Inspection on 02/03/09 for Genesis Residential Care Home Ltd

This inspection was carried out on 2nd March 2009.

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

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

Other inspections for this house

Genesis Residential Care Home Ltd 02/03/07

Genesis Residential Care Home Ltd 16/11/05

Genesis Residential Care Home Ltd 18/06/05

Genesis Residential Care Home Ltd 10/01/05

Genesis Residential Care Home Ltd 05/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Genesis Residential Care Home Ltd 44 Albion Road Great Yarmouth Norfolk NR30 2JD 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: Ginette Amis Date: 0 2 0 3 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. 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 37 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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 37 Information about the care home Name of care home: Address: Genesis Residential Care Home Ltd 44 Albion Road Great Yarmouth Norfolk NR30 2JD 01493853992 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Genesis Residential Care Home Ltd care home 7 Number of places (if applicable): Under 65 Over 65 7 0 learning disability Additional conditions: Date of last inspection A bit about the care home Genesis is a care home providing accommodation for seven people with a learning disability and Care Homes for Adults (18-65 years) Page 4 of 37 associated mental health problems. It is owned and managed by Mr & Mrs Bryant. The home is located between the town centre and sea front of Great Yarmouth. The accommodation comprises of two terraced houses with seven single bedrooms situ ated on the three floors with a lounge, dining room and kitchen on the ground floor in Number 44 and two lounges and kitchen/diner in Number 43. Access to the seven bedrooms is by the stairs. There are two small front patios and enclosed covered conservatories. A Care Homes for Adults (18-65 years) Page 5 of 37 connecting doorway to both houses is accessed at the rear. There is parking in the public car park at the rear of the building.. Fees range from £367 to £759 per week Care Homes for Adults (18-65 years) Page 6 of 37 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 7 of 37 How we did our inspection: This is what the inspector did when they were at the care home This key inspection was unannounced and carried out by one inspector in a single day, spending seven hours in total. An Annual Service Review was conducted in February 2008. T The manager had submitted an Annual Quality Assurance Assessment which also contained information that we took into account. We looked at a number of records kept by the care home including the care plans which showed how the needs of the residents are to be met. Care Homes for Adults (18-65 years) Page 8 of 37 We also looked at staff files and records. Other records seen concerned the way the care home was maintained and the promotion of safety. We looked at a selection of policies operated by the care home and records of medication management. A tour of the home was carried out. We were invited to look at residents bedrooms. We spoke with the manager and members of staff on duty. We were able to speak with 5 of the residents individually in order to gain their views about the care home and the services provided there. Care Homes for Adults (18-65 years) Page 9 of 37 What the care home does well The staff team were described by residents as Good friends and People you could always trust. Residents said they felt they could talk to the manager about anything that concerned them and would not hesitate to go to her if they were unhappy or wanted to complain. The care plans were well written and gave staff the information they needed to care for the residents needs. Care Homes for Adults (18-65 years) Page 10 of 37 Residents were encouraged to develop skills, to be as independent and outgoing as possible and to make their own choices in their daily lives. People chose the kind of meals they wanted on the menu and contributed to plans for going on holiday together. They were able to socialize with one another but also in the wider community, visiting friends and family and making use of local amenities. People benefited from the location of the care home and its proximity to shops, entertainment venues, public transport and other services. Care Homes for Adults (18-65 years) Page 11 of 37 Everyone living at Genesis had their own room which they had been able to personalize in ways that reflected their taste and personality. We saw that communal lounges and the dining room were clean and comfortable and there was a small lounge where people could entertain guests in private if they wished. We found that though the staff group was small turnover was very low. We saw from staff files that residents were protected by thorough recruitment practices and the training made available to help staff perform their duties well. The manager was a person of several years experience and well qualified in her role. Page 12 of 37 Care Homes for Adults (18-65 years) What has got better from the last inspection Since the previous inspection new furniture and flooring had been provided in the two principal lounges. Some redecoration in these areas and in accommodation that remained empty had taken place. A new cooker had been installed in the main kitchen. Some residents files and medication had been moved so that all were now securely stored in the one location. A system of staff supervision had been introduced. Care Homes for Adults (18-65 years) Page 13 of 37 What the care home could do better Records could be better organized to ensure the protection of those who live at the home We noted the absence of any over arching plan