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Inspection on 12/11/08 for Hawthorn House

Also see our care home review for Hawthorn House for more information

This inspection was carried out on 12th November 2008.

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

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

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

What the care home does well

Hawthorn House provides a high standard environment which is well maintained. The home is bright, spacious, furnished to a high standard and has specialist equipment in place to support people with complex high dependency needs. Personal Care Plans are very comprehensive and provide all required information to ensure that health and social care needs can be met by staff. Healthcare needs are well defined and access to a wide range of healthcare professionals is available. There are good established relationships with the GP practice, all people have 6 monthly healthcare and medication reviews. Many staff have considerable experience in the home. Re-deployed staff have contributed additional skills and acquired new ones to meet peoples needs. Induction and training is generally good and the home has an experienced, well-trained and competent staff group.

What has improved since the last inspection?

There were some staffing shortages at the time of the last inspection due to the Changing Lives Programme of the Local Authority which brought into question the future of all residential homes. Since that time staff have been re-deployed from an Older Persons Home that closed, providing experienced staff and a full staffing compliment for Hawthorn House. Contingency plans in the event of an emergency have been finalised as recommended in the last report. A ramp has finally been approved to provide access to the communal areas in Lower Rowans enabling some people with mobility needs to more easily access those areas.

What the care home could do better:

