Inspection on 27/01/09 for Garfield Grange

This inspection was carried out on 27th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Garfield Grange 17/01/08

Garfield Grange 12/07/06

Garfield Grange 05/01/06

Garfield Grange 27/01/05

Garfield Grange 14/07/04

Garfield Grange 10/02/04

Garfield Grange 20/11/03

Extracts from inspection reports are licensed from CQC, this page was updated on 27/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Garfield Grange Lelley Road Preston Hull East Yorkshire HU12 8TX     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: Carol Haj-Najafi     Date: 2 7 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: Garfield Grange Lelley Road Preston Hull East Yorkshire HU12 8TX 01482896230 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Milbury Care Services Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 12 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 12 Garfield Grange is situated on the outskirts of the small village of Preston some 6 miles from the city of Hull. There is no public transport service to or from the premises. The site offers two facilities, a large detached two-storey house and a smaller bungalow to the rear. Garfield Grange provides a respite service to a maximum of twelve people at any one time. The large detached house provides eight single bedrooms and the bungalow a further four. There are sufficient communal areas, toilets and bathrooms in each location. Specialist lifting, moving and safety equipment is provided as necessary. Garfield Grange offers short term accommodation for adults with a learning disability. The staff provide personal care, help, advice and guidance with daily living skills and Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home activities, a catering service, a laundry service and domestic and cleaning services. Activities are offered both on and off site. 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: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations- but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The last key inspection was carried out in January 2008. We telephoned the manager the day before this inspection to let them know we were going. We did this to make sure we would have an opportunity to talk to people when we did our inspection. Before this visit we reviewed the information we had about the home which included an Care Homes for Adults (18-65 years) Page 6 of 31 annual quality assurance assessment (AQAA) that the manager completed. We used this information to help us decide what we should do during our inspection visit. Surveys were sent out to people who use the service and other people who have an interest in the service. We received surveys from six people who use the service and eleven staff. Comments from the surveys have been included in the report. One inspector was at the home for one day. We only had chance to talk to one person who uses the service because they were the only person staying at the home at the time of the inspection. We also spoke to four staff and the manager. We looked around the home, and looked at care plans, risk assessments, daily records and staff records. We spent a total of 7 hours at the home. The manager confirmed that the local authority commissions the respite beds on a block basis. Fees are charged through the local authority and are discussed when people apply to use the service. Feedback was given to the manager at the end of the visit. What the care home does well: What has improved since the last inspection? The service has made good progress since the last inspection. At the last inspection we made seventeen requirements. At this inspection we have only made two requirements. Staff said management have successfully improved the service and it is a better place to work. Since the last inspection the home has introduced a new care planning and assessment process. Staff and management have worked very hard to make sure the plans contain the right information about peoples needs. The plans contain a lot of information about each person, and their daily routines, likes and dislikes. At the last inspection we identified that peoples health care needs, and interests and hobbies should be recorded in their care plan. The new care plans provide this information. Staff receive more regular and varied training, which gives staff the skills and knowledge to meet peoples needs and carry out their job competently. Staff receive more regular supervison, which helps personal development and the Care Homes for Adults (18-65 years) Page 8 of 31 general understanding of the homes aims and objectives. 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. Peoples needs are properly assessed before they move into the home and they are assured their needs will be met. Evidence: Surveys from people who stay at Garfield Grange told us they were asked if they wanted to stay at the home and they received enough information to help them decide if they wanted to stay. In the AQAA the manager explained the process they follow before people start using Garfield Grange for respite care. This includes visits to the home and overnight stays. The manager also told us they always complete initial assessments. We looked at two peoples files who had started using Garfield Grange since the last inspection. They both had pre admission assessments that were completed by the home and very detailed care plans and assessments from a care manager or a social worker. Assessments contained good information about the type of support people Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: required. At the last inspection we identified that the service was not assessing peoples needs properly before they offered them a service. We found that they have made big improvements with the admission process since the last inspection. The home has introduced an admission/discharge sheet. At the end of each respite stay staff complete a summary of the stay so relatives are kept informed. Relatives are then requested to complete a summary when people next come to stay. Staff and the manager said this is working very well, and helps identify any changes in peoples needs. We looked at information that is given to people who start using the service. These documents are aimed at residential care rather than respite services. The manager had already identified that people would benefit from having better information that was more specific about Garfield Grange. Some managers have formed a working group to look at how the documents can improve and better reflect respite services. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given choice and supported to make decisions when they stay at the home. The service has improved how it identifies peoples needs. The new care planning process is very detailed but some aspects dont work well for respite care, which could result in peoples needs being overlooked. Evidence: Surveys and a discussion with a person who was staying at Garfield Grange told us people are happy with the service. One person told us that they like everything about the service. Another person said they always look forward to staying at the home. We asked the staff what the home does well; they all said the home provides a very good respite service. One staff said people really do enjoy coming to stay and ask when they are coming back. Another staff said, Its brilliant. We give people time, good support and try to find out what people like. Another staff said, We try really hard to get care packages right. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: At the last inspection we identified that peoples basic needs were generally met but the lack of assessment, and poor quality care plans and risk assessments had the potential to place people at risk. Since the last inspection, staff and the manager have worked hard to introduce new care plans and assessments. Staff said the new care plans are good. One staff said, You learn a lot and they introduce you to the person. We looked at four peoples care plans and assessments. Two people had the new style care plans. The new care plans and risk assessments contain a lot of information about each person and identify when people need support. The plans have good information about daily routines, likes and dislikes. They are well written and provide specific guidance. For example one plan said, I am unable to communicate verbally very well but can use simple words like yes and no. I will use some makaton signs (adapted sign language). Staff have received makaton training, and people who use the service have been learning some signs at the monthly house meetings. This is good practice and shows that the service is making sure peoples needs are met. The care plans cover every aspect of a persons life and take a long time to complete. The care plan document is being used to identify needs during respite care but is geared more towards people receiving long term care. The manager said they are looking at introducing a different version which is more suitable for their service. It will be very difficult to regularly review such detailed care documents when people visit the service for short periods of time. Some of the plans had information that is not relevant. For example in one plan it said about the person planning and taking part in holidays but this does not apply. A daily living section stated encourage new tasks such as dusting. The person only stays at the service three evenings a month and staff confirmed that the person is not interested in taking part in these tasks. Thirty-six people are using the service but a number of plans have not yet been completed because each plan contains so much detail. Of the four files we looked at, two people did not have care plans that were written by staff at the home. Everyone was working with the pre admission information that was used to identify the persons needs and assess if the service was suitable. Risk assessments had not been completed with people who did not have new style care plans. This means some risks had not been identified or assessed. Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: One persons needs were changing and details of the changes were recorded on sheets of paper because the person does not have a current care plan. This could lead to important information being missed. The manager said it has been a huge task introducing new care plans and risk assessments. They have had to prioritise which plans should be completed first. Staff and management said it would be better once they introduce a care planning system that is geared more towards respite care. The service did not have photographs of the people who stay for respite care. These should be held at the home so people can be identified against their records. Staff record important information about people and what they have been doing. The records are very detailed and show how peoples needs are being met. This is good practice because peoples health, welfare and lifestyle can be properly monitored when they are staying at Garfield Grange. Regular house meetings are held, and people who are staying for respite care are invited to attend and help make decisions about the service. We looked at the meeting minutes, which showed people had been asked to make suggestions for new activities, meals and other ideas. Suggestions were then recorded on a sheet and ticked off when they had been achieved. Staff said they use listening devices (baby monitors) for some people during the night, and explained these are used to alert staff if people have an epileptic seizure or are prone to fall. We looked at one persons risk assessment but this did not contain any information about using the device. The use of listening devices must be properly assessed and there should be specific guidance for when they are used. This will protect peoples privacy. Care Homes for Adults (18-65 years) Page 15 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy staying at Garfield Grange and have a good lifestyle during their respite stay. Evidence: People stay at Garfield Grange for respite care so the level of involvement and responsibility is very different to people who live in a home on a permanent basis. Staff and the manager said the service is good at providing continuity of care. They make sure people receive the same day care packages and try to follow similar routines as when they are at home. We received surveys from six people who use the respite service. They all gave positive responses. People told us they make decisions about what they want to do. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: Some people told us they go bowling, others told us they do activities at the home which includes painting, drawing, and cutting and sticking. One person said they enjoy staying at the home and like going out with staff. They told us they had been shopping with staff, had been to the pictures and went to see some Christmas lights. Daily records had good information about what people do when they are staying at Garfield Grange and they showed that peoples social needs are being met. At the last inspection we identified that peoples interests and hobbies should be recorded in their care plan. The new care plans contain good information about peoples preferences and what they enjoy doing. Care files also contain details of communication with peoples main carers and family. These showed that the service communicates well and makes contact whenever it is appropriate. We asked staff what the home could do better. Several people said compatibility is sometimes a problem. On