for the future development of the home or its maintenance and renewal. Neither had residents views or those of other people significant to the future development of the service been collected for the purpose of constructive evaluation and quality assurance. Care Homes for Adults (18-65 years) Page 14 of 37 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Ginette Amis CQC Capital Park Fulbourn Cambridge CB21 5XE 01223 771300 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 15 of 37 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 16 of 37 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 . People thinking of using this service have the opportunity to find out first hand about the home in advance of making a decision to live there. People chose to live at Genesis once their needs had been identified and they, along with other parties to the agreement were satisfied the home offered suitable support and accommodation. Evidence: To understand how people interested in living at Genesis might learn of the services provided by the home we spoke to the manager and to people who had moved in quite recently. We wanted to find out how people could be sure that the home was right for them, so looked at the records that showed how residents needs had been assessed and at the agreements made between residents and the care home. The manager explained how a social worker who knew the home and was working with a person to help them find the right place to live would first recommend the services at Genesis to them. The social worker would arrange an introductory visit so that the person interested could view the available accommodation. This also gave them the opportunity to meet the manager and staff and talk to people who already lived there and find out their view of the home. One resident said he had visited the home several Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: times before making his mind up. Another said he had learned from other residents that Genesis was a nice place to live. At the time of our visit, a copy of a brochure or Service User Guide for Genesis was not available for us to look at. We heard how social workers in consultation with the person seeking admission assessed what that persons needs were. We examined the records for 4 of the residents at the home. We found that their needs had been well considered. As a result of this assessment, agreement had been reached over the generation of a care plan. This plan was designed to make sure everything thought to be necessary to ensure the welfare of the person concerned was in place. The manager showed us copies of the contracts between Norfolk Social Services and the care home, detailing how services would be paid for. In addition we saw the terms agreed to between each resident and the home, explaining what the resident could expect of the home and the home of the resident by way of behavior, all of which had been signed by the resident. Residents spoken with said they had been encouraged to decide for themselves if the home was right for them. The manager told us about a person who was considering moving into accommodation at Genesis and said the process could never be rushed as it had to be the right decision for all concerned. Care Homes for Adults (18-65 years) Page 18 of 37 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 . Because care plans were regularly reviewed, they reflected the changing needs of people living at Genesis. People were enabled to cope with recognized risks and encouraged to pursue their aims. They took a positive part in daily life both in and outside of the care home. Evidence: We wanted to find out how people were included in the decision making that affected their daily lives. We recognized that choices could involve some risk taking so inquired into how the care home enabled residents to achieve their aims in as safe a way as possible. We wanted to make sure people had some say in how the care home operated day to day. We also needed to know that information held by the care home about people living there was regularly reviewed and appropriately managed. To do this we looked at the records kept by the care home. We observed the way residents interacted with the manager and staff. We talked to 5 people about their experience of life at Genesis. We found that each resident had a care plan provided by their social worker, to which Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: had recently been attached additional information compiled with the resident by the manager. Various potential risks a resident might encounter pursuing their aims had been identified and strategies developed to minimize possible problems. From the records we saw that plans for residents care were regularly reviewed. Residents and their Community Nurse or Social Worker met every 2 months to review progress and ensure that all was well. The care home also maintained detailed record books of events in the peoples lives and these books were the principle source of information used by staff handing over from one shift to another. While the care home did have useful records relating to each of the people living there and these were securely stored, there was scope for improvement to the way records were organized. Observation on the day of the inspection gave us a clear impression that people living at Genesis were very involved in decision making, both where their personal plans were involved and with regard to the way everyone lived together. Each resident owned a key to their room and to the house and could come and go as they wished as long as they let staff know where they were going and for how long they expected to be absent. One person said he frequently caught a bus to neighboring towns to meet up with