Inspection on 07/10/08 for Granvue

This inspection was carried out on 7th October 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Granvue 10/10/06

Granvue 13/12/05

Granvue 16/11/04

Granvue 12/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Granvue Lincombe Drive Wellswood Torquay Devon TQ1 2HH     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: Clare Medlock     Date: 0 7 1 0 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 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Granvue Lincombe Drive Wellswood Torquay Devon TQ1 2HH 01803213970 01803213970 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Community Care Trust (South Devon) Limited care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Granvue is a care home offering rehabilitation for up to eight people between the ages of 18 and 65 who suffer from long-term mental health problems. It is part of the Community Care Trust (South Devon) Ltd, which is a registered charity that provides a range of services for people with mental health problems in South Devon. The home is set in a quiet residential area with attractive sea views over Torbay. It is about five minutes walk to a good range of local shops and about twenty minutes walk from Torquay town centre. There is a steep driveway up to the front door of the home from the road and a few parking spaces on level ground at the top of the drive. The home has seven bedrooms (one double), a lounge (with adjacent quiet room), a dining room, and a room on the top floor that can be used for training, therapies (such as massage) and meetings. Admissions to, and discharges from the home are planned carefully, and follow-up support from the staff employed at the home can be available on an outreach or drop-in basis. The Registered Manager and deputy manager are registered mental Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 8 Brief description of the care home nurses, who supervise the care planning. At the present time the homes minimum fee commences at 357 pounds. The service users have control of their own finances and pay for personal care such as hairdressing, and for social activities they choose to attend that incur a charge. Care Homes for Adults (18-65 years) Page 5 of 32 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: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was unannounced. The site visit took place on Tuesday 7th October 2008. Prior to this inspection we sent and received a completed Annual Quality Assurance Assessment from the Registered Manager. The AQAA is a self-assessment record that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Care Homes for Adults (18-65 years) Page 6 of 32 During our site visit we spoke to the Registered Manager, deputy manager, 2 people who live in the home, and 3 staff members. We case tracked one person who used the service. Case tracking means we looked in detail at the care people receive. We spoke to staff about their care, looked at records that related to them. We also made observations of other people at the home. We looked at three staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the systems used at the home work and what this means for people who use the service. All this information helps us to develop a picture of how the home is managed and what it is like to receive support and care at Granvue. What the care home does well: What has improved since the last inspection? This is the inspectors first visit to this home. Having studied previous reports and discussed the service with people who use the service and the staff at the home it appears that the home has maintained a good standard of service since the last inspection. All requirements and the majority of recommendations have been met since the last inspection. Improvements to the laundry have been introduced. A new fridge has improved cold food storage and the risk of bacterial growth. Fire instruction and its recording has started to improve with reference to new fire regulations on how regular fire instruction should take place. Improvements have also been introduced as part of the Quality assurance programme. The logo for the company has changed and new information via the website has improved. The home have also introduced self-referral forms so people are able to make decisions for them selves. A new questionnaire for people who use the service and the stakeholders has been devised and will be sent in November. Care Homes for Adults (18-65 years) Page 8 of 32 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 32 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 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an excellent assessment and admission process to ensure people are fully involved in the decision and process to move to the home. Evidence: The Manager told us that people who are considering coming to the home are involved in the process and gave one example where a person came t the home when they were well, so staff could meet them when they were well. New admissions follow a comprehensive gathering of information from health care professionals in the local primary care trust, National Health Services and Social Services. The home use a format of their own to correlate the information and now work with two other homes in the group to decide who can offer the best service to meet the individual needs of the person being referred. Referrals can be made by the person using the service or by Community Care Trust staff. Referral forms are completed along side the homes Risk Assessment form and Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: the Care Programme Approach documentation that had been completed by the Community Psychiatric Nurse and Consultant Psychiatrist. People who use the service and staff work together to find what care is needed to aid the recovery of the mental health illness. Some people provide their own detailed care plan whilst staff at the home also use a plan of care called a Wellness Recovery Action Plan (WRAP) People who come to the home then sign agreements relating to their treatment plan that is to be followed. The agreements include the contract of