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Inspection on 16/02/09 for Grosvenor Terrace, 52-60

Also see our care home review for Grosvenor Terrace, 52-60 for more information

This inspection was carried out on 16th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Grosvenor Terrace, 52-60 Grosvenor Terrace, 52-60 Camberwell London SE5 0NP The quality rating for this care home is: one star adequate 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: Mary Magee Date: 1 8 0 2 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 32 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.cqc.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: Grosvenor Terrace, 52-60 Grosvenor Terrace, 52-60 Camberwell London SE5 0NP 02072771619 02072771619 52grosvenor@odysseycsft.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Odyssey Care Solutions for Today Name of registered manager (if applicable) Mr Michael John Strong Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 8 0 care home 8 learning disability Additional conditions: The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 8 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 32 A bit about the care home 52-60 Grosvenor Terrace is a small care home for eight people with learning disabilities. It is in a residential street just a short distance from the shopping area of Walworth Road. The home is made up of two large Victorian terraced houses that are interconnected with a garden and patio at the back. There is a disabled parking bay outside the home that is used for the homes minibus. On the ground floor are 2 bedrooms that are wheelchair accessible. No 60 has a specially adapted kitchen for wheelchair users. The home is close to local shops, entertainment and public amenities. There is no lift in the home. Residents have tenancy agreements. The part of the fees for a place at this home are £62.35 per week. Residents also contribute towards transport costs, varying from £4.25 to £11.06 per week. 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 32 How we did our inspection: This is what the inspector did when they were at the care home This unannounced key inspection lasted over two days. A tour of the premises was made, all communal areas and bedrooms were viewed. Present during the inspection period and assisting with the process were the manager, and two deputy managers. Four support staff were spoken with, two of these were agency staff. All residents we met with over the two days. They acknowledged us and communicated using signs and gestures. Two residents spoke with us, one resident used his electronic device to help with communication. We met with the advocate during the inspection, she has an excellent relationship with residents and has advocated for residents over many years. A Quality Self Assurance Assessment was completed by the home and submitted prior to the inspection. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well The service is delivering a service that helps residents achieve many positive outcomes, A person centered approach is adopted, individual support plans record and reflect the support that people need. The home identifies any risks that may be harmful to individuals, staff make sure that these risks are minimized or removed. Support staff read the person centered plans recorded and know what tasks are needed. Support staff help residents lead meaningful lives, they take part in ordinary activities that they enjoy. People living in this house are supported to select and enjoy a holiday of choice. People using the service are very much part of the community and get to go out and do the things they want to do. Residents have their health care needs met, they see the doctor when they need to, and get the medication prescribed at the time they should. Staff protect residents from people who might hurt them. Residents enjoy their personal space with spacious bedrooms that are attractively decorated. People living at the home feel secure and safe with a number of staff that are familiar with them. Care Homes for Adults (18-65 years) Page 8 of 32 What has got better from the last inspection What the care home could do better Although improvements were found in the service a number of requirements are made to respond to shortfalls. The service is not dedicating sufficient resources in maintaining the premises to a comfortable state. The organisation needs to make provision to keep the premises in a good state of decor, the interior of the home has become shabby and needs to redecorated. Furniture supplied to residents needs to be kept in good repair or replaced as necessary. The house has had a deep cleaning Care Homes for Adults (18-65 years) Page 9 of 32 completed but the place is not managing to control effectively unpleasant odours. Despite the efforts made and recruitment drives to combat these the number of permanent support staff vacancies is still hindering success. Residents are not receiving the continuity and consistencies required from the house team as agency staff continue to supplement the vacant posts. There is less committment as a result and it is preventing the service raising the standard from adequate to good. 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 Mary Magee 33 Greycoat Street London SW1P 2QF 02079792000 Care Homes for Adults (18-65 years) Page 10 of 32 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 11 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 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents are supported to achieve positive outcomes.. The service continues to experience difficulties recruiting appropriate permanent support staff. In the interim regular agency support workers are engaged to help give consistency. Evidence: We met all eight residents. The majority of residents have lived here for many years and feel comfortable with each other. Residents are happy with the support given. Two residents communicated with us verbally, one used an electronic device to do this. Other residents needs are understood by using pictorial guide, and by body language. Needs assessments are kept under review and individual support plans are developed and tailored to respond to the ongoing assessments. Daily logs are maintained for each