Inspection on 27/11/08 for Hawthorne Road (10)

This inspection was carried out on 27th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hawthorne Road (10) 04/12/07

Hawthorne Road (10) 12/10/06

Hawthorne Road (10) 05/01/06

Hawthorne Road (10) 06/07/05

Hawthorne Road (10) 21/02/05

Hawthorne Road (10) 01/09/04

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Hawthorne Road (10) High Wycombe Bucks HP13 7EP     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: Jane Handscombe     Date: 0 1 1 2 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 © (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 32 Information about the care home Name of care home: Address: Hawthorne Road (10) High Wycombe Bucks HP13 7EP 01494472599 01494475497 cliff.humm@advanceuk.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Advance Housing and Support Ltd The registered provider is responsible for running the service Name of registered manager (if applicable) Mr Clifford Humm Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorderexcluding learning disability or dementia (MD) Date of last inspection Brief description of the care home 10 Hawthorne Road is a six-bedded care home providing long term rehabilitation to persons with mental health needs. The home provides all single room accommodation. The home is close to a bus service, which enables service users to access the amenities of the town of High Wycombe. There are local shops near by. The aim of the service is to equip and enable individuals to move on to independent living. People Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 6 Brief description of the care home using the service are encouraged to participate in the running of the home by undertaking household tasks with staff support as required. In addition they are supported in accessing and using local amenities and mental health support services if they wish. The fees at the time of this inspection were #558.11 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 peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection, which took place over 2 days and was carried out by one inspector. The visit took place on the 27th November and 1st December. The purpose of the visit was to see how the service is meeting the National Minimum Standards. Prior to the visit we sent out surveys to people using the service, staff members and health and social care professionals to gain feedback on the service. Results of this inspection report are derived from feedback gained from the completed surveys, discussions with the management team, viewing service users records held within the service, viewing policies and procedures, staff personnel files, general observation throughout the day, along with information provided to us within the AQAA, an annual quality assurance assessment which is a self assessment which focuses on how well outcomes are being met for people using the service and gives us Care Homes for Adults (18-65 years) Page 6 of 32 some numerical information about the service; we ask providers to complete and return these to us on an annual basis and any other information that CSCI has received about the service in order to gain an understanding of how the service meets the service users needs, and impacts upon their lives. Records required by regulations were examined, including staff files and the services policies and procedures We looked at how well the service was meeting the key standards set by the government and have in this report made judgements about the standard of the service. We would like to thank all those who gave their time during the inspection process. Fees for this service are 777.26 pounds per week. What the care home does well: What has improved since the last inspection? What they could do better: Whilst people living at the home are happy with the care and support they receive and Care Homes for Adults (18-65 years) Page 8 of 32 spoke highly of the staff team, there are some areas which could be improved upon for which a number of requirements and recommendations have been made: 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the service is provided to prospective service users, in suitable formats and visits to the home are encouraged enabling them to make an informed choice when choosing a service to meet their needs. All prospective service users undergo a thorough assessment of need and aspirations before moving into the home, to ensure their needs can be met appropriately Evidence: All current and prospective clients are provided with comprehensive information about the home, which outlines the aims and philosophy of the service and how it will support people with mental health problems. The information can be made available in suitable formats, to allow people to make an informed choice about whether the home is able to meet their needs. Prior to moving into the home, all prospective service users undergo a thorough assessment of needs and a number of visits to the home are arranged, to ensure both Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: parties are confident that the assessed needs can be met. Two service users files were viewed and both contained evidence that comprehensive information had been obtained prior to them moving into the home. The registered manager presently undertakes the assessment of prospective service users needs, although he has been working closely with the team leader to provide him/her with support to enable him/her to develop on skills already attained with a view to him/her partaking in the assessment of prospective service users. Information is gathered using a corporate format and covers a broad range of needs including the persons likes and dislikes, any cultural or religious needs, details about the persons past history, their personal and medical health care needs, their nutritional needs and their individual goals and objectives. The majority of those service users who completed comment