residency and such things as massage and or any restrictions that need to be in place. Staff at the home use a rehabilitation service that is well structured and aimed at the person himself or herself being in control of their recovery by making decisions about their care. People have access to pre admission information such as Statement of purpose and Service user guides but told us that 1 to 1 time was more effective in providing information. The Manager told us that the admission process takes varying amounts of time and depends on what the person wants and needs. One example was given of an admission process taking many months before the person was ready to move to the home. The Statement of purpose and Service user guide contains the information required. Discussion was held about expanding the information provided to reflect the complex care that is actually provided. The Registered Manager and her deputy are both Registered Mental Health Nurses. They draw on the many skills of their care staff to provide a well-rounded service. Granvue is a care home and not an Independent Hospital and therefore cannot detain anyone under the Mental Health Act 1983. The manager told us staff are provided with information on specific care needs as they arise, to ensure plans of care and support are person centered rather than being symptom specific. The Manager told us that people who are considering coming to the home are involved in the process and gave one example where a person came t the home when they were well, so staff could meet them when they were well. Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: New admissions follow a comprehensive gathering of information from health care professionals in the local primary care trust, National Health Services and Social Services. The home use a format of their own to correlate the information and now work with two other homes in the group to decide who can offer the best service to meet the individual needs of the person being referred. Referrals can be made by the person using the service or by Community Care Trust staff. Referral forms are completed along side the homes Risk Assessment form and the Care Programme Approach documentation that had been completed by the Community Psychiatric Nurse and Consultant Psychiatrist. People who use the service and staff work together to find what care is needed to aid the recovery of the mental health illness. Some people provide their own detailed care plan whilst staff at the home also use a plan of care called a Wellness Recovery Action Plan (WRAP) People who come to the home then sign agreements relating to their treatment plan that is to be followed. The agreements include the contract of residency and such things as massage and or any restrictions that need to be in place. Staff at the home use a rehabilitation service that is well structured and aimed at the person himself or herself being in control of their recovery by making decisions about their care. People have access to pre admission information such as Statement of purpose and Service user guides but told us that 1 to 1 time was more effective in providing information. The Manager told us that the admission process takes varying amounts of time and depends on what the person wants and needs. One example was given of an admission process taking many months before the person was ready to move to the home. The Statement of purpose and Service user guide contains the information required. Discussion was held about expanding the information provided to reflect the complex care that is actually provided. The Registered Manager and her deputy are both Registered Mental Health Nurses. They draw on the many skills of their care staff to provide a well-rounded service. Granvue is a care home and not an Independent Hospital and therefore cannot detain anyone under the Mental Health Act 1983. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: The manager told us staff are provided with information on specific care needs as they arise, to ensure plans of care and support are person centered rather than being symptom specific. Care Homes for Adults (18-65 years) Page 14 of 32 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. The care planning process, which includes risk assessing, is very good giving the service users control of their treatment and its pace. Evidence: Each of the people living at the home has a care plan that was developed with their input using the WRAP structure and assessment process. A care plan is then devised that includes a Care Plan Diary. This shows what should be happening at different times of the day and on different days of the week. The records include such things as are necessary and may include tasks of getting up and having breakfast to attending doctor appointments. There is also a more descriptive action plan that has been written out and the inspector saw evidence that this has been reviewed regularly. In one case this had been reviewed on a fifteen minute basis for more acute periods of time. Staff are able to be creative with these records, but they show clearly what the person needs, how it Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: is provided and how staff have checked to see if the care has been effective. At all stages evidence shows that the person has been in full agreement of the plan. The reviews recorded information indicating what had been achieved. This approach allows people who use the service to have control and take responsibility for themselves. Each of the people in the home has at least one key worker, and in most cases two, who aids them through their recovery. One person told us these key workers could be changed if that is what was right for them. The planning includes risk assessments regarding behaviour such as self-harm and aggression. Where any form of restriction is placed upon a person this is recorded. The people in the home manage their own money and are involved in the care of the home and those who they share it with. They have cleaning duties and how much support is needed is recorded in their plan of care. One person, when well indicated that they needed