friends. Another said he regularly went out to stay with a friend locally. All of the 5 residents spoken with said they felt members of staff knew them well and understood what things pleased them, how they liked to spend their time and what might upset them. None of them felt that their liberty or freedom of choice were in any way restricted. People said they knew they had regular opportunities to discuss anything they wished to with the manager and from observation on the day of this inspection visit we could see this to be so. Care Homes for Adults (18-65 years) Page 20 of 37 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 people who live at Genesis were encouraged to enjoy an active and independent life style. People engaged in a range of activities that interested them, both in and outside of the home, and enjoyed getting about in the locality. They kept up links with family and friends and entertained friends at home when they wanted to. People enjoyed their meals at Genesis and took an active part in planning the menu. Though people were encouraged to contribute toward keeping the home tidy no one felt obliged to help with the housework. Evidence: We wanted to find out if people living at Genesis felt their lifestyles were appropriately fulfilling both inside and outside of the home. To do this we took account of what residents care plans revealed about them but primarily listened to what people had to say about their lives. People told us about the wide variety of activities they took part in. Some people were enrolled on training courses or regularly attended workshops designed to improve their skills. One resident was particularly pleased to show us Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: course certificates gained over the past years. Another more mature resident had made it clear they were no longer interested in attending training courses but said they found dancing classes very enjoyable. A third person was keen to relate progress gained in literacy. All but one of the people we spoke to regularly took part in leisure activities outside of the home. People mentioned a recent group visit to the cinema and one person related regularly meeting friends both at the local pub and further afield. Friends were visited and also made welcome when they came to Genesis where a small communal lounge was set aside especially for those who wished to entertain in private. Some residents had enjoyed close personal relationships. Residents spoken with knew that they could if they wished ask for help or advice from the manager or other members of staff if they had any difficulties in their intimate personal lives. All of the people we talked with said they were sure that staff treated them respectfully and none felt their right to privacy was ever ignored. Some people more than others related how they liked to help around the house. One person was keen to assist with shopping for food and the preparation of meals because she enjoyed cooking. Members of staff said they knew residents were not obliged to help but did encourage them to lend a hand, for example with washing up and to keep their rooms tidy. One resident took great pride in the perfect order he kept his room in while others displayed less tidy tendencies. The independence with which residents operated, within the agreed remit of their care plans was evidenced by their assertiveness. We witnessed people making their views very plain regarding holiday plans and again at mealtime. Although records showed staff had made serious attempts to enthuse residents with the benefits of choosing a healthy diet, healthy options were not always popular. Some people said they just didnt like vegetables and were not interested in eating them but said they did so because they knew they were meant to do you good. When asked, residents said they accepted being weighed at regular intervals because they understood that putting on too much weight was a bad thing. People said they made individual choices about the kinds of meals they wanted to see on the menu but then took a collective decision over what to have on a particular day of the week. Members of staff reported they always offered 2 vegetables as accompaniments to a main meal and fruit rather than puddings or cakes though the manager said Of course we have treats sometime. The manager reported in the Annual Quality Assurance Assessment of December 2008 that nutritional screening of residents was carried out by East Norfolk Learning Disability Team. Care Homes for Adults (18-65 years) Page 22 of 37 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 of people living at Genesis was safeguarded because their welfare was monitored. Members of staff offered people the care and guidance they needed. People had access to local NHS services. Residents could be confident that when necessary the care home would safely manage their medication for them. Evidence: To understand how well the health care needs of people living at Genesis were being catered for we examined their care plans and talked to the manager and members of staff about the support they offered. We asked residents if they felt they got the help they needed to remain healthy. We looked at the way in which medication was stored and administered. From care plans and conversation with members of staff we found that only one resident needed any help with personal care and even this was minimal in amount. People living at Genesis appeared to enjoy generally good health. The manager told us that most people remained with the GP of their choice, with whom they were registered before they came to live at Genesis and would have automatic access to all local NHS services. Residents were regularly monitored by the Community Psychiatric Nurse assigned to oversee their wellbeing. Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: Members of staff had been appropriately trained and were guided by the homes policies and procedures to handle medication safely. There were only 2 people currently prescribed medication and both preferred the care home to administer this for them. This very limited amount of medication prescribed was securely stored and records were well kept. Care Homes for Adults (18-65 years) Page 24 of 37 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 . Residents were confident that the manager and staff at the home would listen to any concern they might have, treat it seriously and take action to help them. The manager and members of staff were knowledgeable as to their duty to protect vulnerable adults from abuse and this helped to keep people living at Genesis safe. Evidence: We wanted to find out if people living at Genesis knew what to do if they felt they had a concern they wished to raise or if they wanted to complain. We also needed to learn if residents were sufficiently well protected by the care homes policies and procedures for the protection of vulnerable adults and if staff were equipped to cope with any problems they might encounter and knew about the whistle blowing procedure. To do this we talked to residents, the manager and members of staff. We looked at the homes complaints and whistle blowing procedures. We found that though the care home had a complaints procedure in place this had not been given to people living there. All of the residents spoken with knew however that they met with the manager each month and could go to see her at any time if anything was worrying them. Each person made it very clear to us verbally that they would have no hesitation in talking to the manager, or other members of the staff team, about any matter of concern to them. We were also able to observe the way in which people approached the manager to make their feelings about certain issues known to her. One person came to express anxieties about holiday plans and was reassured in a sympathetic manner and given additional information as to how a situation would work Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: out. No one expressed any reticence over bringing their feelings to the attention of the manager or other members of staff. Several people told us they knew they could tell the manager anything about themselves and their concerns. Even so we felt that offering residents simple instructions on how to make a formal complaint would provide additional reassurance to people using or connected to the service. The care home had not received any complaints since the previous inspection though an Incident Book, in which all manner of happenings were recorded, was being kept. It was not good practice to have for example information about different residents mixed with records of visiting maintenance workers all under the one cover. With the one exception, being the latest recruit who had already received guidance during induction for her role, members of staff had attended a training course designed to help them to protect vulnerable adults from abuse. Staff said they were aware of the whistle blowing procedures. All staff had been checked and cleared to work in the home by the Criminal Records Bureau. Care Homes for Adults (18-65 years) Page 26 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The care home was well located and suitable for the needs of its residents. People living at Genesis were happy with the accommodation available to them and found it a clean, comfortable place to live. People had been encouraged to personalize their rooms and this helped them to feel at home there The lack of a planned approach to the future maintenance and development of the home left it unclear if, when and how further improvements would be made to areas suffering from wear and tear or to what use some communal areas might be put. Records kept at the home were not always up to date and failed to adequately reflect how possible safety concerns were being dealt with. Residents had not taken part in any fire drills set up for members of staff so might not have been clear about how to act in an emergency. Evidence: We wanted to find out if the accommodation offered to people at Genesis was suitable for their needs in every way. We considered the location, size and layout of the premises and the way it was being maintained. We needed to find out from residents if they were comfortable in the rooms allocated them and if they had been able to personalize these areas and felt at home in them. We also wanted to take account of the cleanliness and safety of the home. To accomplish this we made a tour of the communal areas and, on invitation, looked at rooms occupied by residents. We talked to members of staff about the cleaning duties they undertook and how residents were Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: involved. We asked staff about the training they had done to help them understand how best to stop the spread of infections and observed them at work. We talked to the manager about safety issues and asked about possible plans for the future development and maintenance of the care home. We were able to ask all but one of the residents what they thought about living at Genesis, its location and suitability in meeting their expectations and especially were they comfortable living there. We noted how the care home was situated close to both the town centre and the sea front. Though the care home lacked a garden there was a small park nearby. Bus stops were within walking distance of the home and there was a car park for visitors at the rear of the premises. The care home was located in a fairly quiet residential street but