cards inform us that they had been consulted with and made the decision to move into the home and had been provided with sufficient information about the home and the services it offers, prior to their moving into the home. Care Homes for Adults (18-65 years) Page 12 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. Users of the service are involved in making day-to-day decisions about their lives, with staff support, and are supported to take risks within a risk assessment framework which ensure that opportunities for involvement are maximised. Service users needs are reflected in their care plans. Evidence: We viewed two service users care and support plans and found them to contain comprehensive information setting out the individuals care and support needed, taking into account the service users preferences and expectations, detailing how the staff are to meet their assessed needs appropriately. Where any risks had been identified, a risk assessment was in place detailing the risks and how these may be minimised whilst promoting users choices and independence, examples of such assessments included those of smoking, the administration of medication, alcohol misuse, history of aggression, access to monies and the vulnerability to abuse, the risk of self harm and neglect. The care and support plans were developed in consultation with the service Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: users according to each individuals circumstances, and were found to be very person centred. Needs arising from diversity had all been documented appropriately with evidence of these being met in their everyday lives. Communication needs had been recorded and there were notes on managing medication, managing finances, maintaining relationships with family and friends, work and leisure needs, nutritional needs, individual life skills and details acknowledging peoples preferences regarding terminal illness/ageing and death. The care and support plans were up to date and the documents contained within them were all signed appropriately. All those living in the home have keys to to their personal bedrooms and the front door. All those using the service manage their own monies. Regular house meetings are held to enable people to voice their opinions and views on different aspects of their lives, both within and outside of the home and allows for them to contribute to the running of the service. The minutes of these meetings are held in the home and were made available for us during this inspection. A local independent advocacy service has been accessed to provide a service to those using the service and details of local advocacy services are made available on the notice board within the home. Care Homes for Adults (18-65 years) Page 14 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. Service users live a full and varied lifestyle according to their wishes and preferences and are encouraged to maintain contact with their families, friends, representatives and the local community as they wish with support being given as required. Evidence: Part of the rational for a placement in this home is to improve the individuals opportunity to integrate into the local community life. The home is very well placed for this as it is very close to the centre of the town and the variety of facilities available offer the residents the opportunity to broaden their experiences. Service users are encouraged and supported to make decisions about their lives, there are no set regimes within the home. People who completed comment cards tell us that they can make decisions about what they wish to do during the day, evenings and Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: weekends. One user of the service described how he/she enjoys taking a taxi to a nearby market town to visit the shops and informed us that he/she is very happy here, happiest Ive been, I dont get disturbed and am not told what to do here , whilst another spoke of clubs and local groups that he attends, of the voluntary work he undertakes and of an up and coming Christmas dinner that he was looking forward to attending. Assistance is given by the staff to ensure that family links and friendships outside the home are maintained and records are kept of any contacts made. Family and friends are encouraged to visit and always made welcome in the home. The residents rooms are very much their private domains and each user of the service has their own key to both their bedrooms and the front door. The staff only enter the service users bedrooms with their permission. The service users have responsibility for housekeeping tasks such as cleaning rooms, cooking and seeing to their own laundry. All service users are consulted on their dietary requirements, likes and dislikes during their assessment, link sessions and house meetings in which they are invited to contribute requests and ideas for meals that they would like or dislike. There are no set times for meals, people using the service choose individually what they wish to eat and when. Service users usually prepare their own breakfast and tea from a range of foods they have played a part in choosing. The lunchtime meal is seen as the main meal of the day which staff prepare from a twelve week menu which offers a range of different meals and the occasional takeaways, according to the services users likes and dislikes. Whilst the lunchtime meal is seen as the main meal of the day, users of the service are able to choose to eat this at times suitable to them. During our visit, one user of the service had been out during the day and chose to take his/her main meal in the evening, which consisted of fruit juice, tuna and pasta bake with salad followed by a yoghurt. The service user described the meal as very good and tasty and informed us that the flexibility in meal times suited his needs. Care Homes for Adults (18-65 years) Page 16 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. Healthcare