occasions people who do not get along stay at the home at the same time, and this upsets some people when they receive respite. The manager explained that the local authority co-ordinates bookings and arranges respite approximately one month in advance. Most people stay over weekends so it tends to be much busier during these times. The manager is liaising with the local authority to see if they can have a better system for planning respite care. The home has a standard menu that is followed. Staff said this has been devised around popular meals although they can change the menu if they know the people who are staying prefer different meals. On the day of the inspection only one person was staying at the home. Rather than follow the menu staff had asked the person what they would like to eat. Changes to menus are recorded so nutrition and variety can be properly monitored. The person who was staying at the home said meals are very good. The home prepares specialist foods/diets for people who need them. One staff said they had received training, support from a healthcare professional and researched food types for one persons diet. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are well met during their respite stay. Evidence: In the AQAA the manager said, New support plans cover every aspect of personal care so once completed it tells anyone exactly how to care for the individual. We have an established staff team that know the guests very well and how they prefer to be cared for. Staff said the home is good at meeting peoples personal and healthcare needs. The person who was staying at the home said they have good daily support with their personal care. The service is not responsible for making sure general healthcare needs are met but they have good systems in place to make sure healthcare needs are met and monitored when people stay for respite care. Daily records are well written and show that care is being provided as detailed in the care plan. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: For general health enquiries staff said they contact the main carers or the persons GP if they have any concerns. The service has an agreement with the local surgery that they can contact them for advice and support if necessary. We looked at medication systems. Two staff check any medication that is brought in or sent home. All medication must be in containers that have been labelled by the dispensing pharmacist. The manager and staff said the system works well. In the AQAA the manager said, Any changes in medication we request written notification. We looked at medication administration records. These were completed correctly. All staff who administer medication have completed a medication course. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who stay at the home are safeguarded. People are confident that they will be listened to and that appropriate action will be taken when necessary. Evidence: Surveys from people at the home told us they know who to speak to if they are not happy. Staff surveys told us that they know what to do if people have any concerns about the home. The home has some I am concerned cards for people to use. At a recent house meeting, everyone talked about what people could do if they are worried or unhappy. The cards were discussed and staff explained how people could use them. These are kept at the entrance of the home. Staff said they would report any concerns to the management team and they are confident they would deal with them promptly and appropriately. In the AQAA the manager said, They take concerns, complaints, protection issues seriously. We have positive communication patterns with main carers. All staff have completed protection of vulnerable adults training. All families and carers have received a letting us know what you think policy and the complaints procedure. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: The service has received two safeguarding referrals. These have been properly investigated and dealt with appropriately. Details of any investigations are well recorded. Staff have received safeguarding training. They were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They were also able to describe the different types of abuse. At the time of the inspection the home were not holding monies on behalf of people staying at the home. We looked at personal money records that showed money transactions are recorded and people take any remaining money home when they leave. 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 stay in a homely, pleasant and safe environment. Evidence: Surveys from people who live at the home told us the home is always clean. When we looked around the home it was clean, tidy and looked homely. The home consists of two properties, an eight-bedded house and a four-bedded bungalow. The bungalow is not used very often for people to sleep but is sometimes used if people want to spend time in a quiet area. The house has a large lounge and dining room which is where people spend most of their time. There is no other communal area in the house for people to spend time. People could use the bungalow but this means they are in a separate building and away from everyone else. When asked what could be better staff suggested an additional room in the house. They explained that when eight people are staying it can get quite noisy and some people who stay for respite struggle with this. One staff said that they are restricted in activities because if some people are watching TV, others are chatting it is difficult to Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: organise quieter activities. The home is well maintained, and furnished and it is decorated to a good standard. The ground floor was redecorated and refurnished just over a year ago, and this looks homely and is very pleasant. Some areas of the first floor are looking a little worn and ready for decorating. Specialist equipment is available including baths, hoists, beds and a wet room/showers. People with physical disabilities use the service and often require the use of a hoist. The home does not have overhead tracking but the manager is hoping this will be authorised shortly. Staff and the manager said the home would benefit from having overhead tracking especially in the bathroom. We checked water temperatures around the home. These were satisfactory. In the AQAA the manager said equipment has been serviced or tested in line with manufacturers guidance or regulatory body. We looked at electrical equipment and fire equipment test dates; these were up to date. Clinical waste is properly managed and staff wear protective clothing when attending to the personal care needs of people who live at the home. 