staff to nag with these tasks and highlighted when events would be a sign of being unwell. The home has its own missing persons policy and procedure that is used where there is an unexplained absence. People who live at the home told us they participate in decisions such as recruiting new staff, and deciding on meals for the week. We were told there are weekly meetings for people to air their views, but most people are not keen to attend because nothing is done with the information and requests. The records of the meetings confirmed this. This shortfall was shared with the manager, who gave assurances that this would be addressed. Care Homes for Adults (18-65 years) Page 16 of 32 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 approach to recovery at Granvue focuses on supporting people to achieve their goals and have a positive lifestyle. Evidence: The staff, and in particular the key workers provide a very supportive role without taking control form the person, unless this becomes absolutely necessary. The home facilitates the person in achieving their goals that may include returning home or good health. At present no service user is gainfully employed due to their complex need. The manager told us that should this arise, staff at the home would facilitate the person to seek specialist advice and guidance. People who use the service manage their own financial affairs and access the community and its services such as the shops, leisure activities, cinemas and health care services. The staff support people in planning activities and have a notice board in the dining room where information is Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: displayed. Activities are not just a daytime weekday event but also cover evenings and weekends and include contact with family and friends. The main role of the staff is to support people on their journey of recovery even when they have left the home. Some people who have re occurring symptoms are able to return to the home or request additional support, as they need it. One person told us they could see that they have improved since they had been at the home. We were told that sometimes no support is needed, but knowing it was there was enough. Then at other times if it is requested, staff are there. People who use the service appeared relaxed at the home and able to approach staff for casual conversation or more in-depth discussion and support. Staff told us that there is a daily routine like any domestic household, but this is flexible depending on need. People who use the service are involved in the cleaning of the home and keeping their own rooms tidy. They do their own laundry in the homes separate laundry room with supervision from the staff. People make their own breakfast and can prepare drinks and snacks as they wish. The main meal is in the early evening. People are encouraged to eat this together in the dining room, although they are able to eat separately if they request. When people who use the service users are reaching an advanced stage in their recovery they begin to self cater so that they learn the skills of buying and preparing a healthy diet from their finances. One person told us they are self catering which means they have a budget, shop and cook for them selves in preparation for going home. People told us they are able to go on holiday with their key workers if they would like. Examples were given of people going to holiday camps in Cornwall and also Wales. All the bedrooms are lockable and staff knock and wait to be invited in. There is a no smoking rule inside of the home. Bedrooms can be personalised and laid out to the individual persons preference. The home has a domestic feel to it and the occupants live together as a community sharing responsibilities. It is now a no smoking home and those who wish to continue smoking was seen to use the covered patio area for this. Care Homes for Adults (18-65 years) Page 18 of 32 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 home provides a supportive environment for people to become independent and take control of their own personal and health care needs. Evidence: The home provide people with advice, guidance and support without taking their independence to make decisions from them. People either write their own care plans based on their desires and goals, or have help writing these following periods of discussion and conversation. People who use the service set their own times as to how the day will unfold in their diary. Getting up, having meals and attending appointments or activities are all part of their plan. They receive guidance, prompting and encouragement from the key workers when appropriate. Each person has their own General Practitioner and Consultant Psychiatrist who are involved in regular reviews of their general and mental health needs. Other members of the Mental Health Services are called upon from time to time to respond to the Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: needs of the person if they have an acute time where their symptoms are heightened. The home has its own policies and procedures for a person if they are suitable to self medicate. None of the people at the home presently self medicate. There are lockable facilities in their rooms for this to be possible when it is assessed as appropriate. The main storage facilities for medication are suitable and the inspector found the administration records to be satisfactory. Minor adjustments to these records would further minimise any risk to people at the home. All the care staff are involved in medication management and administration of medication from the monitored dose system used by the home. Four staff are registered nurses and some care staff have received formal medication training. Discussion was held about the importance of retaining patient information leaflets for medications used at the home. People at the home are responsible for arranging and attending such things as the dentist or chiropodist as a part of their recovery, but can ask staff for support with this if needed. Key workers may assist this process by providing transport to an appointment and