with a public house on the junction with the main road. Residents said they thought the care home conveniently located, it being close to public transport, shops and the attractions of the seaside. The care home remained 2 separate houses linked by undercover back door access. The communal areas roughly mirrored one another but it was evident from observation and the remarks made by residents that most people liked to be in house number 44. Through the day people took their meals and made use of the lounge there while rooms in house 43 remained unused. A third small lounge at the rear of house 43 was kept for entertaining visitors. These communal areas were generally clean and tidy with sufficient comfortable furnishings. The rooms were warm but airy and there were no unpleasant odours detected. Since the previous inspection of 2007 new flooring had been laid and furniture replaced in the lounges of both houses. A new cooker had been installed in house number 44. Although the care home was generally in order, as noted in 2007, there were some areas where wear and tear were evident. While residents said they were happy with their surroundings, there remained a need for further improvements, for example in the hall and stairways and the bathrooms. The failure of residents to make full use of all the available facilities in house 43 was largely unexplained. While the manager expressed a number of ideas for improving the premises, no overall plan for the future development of the care home had been produced. There were no shared rooms at Genesis and each person living there was pleased to show us their room. Everyone had been issued with a key to their own door as well as to the front door of the house so that they could come and go as they pleased. We saw that residents rooms were sufficiently large and while only 3 had en suite facilities, bathrooms were near by. It was notable that people had personalized their own rooms in ways they felt made them comfortable and reflected their personal taste. One resident had a particularly tidy room of which he was extremely proud. Another had a great collection of objects that had sentimental value and made her very happy. One resident showed us his extensive collection of CDs and DVDs and had 5 music centers and a DVD player located in his room. We raised our concerns over the suitable testing of these appliances with the manager, recommending she seek authentication of Portable Appliance Testing in line with the provisions of the Health Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: and Safety at Work Act 1974. We noted how a risk assessment of the premises had been conducted in 2002 and while the manager said this had been reviewed and no changes found, supporting records were unavailable. We examined evidence that showed how fire fighting equipment had been serviced and tested. While there were records of staff having taken part in fire drills and training this had never involved any of the residents and we felt the home should arrange for this to happen so that residents too knew how to act in the event of any emergency. Care Homes for Adults (18-65 years) Page 29 of 37 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 living at Genesis were supported by a small group of care staff with long standing experience and knowledge of the home and those who lived there. People working at the home were well trained to fulfill their roles. Staff members were supervised but the means and records relating to how this was accomplished could have been improved on. Evidence: We wanted to find out how well supported people who used the service were. We needed to take account of how the care home was staffed and if each resident could be assured there would always be someone on hand to assist them if the need arose. We were interested to see if recruitment procedures did all they could to ensure residents were in safe hands. We also wanted to be sure members of staff were sufficiently well supervised and trained to perform their duties and that they demonstrated kindness and understanding of people in their care. We examined records to find out what safeguards were in place to ensure only suitable people worked at the care home and to see what training and support they received to help them do a good job. We talked to the people using the service to find out what they thought of the staff team and if they believed themselves well supported. Records revealed that the care home continued to operate good policies and Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: procedures for the recruitment of staff. Staff files contained evidence of how their applications had been processed, together with references and clearance to work with vulnerable people by the Criminal Records Bureau. Although staff turnover was low, there had been one recent new appointment. That person was able to confirm how appropriate induction training had been made available to her when she began work, how she had been able to shadow a more experienced member of staff till she and the manager felt sufficiently confident of her abilities. Further training was being made available to her. All the team members had gained NVQ Level 2 Accreditation save the new recruit who was working toward this skill attainment. The files belonging to other members of staff also contained evidence of the training they had received. When spoken to staff said they felt their experience stood them in good stead and it was evident from discussion that people employed at the home knew the residents very well. Staff said they were confident they could always turn to the manager for help and guidance. In the course of the inspection visit both the manager and at least one other member of staff was on duty at all times. At