individual. Monitoring reports are recorded monthly, copies are sent to local authority. The records we viewed demonstrate that individuals are supported to achieve their goals and aspirations. Individuals do not hold contracts but have tenancy agreements for the accommodation. All residents must be supplied with a copy of the the contract of terms and conditions agreed between the home and the local authority. All residents have person centered communication passports which enable improved communication for each individual. Support staff spoken to during our visit Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: demonstrated a good relationship and understanding of residents needs. A number of staff worked with residents over many years. The home has vacant posts (7). Regular agency staff cover vacancies, although this is not always possible due to other commitments. The organisation has held recruitment drives in the past year but these were not successful and no suitable applicants were found. The manager has identified areas of shortfall in relation to the service operation, and acted positively to address these. The actions taken in addressing these benefits all residents. The following changes have been made within the service, a staff picture rota is displayed, a picture menu board on display. When covering vacant shifts the service strives to ensure where possible to use the same agency staff who are familiar with residents. The service recognises that there is a shortage of male carers and those that can drive. It seeks to address this issue in future recruitment plans. 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 home supports individuals to take risks and enables residents to lead as independent a lifestyle as possible. Individual support plans are in place that reflect any changes in need and circumstances. Evidence: We case tracked the support arrangements for three residents. Individuals find that their needs and aspirations are regularly assessed and that these are recorded in personal plans. Individual support plans reflect how these support needs are to be met both in the home and in the community. Internal reviews take place every six months, some statutory reviews have taken place. Reviews internally are regular, they focus on asking what has worked for the individual, looks at progress, achievements, concerns and identifies action points. Generally the local authority reviews are overdue, the manager has contacted the relevant department. Residents received support from staff to develop communication passports, together with staff they develop appropriate care and support plans that meet changing need and aspirations. Support plans are totally individualised and describe the guidance and Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: recommendations on how to manage areas that may be challenging or cause harm. Residents are supported and enabled to take risks with an emphasis on supporting decision making, and respecting freedom of choice. Reviews focus on asking what has worked for the individual, where there are progress, achievements, concerns and identifies action points. Each care plan includes a comprehensive risk assessment, which is reviewed regularly. The management of risk is positive in addressing safety issues while aiming for improved outcomes for people. Where there are limitations recorded evidence that decisions were made with the agreement of the resident or their representative and are recorded. We found that records relating to old risk assessments and no longer relevant make the files bulky. Each resident has a named keyworker. The keyworkers responsibility is to ensure that they are directly involved in working together with the resident, identifying and setting new goals. Due to staffing issues agency staff are named keyworkers for some residents. This not working effectively. Senior/deputy maangers and support staff should take on the role of key worker until permanent support staff are recruited. We looked at how residents are supported to manage their finances, records were seen of all incoming and outgoing transactions. During handovers checks are made to ensure accuracy of receipts and money held. Two staff signatures are required for each record of transaction. These records have no evidence that they are independently audited. It is recommended that the personal finances for each resident are regularly audited. Daily records are maintained of progress and state of well being, also too records of participation in events. Quarterly monitoring reports are maintained for each resident, they record the progress made in achieving goals and aspirations, outcomes of any internal reviews. 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 home makes provision for supporting residents to lead ordinary and meaningful lives. Opportunities are available for personal development and acquiring independence. Residents integrate into the community and are enabled to access community activities and facilities. Meals are varied but individual preferences are not always considered. Evidence: Residents are given opportunities for personal development. While case tracking we found that all three residents lead fulfilling lifestyle. One of the residents returned from day activities. He spoke of his enjoyment at regularly participating in activities. He is supported to keep in contact with his father who lives locally. Another resident communicated with us through his Dynavox, he is competent at using this to communicate with support staff and with day centre staff. Community activities are varied, during our visit a number were supported to the day centre in the homes minibus. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: The manager spoke about recent changes that affect the community, residents experience cancellation of activities in the community at short notice due to staffing issues. Social leisure and recreational activities that reflect individual preferences and lifestyles are experienced by residents. Important and meaningful activities such as going to the local pub or restaurants residents like to do, staff are allocated in appropriate numbers to enable this. We found that improvements are to be found, the following areas are an example. More in house activities take place, these include hand and foot massage, music therapy. Opportunities are given to residents to be involved in food shopping, some go to the local market to buy fresh produce with support staff. Residents have weekly meetings and plan menus with meals that they like, also discuss any issues about the service. The information recorded is brief and may not reflect the views of all those living at the house. As the majority of residents are not able to verbalise the service might focus on the more able individuals and not always recognise the maximum potential of all people using the service. A recommendation is made that residents meetings are more inclusive with key workers present to enable clearer communication. Each resident is consulted on holiday choice and fully involved in deciding on planning a holiday. Previously it was a group holiday for all residents. Each resident is allocated a Chat time every evening to spend time with a staff member of their choice. Photo boards of staff on duty are displayed alongside menu boards. While there are improvements in the promotion of more healthy eating such as low fat spreads, and more wholemeal bread there are more efforts required. A large proportion of the food used is prepared and pies and chips feature frequently on the menu, this prevents residents from learning about meal preparation. On the records of food served we found little evidence of residents choosing or availing of other options or consideration to individuality. It is evident from records seen that same meal is served to all residents and that there is no evidence of residents opting to choose otherwise. For two of the residents the notes recorded that frequent weight monitoring was required due to obesity. We found that body weights are not always monitored and weights are not recorded consistently. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents find that they receive personal support in a way that promotes privacy and dignity. The healthcare needs of individuals are promoted with access and support facilitated to healthcare professionals. Prompt action is taken to respond to any changes in conditions or well being. Medication procedures are safe and . Some inconsistencies are experienced in the keyworking sessions due to the high number of agency staff engaged. Evidence: We observed working practices over the two visits to the home. Care is promoted in a way that promotes the dignity, fairness, respect, and autonomy of the resident. Guidelines are in place on the level of support required by each resident. This is incoorporated into communication passports. Residents are supported to express their personality in their appearance, they choose and dress in clothes that reflect individual preferences. Personal support is provided in private, incontinent issues are addressed discreetly. The home recognises areas that could make life better for residents. It is seeking to recruit more male carers to reflect the balance of the user group, currently the majority of residents are male. The service has designated key workers but as referred to earlier in the report this is Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: not totally satisfactory. Agency staff are selected as designated key workers, they receive essential information on the first day of working at this home. It is not possible to establish sound and effective working relationships when employed on a short term contract. This is not promoting consistency as there are senior support and management staff available within the home who are familiar with all the residents. Having in house senior staff would contribute to more positive outcomes for residents. Health action plans are in place for residents but not all the new plans are up to date. We looked at three of these. We found that there is some excellent support afforded, for example a resident was hospitalised outside of London region. Support staff were rostered to support the person for this period. Record keeping is improving. The outcome of the admission is recorded in the care file/health action plan. Residents are supported to consult with the GP, dentist, chiropodist. We looked at the procedures in place to promote the health and well being of residents. the state of well being are monitored and recorded. Appropriate action is taken in summoning help from professionals to respond to any unexpected changes or conditions. Best interests meetings are held with health professionals if a medical procedure is necessary and resident is unable to consent. Some residents are prone to obesity and weight reduction diets with weight monitoring set as goals within personal plans. We observed that not all the necessary goals set or recommendations made are followed, for several residents it is recommended that regular weight monitoring takes place and that weight reducing diets are followed. We found that support staff are not following these recommendations and that individuals are not having their nutitional needs monitored. Medication is supplied in monitored dosset boxes. None of the current residents are assessed as suitable to self medicate. Training records show that medication training is provided to all in house staff. According to information supplied in the AQAA only staff that are trained and deemed competent are allowed to adminster medication. We viewed on residents files evidence of medication reviews. The medication records seen were completed appropriately. Annually a pharmacist completes a quality check. There is no inhouse audit. We recommend that monthly audits and spot checks are done of medication procedures. 