records indicated that the health needs of residents are met effectively and the home has good links with external healthcare professionals. Users of the service are, where appropriate, encouraged to maintain responsibility for their medication, within a risk management process Evidence: Healthcare records were in good order and included separate records of contact with various healthcare professionals. The records indicated appropriate regularity of appointments and appropriate one-off consultations where necessary. Feedback from healthcare professionals who completed comment cards all indicated satisfaction with the provision of care at the service and the good working relationships they have with the service. One care manager said I have worked with staff at Hawthorne Road for seven years now and have always found them to be very helpful and we have a good working relationship that I feel is very beneficial to service users living there. This same person also indicated that the individuals health care needs Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: are always met by the care service and that the service has always responded appropriately if he/she has raised any concerns about the provision of care. Another care manager tells us that the care service always seeks advice and acts upon it to manage and improve individuals health care needs adding that staff at Hawthorne Road are very good about ensuring my clients health care needs are met, chasing up information (i.e. blood test results, medication changes), and addressing their, my, and the clients concerns. A further healthcare professional gave very positive feedback on all aspects of the care and support provided at Hawthorne Road and added that it is an excellent service communication very sound, workers understand the needs of clients and show empathy and empower clients in their care.....very satisfied with the service provided, I have a good working relationship with the staff team at Hawthorne Road. As part of the inspection process we looked at the medication systems within the home. All medication is supplied to the home via the Boots monitored dosage system and the pharmacy undertake visits to the service to ensure the home maintains good practice and provides medication training and advice to the service. A recent medication visit was undertaken by the pharmacy in October 2008, resulting in a positive report. People who wish to maintain responsibility for their own medication are enabled to do so within a risk management process. At present two users of the service are self-administering their own medication within a risk management process and have been provided with lockable facilities in which to store them. All medication was found to be stored appropriately and securely. A sample of medication administration records (MAR) were viewed as part of our case tracking; the medication administration records were completed and were generally signed appropriately, although on one particular day there was evidence of poor recording. Whilst MAR sheets had been signed, indicating that service users prescribed medications had been administered, the said medication remained in the service users dossette boxes. We discussed the findings with the registered manager who explained that as he recalled the pharmacy had delivered the medication in separate boxes and not in the usual monitored dosage system, although whilst he was not on duty at the time he did recall that a member of staff had spoken of the medication being delivered in separate boxes but felt sure that the medication had infact been administered. One user of the service who came to the office for his medication, was one of those being casetracked and whose medication remained in his monitored dosage system for this particular day in question. Upon enquiry with the said service user it was apparent that he was aware of the medication having been delivered in separate boxes and we asked if he could confirm if his medication was administered on this particular occasion from the boxes in which it was delivered, he informed us that as he recalled the medication was not Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: administered. Evidence was found within the diary acknowledging that the medication had been delivered in boxes on this particular day, however there was no note of what actions had been taken to address the issue or any evidence to highlight whether the said medication had been administered as prescribed. It is recommended that the service ensures to document any medication errors and any actions taken to ensure that users of the service are not placed at risk and to allow for a clear audit trial of medication that has been administered to those using the service. Care Homes for Adults (18-65 years) Page 19 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 adequate 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 updated complaints procedure in place, which is accessible to service users, family members and visitors to the home. Policies and procedures are in place to safeguard service users from harm although the service must ensure that appropriate training has been provided to staff who are rostered to work shifts alone to ensure the service users are not placed at risk. Evidence: Service users and their representatives are confident that any concerns or complaints they may have would be listened to, taken seriously and acted upon appropriately and if the need arose would use the complaints procedure. Discussions with those using the service confirmed that they would have no worries taking forward any concerns or complaints they may have and all knew whom to approach with such concerns. All those using the service have access to an independent advocate who will support them to get their voices heard if required, details of which are posted on the notice board within the home. Since the last inspection, the complaints