safe. Staff test the water temperatures regularly to make sure they are not too hot and people are not at risk of being scalded. Fire records showed that staff had training in fire safety in October, it is good that people who live at the home had also been able to attend the training. Records show that regular fire drills take place. This helps staff and people at the home know what to do if a fire happens. Records showed that an engineer regularly services the fire equipment so that it is well maintained and would work when needed. Staff also test the equipment regularly to make sure it is working. One person at the home has hearing difficulties, a flashing light is installed in their bedroom and linked to the fire alarm system. This helps to alert them if the alarms sound. One person at the home who is not able to access the stairs would need assistance from staff to evacuate the home in a fire. As stated earlier in this report there is only one staff on duty at night and so it is not clear how staff would be able to do this safely. The manager has recognised this as a risk and has written to social services raising this as a concern. Staff spoken with said previous practice would have been to make sure this person was safe behind a fire door and evacuate other people from the home and await assistance from the fire service in evacuating the other person. However, the manager said they had recently been advised by a fire officer that they needed to be able to evacuate everyone and not rely on the fire service. Staff told us that an evacuation sledge had recently been purchased for this but had still to be risk assessed. Discussion with the manager indicates that an evacuation plan had not been completed for the person with mobility difficulties. Review of the fire procedures needs to be completed to ensure staff have clear information about how to keep people safe. Following the key inspection the manager sent us information to show that fire procedures had been reviewed. 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 9 13 Risk assessments need to fully assess areas of risk to people. This will help to ensure that satisfactory control measure are in place to reduce the risk of people being harmed. 29/12/2008 2 33 18 The home must make sure there are enough staff on duty at all times to meet peoples needs. This will help ensure people receive the support they need in the way they prefer it. 24/12/2008 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 for the home should be reviewed annually to make sure it is up to date and people have current information about the home. The home should introduce re-positioning charts for people who have sore skin so that staff can be sure and the home Page 29 of 31 2 19 Care Homes for Adults (18-65 years) can evidence that care is always provided in line with the care plan. 3 20 Medication assessments should be introduced for staff so that people can be assured that staff are competent to administer medication, so they receive their medication safely. Internal medication audits should be introduced so that the home can be sure that people are receiving their medication safely. The home needs to make sure that the complaints log is dated when complaints are received so that complaints can be effectively tracked. The home should make sure that any repairs needed to the hot water supply are carried out quickly so that people can have a bath if they prefer rather than having to shower. Individual fire evacuation plans should be completed for all people who live at the home so staff have clear information and people are kept safe should a fire occur. 4 20 5 22 6 24 7 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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