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 . The home operates procedures that are robust and that safeguard vulnerable adults. Support staff are kept updated on safeguarding procedures and management of conditions such as epilepsy. An accessible complaints procedure is made available for residents. Opportunities are given for residents to raise any issues or concerns in the service. Evidence: Support staff received training on safeguarding procedures. Other training around dealing with physical and verbal aggression is also made available to staff. Staff receive regular supervision, direct observations are made by management to assess competency levels of staff. Staff have a good awareness of the need to highlight any concerns they may have regarding an individual they support. Agency staff must provide training profiles before they begin work in the service. Professionals (external)are involved in the decision making process about any limitations to residents choice in this area. Individual assessments are always completed which involve the individual where possible, their representatives and any other professionals such as the care manager or GP. Those support workers spoken to includng agency staff demonstrate a good knowledge of the indicators of abuse or neglect. They also demonstrate a knowledge of appropriate procedures to adopt when necessary. Opportunities are given for residents to safely raise issues in a group setting. Regular in house meetings for residents take place which are documented. Residents have an independent advocate who attends in Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: house reviews. There were no allegations of abuse or neglect received in the past twelve months. The home has an accessible complaints procedure. Records are maintained of all complaints received, a low number of these were recorded for past twelve months. Residents we met say they feel satisfied with home and have no issues or concerns to raise. Residents were at ease with staff and body langauge used was positive in approach. In house reviews were all up to date and have identified any areas that would be beneficial for residents. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is spacious and homely. Residents have plentyof communal areas to socialise. The comfort of the home is affected by an interior that has become shabby with a number of areas needing attention. The home is not managing to keep the premises odour free. Evidence: We viewed all bedrooms as well as the communal areas. New curtains were purchased in the last year, some new bedroom furniture too was purchased. However the home is very large and consists of two houses cojoined. It needs significant investment to keep it refurbished and in a good state of repair. The paintwork is tired and shabby and the interor in hallways and landings needs redecorating. Broken furniture was observed in one bedroom. Bathrooms and toilets are conveniently placed, (some) are heavily stained and the sealant needs attention. The interior of the home was clean but it had a strong unpleasant odour on both days. Staff discussed the management of one resident that chooses to sleep in a chair in the lounge at night rather than use his bedroom. There is an issue with how he is supported with promoting continence. Care Homes for Adults (18-65 years) Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The organisation provides a good range of training for staff employed at the home. As a result the team has acquired more skills and expertise. Due to the engagement of agency staff to cover regular vacancies this causes some shortfalls in the service, it affects continuity and the service may not be as consistent as residents require. Evidence: We found that new manager has addressed many of the issues highlighted in the previous inspection report. Records were seen of minutes of regular staff meetings held with the team. Ongoing supervision and support sessions take place, with any issues regarding competency and poor practice addressed. Ongoing training needs are identified to address shortfalls in practice. A number of staff identified and found to lack the skills and competencies are no longer employed at the home. Staff have individual development plans/diaries in place, all identified training needs are discussed and responded to appropriately. Essential training is kept up to date, that includes communication skills, POVA training, team building. We spoke to four staff members, two agency and two in house support staff. We found that agency staff covering vacant posts are not quite as knowledgeable as in house staff. The home has a number of vacancies for support staff. Recent recruitment Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: drives were unsuccessful in selecting suitable support staff. The organisation employs staff that have a variety of terms and conditions due to transfer from local authority, this is not satisfactory and may impact on recruiting new staff. Staff recruitment personnel files are held at head office. We did not review these on this occasion. We examined Schedule 2 held at the home for both newly recruited staff. According to the information seen both staff were fully vetted before appointment. We spoke to these staff members. One of the support workers previously worked for an agency at this home and was familiar with residents. A structured induction programme is in place for all new staff. Agency staff also receive one days induction to famiiarise themselves with residents needs. The home has made improvements to the engagement of agency staff. All agency support staff are interviewed by the manager and supply a staff profile before they work at the home. The home endeavours to where possible use regular locum staff who get to know the people they support. The use of temporary agency staff impacts on the service. Agency staff are allocated the role as key workers despite the availability of senior staff that are familiar with residents. The Registered Individuals must ensure that the current staff vacancies are recruited to as a priority. The requirement stated in the previous inspection report remains unmet. Care Homes for Adults (18-65 years) Page 25 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 service is benefiting from an experienced and capable manager and the service continues to improve on the service for residents. The home promotes the health and safety of residents and staff by keeping the premises in a safe and sound conditions and promoting safe working practices. Evidence: The manager is skilled and competent, he has achieved NVQ Level 4 and the Registered Managers Award. He has enthusiasm and demonstrates the capacity to recognise areas of strengths and weakness in the service, and is addressing them appropriately. Staff working at the home