accompanying them. Care Homes for Adults (18-65 years) Page 20 of 32 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. Although people can be confident that concerns and complaints will be managed appropriately, changes are needed to ensure people have access to up to date complaints information. The lack of information and staff awareness on local safeguarding reporting procedures has the potential to place people at risk. Evidence: One person told us that they had recently made a formal complaint at the home. We were told, initially this had been done informally but they had been told by the manager to do this formally in writing. We were told this had been received in the last week and was currently being investigated. The CSCI have not received any complaints with regard to Granvue since the last inspection. People who use the service told us if they were not happy, that they would speak to staff and felt confident that things would be sorted out. The home do have a complaints procedure, although this was not displayed in the home and contained out of date details of the Commission for social care inspection. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: People who use the service told us they felt safe living at the home and that staff do all they can to make us feel safe when symptoms cause them to feel unsafe. We were told that the majority of staff were kind and easy to get along with and that none of the staff were rude or cruel. All staff we spoke with were aware of what abuse was and said they would report any allegations to the manager. The manager was aware of the correct reporting procedures and knew of the local safeguarding team. However, staff were less certain about what to do in the absence of the manager and gave information that was not in line with local safeguarding procedures. This shortfall was shared with the manager, who gave assurances that staff would be provided with the correct guidance as a matter of priority. Staff said they had either received training in the prevention of abuse or had this training booked. The home has its own policies and procedures manual, which contains a whistle blowing policy, aggression towards staff policy and one on Physical Intervention. Prior to employment staff have a CRB (Criminal records bureau police check) and POVA (Protection of vulnerable adults register - pre employment check) check first. However, not all files contained evidence that these had been performed. The manager confirmed that these checks had been performed but some documents had been missing since they had been transferred to the home. A member of staff whose file was inspected confirmed that she had been sent an enhanced CRB form as part of her recruitment procedure. This shortfall is scored in the staffing section of this report. Care Homes for Adults (18-65 years) Page 22 of 32 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. The environment is domestic in style, clean, comfortable and suitable for its purpose. Evidence: The home provides a suitable environment for up to eight people. The house is in a good location within walking distance of a selection of local shops, and it is a short walk to the centre of Torquay. There is also close access to a bus service, which goes to the town centre. The home is in an elevated position on a quiet residential road with far reaching views across Torbay. It is accessed by a steep drive to the front door with level parking at the ground floor level. It has a reception area that has the homes public telephone in it as well as the play station and computer. There is a lounge with a quiet room off it, a dining room with the office off one side and the homes large domestic style kitchen off the other side. A separate domestic style laundry has been re plastered to address a damp problem. The laundry is equipped with a domestic washing machine and dryer, which are suitable for the purposes of the home. There is a wash hand basin, soap and hand towels in the laundry. A member of the staff who has had health and safety training carries out a weekly health and safety check on the house including the kitchen and dining room. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: The home has a new fridge since the last inspection. Food storage and kitchen facilities were appropriate for use. There are two single bedrooms on the ground floor. The first floor has four single rooms and one double room. There is a bathroom with wash hand basin and toilet and a separate toilet on this level. On the top floor there is a sleeping in room for the night staff, and office and a meeting room that has other uses such as for massage. The home is comfortable and warm with a domestic nature to its structure. It is adequately decorated with people being able to decorate their own bedrooms to their preference. The Registered Person has maintenance arrangements for the home and details of service of equipment were provide in the AQAA. Care Homes for Adults (18-65 years) Page 24 of 32 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 use the service benefit from the stable well-trained staff group. Improvements to the induction and recruitment records would show that staff have received all the pre employment checks and induction. Evidence: Staff told us they were clear about their roles and responsibilities at the home and felt supported by the manager and deputy. Staff explained that they have been provided with training which is specific for each person and on Support time and Recovery STR training. Staff at the home are called Support time and Recovery Worker. They are equipped to support the service users through their recovery programme in house and in the community through the Trusts Domiciliary Care Service to provide continuing care. The staff have a wide range of skills that range from formal mental health nurse training to alternative therapies such as hand massage, aromatherapy and reflexology. Certificates are displayed that show evidence of formal training in the alternative approaches that the home has to offer the service users. Other training has occurred in Loss and Bereavement by Cruise and