Where there are concerns about a persons weight loss, it is important that they should be weighed regularly. This should be recorded and will ensure that weight and health can be monitored closely. All staff should receive training in the Management of Actual or Potential Aggression. This will ensure that all staff have the training and skills necessary to ensure the safety of all people in the service. Quality Assurance methods should seek the views of people in the service and also a wider view of others including relatives, visitors and external professionals. This will ensure the views of a wider range of people can inform monitoring and review of the service. Regular visits by the Providers representative must be carried out monthly and a report of the visit left in the home. This provides a snap-shot view of the service and can swiftly highlight any areas of concern which can be addressed to improve the service for people.More regular residents meetings and recorded minutes provides an opportunity for people using the service to make comments and influence decision making.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Hawthorn House Burton Old Road West Lichfield Staffordshire WS13 6EN     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: Peter Dawson     Date: 1 2 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Hawthorn House Burton Old Road West Lichfield Staffordshire WS13 6EN 01543252211 F/P01543417499 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Staffordshire County Council, Social Care and Health Directorate Name of registered manager (if applicable) Suzanne Morris Type of registration: Number of places registered: care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability mental disorder, excluding learning disability or dementia physical disability Additional conditions: Date of last inspection Brief description of the care home Hawthorn House is a Local Authority home within the residential area of Lichfield and provides long-term care and support for twenty nine adults with a learning, physical disability and more complex needs including sensory disabilities, challenging behaviours and mental health issues. The home consists of two buildings, both purpose built and provided care within four separate units. Upper and Lower Hollies provide twelve bedrooms and Upper and Lower Rowans provide sixteen bedrooms. Both units have a ground and first floor. Each unit consists of three communal lounge/dining Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 10 15 4 0 10 29 4 20 Brief description of the care home areas kitchen or basic kitchen facility, bathroom, shower room and each individual had a single room. There is an industrial kitchen and laundry room in each building. In Upper Rowans, the unit has a small flat where people can be supported to live semiindependently. Lower Hollies provides a six bedded special care unit for people using the service who have more profound disabilities. People have access to Lichfield Day Services. Information provided in the pre inspection questionnaire identified that the current cost of a placement at Hawthorn House was £1040 per week. People would be expected to fund any private purchase including holidays and outings. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out by one inspector on one day from 8.30 - 5.00 pm. An Annual Quality Assurance Assessment (AQAA) was provided to us prior to the inspection by the Registered Manager. This is a legal requirement and some information from that assessment is included in this report. There was an inspection of the environment including all communal areas and a sample of bedrooms. Records relating to care planning information, staffing records, medication and other records relevant to the inspection process were seen. Most people using the service were seen and some spoken with. People with Care Homes for Adults (18-65 years) Page 6 of 30 communication difficulties were engaged by staff to establish rapport and establish well-being. People generally seemed relaxed and happy in their home. Staff on duty were spoken with and were spontaneous and keen to be involved in the inspecton process, they demonstrated detailed knowledge about the needs of the people they were supporting. What the care home does well: What has improved since the last inspection? What they could do better: Where there are concerns about a persons weight loss, it is important that they should be weighed regularly. This should be recorded and will ensure that weight and health can be monitored closely. All staff should receive training in the Management of Actual or Potential Aggression. This will ensure that all staff have the training and skills necessary to ensure the safety of all people in the service. Quality Assurance methods should seek the views of people in the service and also a wider view of others including relatives, visitors and external professionals. This will ensure the views of a wider range of people can inform monitoring and review of the service. Regular visits by the Providers representative must be carried out monthly and a report of the visit left in the home. This provides a snap-shot view of the service and can swiftly highlight any areas of concern which can be addressed to improve the service for people. Care Homes for Adults (18-65 years) Page 8 of 30 More regular residents meetings and recorded minutes provides an opportunity for people using the service to make comments and influence decision making. 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 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Adequate information and procedures are in place to ensure that the needs of people admitted to the service can be met. Evidence: The Statement of Purpose was updated as recommended in the last inspection report. Further amendments are needed to update the Inspector and CSCI address and telephone numbers. A pictorial copy of the Service Users Guide is available for people using the service. Pre- admission procedures include introductory visits prior to admission and preadmission mulit-agency assessments. This is a home with long-term placements, the last admission was in May 2006 when the pre-admission procedures outlined above took place. The AQAA (Annual Quality Assurance Assesssment) states the admission process allows prospective service users to come and look around and visit - including tea, overnight or weekend stays to ensure they wish to move in Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: All people using the service are sponsored by the Local Authority and copy contracts were present in records seen. Care Homes for Adults (18-65 years) Page 12 of 30 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. Care plans and risk assessments ensure the needs of people are known and met wherever possible balancing safety with quality of life. Evidence: Samples of 3 care plans were seen. All had good and comprehensive information based upon assessments and reviews. Personal Care Plans are reviewed 6 monthly, there is input from the person, home staff and relevant professionals. Advocates and CPNs are present at some reviews. Plans included information about specialist healthcare needs and procedures to be followed when challenging behaviours are presented. Risk assessments relating to daily living and healthcare needs were seen. These included smoking, risk of falls, risk of choking etc. Advice from Speech and Language specialists had been sought in relation to the risk of choking together with dietary advice and information. There were indications that people were supported to take Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: assessed risks in the promotion of independence and quality of life. One person without verbal communication enjoys outdoor pursuits and is supported in this. Daily notes contained adequate information about the daily support given. There is a list to record outings/activities although these had not always been completed, a list showed one resident had not been out for the past month - this was apparently incorrect but had not been recorded. Staff consult people about their daily choices and activities where possible. Many attend the local Day Service each day. Residents