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. People who stay at the home are supported by a competent and skilled staff team. Evidence: Surveys from people who use the respite service told us staff treat them well and carers act on what they say. One person said, The staff are nice. The person staying at the home said, The staff are helpful and good. Staff told us people who stay at the home receive a good service. We received twelve staff surveys and spoke to four staff. We received a good range of comments of what the service does well. Several staff described it as an excellent respite service. One person said, We provide first class personal care. The home has had a low turnover of staff. Staff said this has contributed to the good quality service because people receive consistency and continuity of care. Staff said they enjoy working at the home and everyone works well together. Several people talked about the good atmosphere and good teamwork. Staff also said everyone has a good understanding of their role and they regularly meet with management to discuss how they are working. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: Staff told us staffing levels are generally good during the week but sometimes they are stretched on a weekend. Two surveys said there are always enough staff. Seven surveys told us there are usually enough staff. Two surveys said there are sometimes enough staff. Staff said training and training opportunities are good. Staff told us they receive training that is relevant to their role, and helps them understand and meet the needs of people living at the home, and keeps them up to date with new ways of working. In the AQAA the manager told us staff regularly attend training. The organisation uses an online training programme for the majority of training courses. Staff said, in the main, the training programme provides them with the right information. Some people thought they would benefit from practical training, alongside the online training for medication and first aid training. Staff have received training to meet peoples specialist needs. For example epilepsy training. All staff complete the learning disability qualification. We looked at a training matrix which shows staff have completed a good range of training since the last inspection. A member of staff that was recruited within the last twelve months talked about the recruitment and induction process. They confirmed that they attended an interview, and had to wait for satisfactory checks before they could start work. They also discussed the induction process which they said was very good. All staff surveys said their employer carried out checks before they started work. The manager confirmed that they always complete an initial criminal record check before people start work, and new staff always work under supervision until they receive a satisfactory enhanced criminal record certificate. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and everyone feels very supported. In the main, peoples health and safety is promoted. Hazards are usually identified but the use of stairgates has not been assessed which could put people at risk. Evidence: People told us they are very happy with how the home is managed. Several staff said the manager has made a huge difference to the home and focuses on the people who receive a service. One staff said, We have an excellent manager. She has worked wonders. Another staff said, She is so enthusiastic, a good role model, and leads by example. The manager is appropriately qualified and is experienced in the management of care services. She is preparing her registered managers application and said she will be submitting it as soon as she has all the relevant documentation. People who stay at Garfield Grange attend regular meetings and are asked to complete Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: surveys about the quality of the home. Surveys results from September 2008 were analysed and discussed with people who live and work at the home. The home has stairgates at the top and bottom of the staircase. Staff said these are used to make sure people dont fall downstairs or go upstairs when they shouldnt. The top stairgate is closed during the night. A risk assessment is in place for a risk of falls or injury and action taken states stairgate at top and bottom of stairs. However the risk of having a stairgate in the event of fire has not been assessed. At times the stairgate is also used as a control to prevent people going upstairs. This must also be properly assessed. The manager agreed that the stairgates would not be used until they had been fully assessed. The manager usually tells us about important events that happen at the home. However, we were not notified of a safeguarding alert at the time but the manager has agreed that she will inform us of any future incidents. No concerns around safe working practices were seen on the day of the inspection. We looked at health and safety records, which included fire alarm testing and environment checks. These had all been carried out on a regular basis. In the AQAA the manager told us they have all relevant policies and procedures in place. 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 Potential risks to people who 31/03/2009 live at the home must be properly assessed and risk management strategies agreed. This will make sure the risk of harm is minimised. 2 42 13 The use of stairgates must be properly risk assessed to make sure risks are being appropriately managed. This will make sure people are safe. 31/03/2009 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 People who are interested in using the service should have access to better information about the service they can expect to receive. Photographs of people who use the service should be held on file. This will help make sure people can be identified against their records. Page 29 of 31 2 6 Care Homes for Adults (18-65 years) 3 6 The care planning process should be adapted so it is more suitable for a respite service. This will make sure peoples needs are properly identified and met. Listening devices should only be used to minimise the risk of harm if it has been identified through a comprehensive risk assessment process. This will make sure people are safe and their privacy has been taken into account. The relationship and compatibility of people who are staying at the home should be more closely looked at when respite care is being offered. This will help make sure people enjoy their respite stay. People who stay for respite should have the option of using a second communal area. This will make sure people can access a quieter area if they prefer. The registered person should make sure CSCI are informed of all significant events that occur at the home. 4 9 5 15 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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