Counselling Skills by Relate. Not all staff were Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: up to date with mandatory training such as first aid and food hygiene but this training has been booked. The Registered Manager and her deputy are both trained in supervision and it is during these sessions, and staff appraisals that individual training needs discussed and recorded in the notes that are held with the staff files. Staff told us an induction takes place for all staff coming to the home, which covers the routines of the home, emergency procedures and information on policies and procedures at the home. The deputy manager told us the staff are responsible for completing this induction. Discussion was held regarding making the process more formal to evidence that all staff have been provided with the information and induction needed to perform their roles in a safe way. The manager told us the recruitment files and the procedure itself has been handed to the home. The manager told us a recent audit of staff files had identified gaps where evidence of checks was missing, and showed new files where staff recruitment records will be stored. Inspection of staff files supported that some recruitment records were missing. One file contained no CRB or POVA check or references although the staff member concerned gave assurances that these checks had been completed. One file did not contain a photograph and two did not contain evidence that an induction had taken place. Care Homes for Adults (18-65 years) Page 26 of 32 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 Registered Manager is qualified and experienced to carry out the task of managing this home and its resources so that it meets its aims and objectives. There are suitable arrangements in place for the maintenance of the premises and equipment in it. Evidence: The Registered Manager is a Registered General and Mental Health Nurse. She also holds a Professional Certificate in Management from the Open University. She has been in charge of the home in excess of ten years and demonstrated to the inspector her ability to manage the staff and the care of people who use the service during this inspection. She also has some budgetary control of the home with the Trust having overall control. During the inspection the manager was able to describe the plans and process of recovery of people that live at the home and national good practice guidance. Through new and continuous learning the home has developed a service that allows people Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: more control over their rehabilitation within acceptable levels of risk. Feedback about the service is obtained from people who use the service on a 1to 1 basis, via their reviews and regular resident meetings. There are monthly staff meetings. The Trust general manager carries out an annual clinical audit and visits the home at least monthly (under Regulation 26). In addition the Trust Directors visit the home twice per year. The manager produced a questionnaire, which will be issued in November to get feedback from people who use the service and other stakeholders involved with the home. The AQAA form provided evidence that the home has in place regular maintenance of equipment. The inspector also saw evidence of up to date fire systems maintenance, portable electrical appliance testing and ongoing health & safety checks of the premise as regularly as every week. People who use the service told us that there are regular fire drills and that staff have done these unexpectedly as announced drills had been poorly responded to. Staff told us not all of them were up to date with mandatory training, but that dates had been booked. Training records did not clearly show what staff had done in respect of this training. Care Homes for Adults (18-65 years) Page 28 of 32 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 29 of 32 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 8 12 The manager, for the purpose of providing a care service, must take into account the wishes of feelings of people who live at the home. To ensure people who use the service have their wishes and feelings taken into consideration 22/01/2009 2 23 13 The Manager must ensure all staff are aware of the correct procedures to be taken if an allegation of abuse is seen or made. so staff are aware of how to correctly report allegations and do not take actions which could affect any investigation 22/01/2009 3 34 19 The Manager must ensure staff do not work at the home unless evidence that the pre employment checks have been carried out. This information must include a 22/01/2009 Care Homes for Adults (18-65 years) Page 30 of 32 recent photograph, two written references and CRB POVA checks. so staff that care for vulnerable people have had all the pre employment checks performed 4 42 23 The Manager must ensure all staff are up to date with mandatory training so staff have the knowledge and skills to perform their roles in a safe way 22/01/2009 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 8 The manager must ensure systems are in place to listen and where appropriate act on the requests and wishes raised at residents meetings. The manager should consider obtaining two signatures when prescriptions are hand written by staff onto the medicine administration record. This will reduce errors being made The manager should also obtain patient information leaflets on medications used in the home for staff reference. The manager should ensure the CSCI contact details are correct on the complaints procedure and should ensure the procedure is on display for people to use. The Manager should consider using the local safeguarding adults training The manager should consider formalising the induction process to provide evidence that staff have received all the information required to perform their roles in a safe way. The manager should devise a system to check that staff are up to date with training 2 20 3 22 4 5 23 35 6 42 Care Homes for Adults (18-65 years) Page 31 of 32 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. 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