receive direct management support from the manager. He allocated duties to senior staff and gives opportunity for development and career progression. We observed that he is a good role model for staff and has developed excellent relationships with residents. Residents relate well with him and feel confident and comfortable with sharing any concerns with him. He has applied to CSCI to register as manager but this was not processed at time of writing this report. We found that some of his time is taken up overseeing the management of another Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: service on the road. We find that this is detracting from the improvements he is making at this home. We recommend that the manager is solely dedicated to managing this service, and not allocated the additional duties of managing any other home. A number of areas have improved in the service, record keeping is more relaible, communication within the staff team as well as with residents is good. There is an improvement in staff morale too. Quarterly monitoring reports are sent to commissioning describing each residents progress, also staff training and development. Annual development plans are built into individual person centred plans with goals and objectives and these are reviewed six monthly. Residents and team meetings take place regularly to gain their views. An independent advocate familiar with each resident attends the annual reviews. Despite these various methods for seeking views of residents and families the overall picture is not gathered together tp produce results of the quality assurance process, information is not collated and analysed to get a view overall of the outcome of individual processes or of the service performance. A recommendation is made that the home ensures an effective quality assurance process is developed for the service involving residents and that an annual audit takes place to produce the outcome of the QA process. Petty cash and personal funds for residents are checked at each handover. Shift leaders are allocated the role of leading the team on each shift and accountable for roles and duties of staff on each shift. According to records regular health and safety checks are carried out, and the premises and essential equipment are serviced and kept in good working order. Hot water, and fridge and freezer temperatures are checked out daily. Fire fighting equipment is serviced and tested regularly. Regular fire evacuation procedures take place. We were unable to verify the frequency of health and safety checks as logs of actions varied. It is recommended that frequency of health and safety checks are included in the health and safety risk assessment for the premises. Care Homes for Adults (18-65 years) Page 27 of 32 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 1 3 18 (1) (a) The Registered Individuals 30/04/2008 must ensure that the current staff vacancies are recruited to as a priority. Previous requirement: -unmet 2 38 S11 Care The Registered person must 31/03/2008 Standards Act ensure that the new manager completes and submits an application to be registered as manager to CSCI: The application was submitted but CSCI have not completed the registration process at the time of writing this report Care Homes for Adults (18-65 years) Page 28 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 Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 5 5 Each resident must be supplied with a copy of the agreement made between the local authority and the home specifying the arrangements. 30/04/2009 So that each individual is aware of the agreements 2 17 16 Consideration must be given 30/04/2009 to individual preferences.Suitable wholesome and nutritious food with variations to meet individual needs must be provided for. To respect individual preferences 3 18 18 Designated key workers must be allocated from within the senior support staff 31/03/2009 Care Homes for Adults (18-65 years) Page 29 of 32 To promote consistency of service 4 18 13 Arrangements must be improved to promote good health. Residents must be supported to follow recommendations made by health professionals. 30/04/2009 To monitor the nutritional needs of residents 5 24 23 Attention must be given to 30/06/2009 redecorating the interior of the premises in all communal areas. To provide a homely comfortable environment 6 26 16 Rooms occupied by residents 30/04/2009 must be supplied with suitable furniture that is in good order . To make the bedrooms comfortable 7 27 23 Bathroom and shower areas 30/06/2009 are heavily stained and need to be refurbished To provide a pleasant environment for residents to bathe 8 30 16 All areas of the home must well maintained and kept odour free 31/03/2009 So that residents Care Homes for Adults (18-65 years) Page 30 of 32 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 2 6 6 Old risk assessment records no longer relvant should be removed from personnel files and archived. Until new staff are recruited to vacant post support staff allocated as key workers should be selected from the senior support staff team. An audit should take place regularly of money held for each resident, preferably on PIC visit. For residents meetings named key workers should be present to assist with communication. More work should be undertaken in developing links to resources that can assist those with limited communication, so that they are enabled to express themselves. The health action plan for each resident should be updated to reflect current need, all old information should archived. Monthly audits an spot checks are recommended of medication procedures It is recommended that the manager is permitted to focus on managing this service, and not distracted by accepting additional duties of managing other homes nearby. The service should ensure that an effective and verifiable quality assurance is developed to measure the success of the service in supporting people achieve their aims and objectives, also to refelct how the service is performing. Health and safety risk assessments should determine and srecord the frequency of which health and safety checks/audits for the premises are undertaken. 3 4 5 7 11 11 6 7 8 19 20 37 9 39 10 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!