night time one member of the team slept on the premises to provide support to anyone needing it and to deal with any emergency that might arise. The manager and registered provider lived very nearby and were generally on call. The managers son was the appointed deputy manager who took over in her absence. Although the requirement of the previous inspection had been acted on and a system of staff supervision introduced, we found that the recording of these sessions failed to show the aims and outcomes of the meetings. Members of staff indicated they were not sure what supervision was meant to achieve, indicating that supervision methods needed to be revised. When we talked with people who used the service they told us that members of staff were always kind and helpful to them. People had no reservations about this and praised the staff team saying they were good friends and could always be trusted. Care Homes for Adults (18-65 years) Page 31 of 37 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 . People living at Genesis benefited greatly from the presence of a competent and experienced manager who understood their needs and appeared committed to supporting their best interests at all times. Residents also enjoyed the open, positive and inclusive atmosphere generated at the care home, and from the resemblance of the establishment to a family home. People using the service were kept safe by the care homes policies and procedures and by the staff teams general awareness and promotion of health and safety. More effective systems for monitoring the quality of the service were needed to ensure the care home could be seen to reflect the hopes and expectations of people who lived there. Records in some cases needed updating and reorganizing to provide a more thorough and transparent audit trail. Evidence: We wanted to discover if people using this service benefited from the experience and leadership of the care homes manager. We needed to find out if the manager was competent and had established a comfortable ethos in the home. We also needed to discover if the home was indeed listening to its residents and developing along lines Care Homes for Adults (18-65 years) Page 32 of 37 Evidence: which would benefit them. We needed to be assured this was a safe place to live in. To do this we spoke with the manager and staff and with the residents. We also examined some of the records that might show how health and safety were promoted. As was noted at the previous inspection we recognized how the manager was qualified and experienced. As importantly, she demonstrated her comprehensive knowledge of each individual living at the care home and understood their needs, aspirations, projects and ability to achieve them. She was equally knowledgeable about the staff group and mindful of their needs. From observation of the interactions taking place on the day of the inspection visit, involving residents and staff with the manager, it was clear how an open door policy was in operation and that no one felt too inhibited to approach with any issue. When asked, residents all said they knew they could always go to the manager, that she would listen and help them through whatever problems they might have. Residents and staff said they felt they were fairly treated. Again as at the previous inspection, we noted that residents daily records revealed how peoples needs were addressed and their views taken account of. People who used the service told us they thought their personal opinions were known and respected and that if they put suggestions or asked for changes to be made, in daily routines for example, they would be listened to and action taken accordingly to try to satisfy them. Additional evidence that the quality of services provided was being monitored had not so far been compiled. We recommended residents views should be incorporated into plans for the care homes future development. Other than issues detailed in Outcome Area 6, we did not note any other obvious health and safety concerns. Adequate provision was in place for protection from the risk of fire. Equipment was regularly serviced and maintained. We recommended the manager should take some time to update records generally so as to ensure a more thorough transparent audit trail was in place. Care Homes for Adults (18-65 years) Page 33 of 37 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 34 of 37 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 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 A simple guide to the care home that includes information about how to make a complaint should be given to each resident The registered manager should write to all parties concerned with an admission confirming what has been agreed The registered manager should ensure that all records relating to a resident are stored in an appropriate manner, with due regard for the terms of the Data Protection Act 1998. An appropriate version of the complaints procedure should be made available to residents at the home. The care home should keep a dedicated record of any complaints it may receive along with the outcome of inquiries into the complaint and its resolution The registered person should record the aims and outcome of each supervision session together with the agreement 2 5 3 10 4 5 22 22 6 36 Care Homes for Adults (18-65 years) Page 35 of 37 between parties to the meeting 7 8 39 41 The registered person should introduce a formal means of measuring the quality of the services provided by Genesis The registered person should update and organize records to ensure a more thorough and transparent audit trail Care Homes for Adults (18-65 years) Page 36 of 37 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. 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