meetings are reported to be held, although records of those meetings showed a 1 year gap until March 2008 and 4 had been recorded since. It was stated that more regular meetings had taken place but had not been recorded. A Link Worker system ensures individual contacts and responsibilities for named people. Care Homes for Adults (18-65 years) Page 14 of 30 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. Personal and family relationships are promoted together with internal and external activities to support people in the daily living situation where possible. Evidence: The home is registered for up to 29 people. Presently there are 24 in the age range 30 - 86 years and have quite diverse needs. There are 4 units based in 2 separate buildings, each staffed separately. There is a special care unit with highly dependent younger people - all go to Day Services (Local Authority), another unit has 6 people in the age range 64-86 years who are now retired from Day Services. Overall 15 people attend Day Services located at Scotch Orchard, Lichfield. This provides the usual day facilities and some people accesss college courses from there if they wish. Activities are provided for those not attending the Day Service. Staff were observed to Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: engage positively and have a good rapport with those people. External activities include access to local facilities including, shops, theatre, concerts and social groups. One person with no verbal communication is supported in outdoor pursuits, another taken to meet her sister who is in a care home 40 miles away. Efforts are made to access community facilities and promote family contacts. One person visits home each weekend but none able to have overnight stays. One person has 2 cats. She takes responsibility for feeding and monitoring them and is able to have them in her bedroom. In the past year 17 people have been on day trips to places including Blackpool and Southport, whilst 6 have had holidays supported by staff at Centre Parcs and Butlins. There are facilities to allow people to prepare and serve food as part of skill development but these are no longer used and people are not involved in simple domestic tasks to further develop social skills, the reasons given are the ageing resident group and limitations on living independently. Those attending Day Services do have opportunities to engage in some of these activities to promote their independence. Where possible people are encouraged to make decisions about daily routines. Staff were seen to respond to the wishes of those people unable to verbally communicate by using other means and interpretive actions. The AQAA states that residents meetings are used to seek views about social activities but minutes were not available to support regular meetings - there was a gap of 12 months, although more meetings have been recorded this year. There is a kitchen facility in each building with meals prepared by catering staff. Menus seen were varied and offered choices. Several people have special diets provided following consultation with Speech and Language staff and Dieticians. Support from staff with eating is needed by some people. The Environmental Health Officer recently inspected and awarded 4 Star category for food provision. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and person care needs of people are met with appropriate support from staff with detailed knowledge of their needs. Evidence: Varying levels of personal support are needed. Some people with complex healthcare needs need considerable input for daily care. All have a learning disability, 10 have mental health needs, 2 have diagnosed dementia and some have other physical conditions including cerebral palsy, diabetes, epilepsy with seizures and some challenging behaviours. There are good bathing facilities and walk-in showers. There are several people using wheelchairs and the home is suitably adapted with grab rails, ramps, toileting aids, ceiling and manual hoists. Specialist equipment is provided for personal care. Staff do provide a high level of personal care for many people. Healthcare needs are recorded in the Person Care Plans with clear instructions to staff on how to meet those needs. The home is supported with a reportedly good service Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: from the GP surgery where regular health checks are carried out, examples include monitoring of breastcare issues, prostate monitoring and general health and wellbeing. All have 6 monthly health and medication checks with the GP. The District Nursing Service currently provides support in daily insulin and some woundcare. Physiotherapists and Occupational therapists are involved in assessments and advice relating to pressure relieving equipment (provided) and positioning/re-positioning which is important for several people with poor mobility and unable move independently. Dieticians are involved where special diets are required and support for eating and drinking is needed. A range of services from the PCT (Primary Care Trust) via the local Learning Disability specialist team are accessed. In the absence of the NHS (National Health Service) free Chiropody service the home have established a private service for all people using the service. They have to pay for this. Concerns were raised with the Manager about this and the ability/willingness of all to pay for a service which should essentially be free. The NHS service will not be reinstated whilst the private service is operating. Some people have a priority need for this service having diabetes, poor circulation or other conditions. A person admitted to hospital for 6 months was supported with 2 shifts of daily staff in the hosptial for her stay. She had severe weight loss and needed support from staff with knowledge of her needs. Since returning from hosptial she has made progress but this was not recorded in relation to her weight. She was last weighed 3 months ago with a recorded weight of 5 Stones. It is important that people are weighed regularly where there are concerns about weight loss and this should be recorded and monitored. Staff have training in MAPA (Managing Actual or Potential Agression). There have been 3 recorded incidents of restraint in the home over the past year. Records have to be completed in detail for each incident and were inspected. Usually diversionary and deescalation procedures are adequate but where there is a threat to other people physical restraint may be the last and only resort. In one instance two members of staff applied restraint by sitting one each side the person in physical contact. It is important that all staff have MAPA training and it was noted that 6 new and existing staff required training and were booked for a course in January 2009. It is not always possible to direct trained staff to an incident of restraint. Part of the medication system (in Rowans only) was inspected and been managed correctly. The home notified us of a medication error recently as a result of a person not having a depo injection for 6 weeks, although this should have been 2 weekly - it was overlooked. A referral to the Safeguarding team was made and new procedures introduced to remind/review, ensuring it should not happen again. Care Homes for Adults (18-65 years) Page 18 of 30 Care Homes for Adults (18-65 years) Page 19 of 30 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. There is a clear complaints procedure in place, known to visitors and people in the service. Training and procedures ensure the protection of people. Evidence: The complaints procedure is in place and available in the home for visitors. People in the service have a pictorial version of the procedures. Some people have Advocates involved to protect their rights and interests and assist in decision making where necessary. Staff have had training in Safeguarding matters. All people have linkworkers whose role is to communicate individually with the person and highlight any areas of concern which may be expressed. This is particularly important for those people with limited or no verbal abilities. A recent matter was referred to the Safeguarding team by the home who followed the correct procedures. Six monthly reviews also provide the opportunity to review any concerns which the person may have and other professionals/family are involved where possible. Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: No complaints have been received by the home or by us since the last inspection. The AQAA states that there is positive feedback and compliments from staff, service users and carers. Care Homes for Adults (18-65 years) Page 21 of 30 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. A high standard environment which is well equipped and maintained, provides a spacious, comfortable, safe home for the people who live there. Evidence: There is a good standard environment which is also well maintained. Communal areas are very spacious, bright, homely and well furnished. Bedrooms are of average size, some larger than others, there are no en-suite facilities but good bathing, shower and toilet facilities located throughout the complex. Bedrooms seen were comfortable, well furnished and personalised to reflect individuality. Many bedrooms had double beds and there were specialist beds and equipment to ensure good posture and promote good tissue viability. There is a kitchen in each of the two buildings where catering staff provide food, these were well-equipped and maintained. There were good standards of cleanliness and hygiene observed throughout the home. Several people need 2 staff to assist with daily personal care. Specialist equipment is available including assisted bathing aids, ceiling and manual hoists, hand and grab Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: rails located throughout the building with ramps for easy/wheelchair access. A ramp has finally been approved for installation in the Lower Rowans unit to improve access to the main lounge areas. All necessary equipment is in place. Care Homes for Adults (18-65 years) Page 23 of 30 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 are well supported by a committed, well-trained and competent staff group. Evidence: There are 7 suport workers on duty plus a Senior Manager on duty though out the day. At night time there are 3 waking night support workers plus a Manager sleeping-in and on call. The Registered Managers hours are supernumerary to the above figures. There are 4 separate units to staff spread over 2 buildings. Staff are allocated to specific units although there are inevitably times when staff have to move between units. The staffing numbers stated reduce only when people attend Day Services - for example all 6 people in the high dependency special care unit attend Day Services and staff work split-shifts to accommodate this. The staffing numbers are adequate for the perceived dependency levels of the people and the geography of the building. There is a staff training matrix highlighting training completed or required. There is a comprehensive induction programme which has also been applied to staff re-deployed from Older Peoples Services. Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: From records seen all training was up to date including refresher training with the exception of MAPA training - 6 staff are awaiting a course in January 2009, this includes new staff. The training is vital - some people have challenging behaviours and there are incidents of restraint. This is unpredictable and any member of staff could find themselves involved in these situations - training should be undertaken as soon as possible. Supervision for all staff is in place and evidenced with a supervision matrix. All have supervision every 6-8 weeks, this is recorded, signed by both parties and a copy given to the supervised person. Annual appraisals are also now carried out with all staff. Staff files were inspected and all checks, references and documents required under regulation were evidenced. The re-deployment of several staff following closure of Older People services has been very successful. They have integrated well with established staff at Hawthorn House and been assisted with comprehensive induction and ongoing training programmes enabling them to transfer and extend their existing skills to meet the needs of people with learning disabilities and other complex needs. The home is now fully staffed. May staff have long term service at Hawthorn House and a mixture of experience, training and skills ensure staff are able to meet the needs of people living there. Staff spoken with were relaxed, positive, keen to talk about their work and clearly have a commitment to the people they support. Engagement with people was observed to be good and professional and particularly positive, was the ability of staff to engage with people with poor verbal skills and in some cases, none at all. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed with systems in place to ensure the protection and wellbeing of people in the service. Evidence: The Registered Manager completed the Registered Managers Award in June 2008. She has the necessary experience and qualifications to run the home. The home is well managed, the Manager is well-organised and methodical in her management and has detailed knowledge of the needs of the people in the home. There is an open and positive atmosphere, staff are relaxed. Although there has been a period of uncertainty and staff shortages due to the Changing Lives Programme of the Local Authority, managers and staff have remained focussed on the main objective which is to provide a high standard of care and meet individual needs. Staff morale at this time was evidenced to be high - this was clear from discussions with staff, observations of interactions and care practices during the inspection. Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: Quality Assurance is an area that could be improved with more regular and recorded residents meetings, more formal written feedback from relatives and feedback from external professionals. At this time there are 2 social events per year which relatives attend and the AQAA states there are good relationships with healthcare professionals and people make positive comments - but a more formal feedback in written form would provide tangible evidence of service provision and practice which can be reviewed in the light of those responses. The Providers representative must visit the home monthly, unannounced and provide a report of that visit to the Manager and a copy left in the home. There were reports of only 2 visits this year from that person in January and October 2008. Regular visits must be made and reports available in the home as stated. This is another aspect of Quality Assurance and review of the service which should be undertaken regularly. Records inspected were to a good standard and meet required professional standards. Records are kept in compliance with statutory regulations. Fire records were not inspected on this visit. Since the last inspection considerable work has been carried out to comply with new Fire Regulations - this was mainly in providing greater security in the roof/void areas of the home which now meet current fire standards. The management of the service and compliance with policy and practice procedures ensures the effectiveness and accountability of the home. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 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 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 19 Where there are concerns about weight loss regular weighing and recording is essential to monitor the health and well being of the person. MAPA (Management of Actual or Potential Aggression) training must be provided for all staff. This will ensure peoples challenging behaviours will be dealt with appropriately and safely. Quality Assurance monitoring could be improved by seeking the views of people in the service, relatives, staff and external stakeholders. This will demonstrate how the home is achieving goals for people using the service. Vsits by the Providers Representative must be undertaken monthly and a copy of the report of the visit left in the home. This will ensure ongoing monitoring for people using the service. 2 35 3 39 4 43 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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