procedure has been updated and changes have been made to ensure that it contains the correct up to date contact details and name of the regulatory body. A requirement was made at the last inspection to ensure that staff members mandatory training be brought up to date, which included that of adult Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: protection/safeguarding training. At that inspection it was found that whilst staff are provided with training around the safeguarding of vulnerable adults in their induction training enabling them to recognise the signs of abuse and how to respond if an allegation or incident is brought to their attention, the updating of this training had not been undertaken for a number of years. The registered manager informed us during this visit that all staff had been provided with safeguarding of vulnerable adults training in October of this year. Evidence to substantiate this was seen in the two staff members personnel files viewed. However, it was noted through discussion with a member of staff who was on duty during this visit and from viewing information within his/her personnel file that he/she had not received such training and is at times rostered to cover the sleep in shift and is therefore on duty alone. An immediate requirement was made to ensure that the registered manager ensures that suitably trained staff are on duty at all times to ensure the service users are not placed at risk. The registered manager assured us that he would attend to this immediately. The home has an adult protection/safeguarding policy in place and staff are all provided with and understand their responsibility to use the agencies whistle blowing policy if the need should arise. A copy of the Buckinghamshire local interagency policy and procedure for safeguarding adults was available in the home. The Commission for Social Care Inspection has not received any correspondence from the service itself or the general public in relation to concerns, complaints or allegations since the last inspection and information provided to us in the self assessment, completed by the registered manager tells us that there have been no complaints or safeguarding investigations during the period under review. Feedback from all five healthcare professionals who completed comment cards tell us that the service always responds appropriately if they or the person using the service have raised concerns about their care. Care Homes for Adults (18-65 years) Page 21 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. Service users are provided with a comfortable, clean, safe environment in which to live, which suits their needs and lifestyles. Evidence: 10 Hawthorne Road is located in a large residential estate, a couple of miles from the town Centre of High Wycombe. It is a terraced property and is indistinguishable as a care home. Parking facilities are not provided and staff and visitors make use of the surrounding residential streets. The accommodation is arranged over two floors; the ground floor contains two lounges, one of which is non smoking, the dining area, kitchen, laundry area, shower room, toilet and a couple of bedrooms. On the first floor there is the office, staff sleeping in room, further bedrooms and a bathroom and toilet. All bedrooms are single occupancy. The service continues to upgrade the environment to ensure comfort and meet the needs of the people living there. Areas for improvement were highlighted during the last key inspection and actions have been taken to address those areas. New net curtains have been hung in the smoking lounge and new sofas have been provided in both lounges, which service users were involved in the choosing of. New flooring has been provided in the shower room which has been re painted and tiled. Grab rails have Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: now been provided in the outside garden area to allow for the safety of those using the service. During the last inspection, it was also noted that the manager informed us that the bath was to be replaced due to chips in the enamel. We are informed that the purchase of a new bath has now been approved as has the provision of thermostatic valves to the radiators to ensure that they can be regulated enabling users of the service to choose the level of heating they require, which the manager informs us, are to be purchased and fitted accordingly. Discussions with service users informed the inspector that they were happy with their bedrooms and their surroundings and that the home is kept to a good standard of cleanliness. Service users are encouraged to bring personal possessions with them, many of which were seen to be on view in those bedrooms viewed during this vist. Whilst touring the home, it was noted that in both the shower rooms upstairs and downstairs there was no provision for paper towels or liquid soap for service users use, rather there was a shared hand towel for them to use. This is not good practice as places one at risk of cross infection and a recommendation has been made to address this issue. It was noted that the radiator guard in the upstairs WC facilities needed fixing securely to the wall, the registered manager assures us that it will be attended to appropriately. Whilst viewing one service users bedroom, it was apparent that the temperature of the hot water from the tap was above that recommended and was rather hot to the touch. This was reported to the registered manager, who was aware of the situation and informed us that the hot water supply to three other bedrooms was also at raised temperatures and the issue had been logged in the maintenance book and reported to the plumber who the service is awaiting to rectify the problem. All areas of the home were found to be clean and generally provide a safe environment in which to live. 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 home is staffed in accordance with the needs of the service users and staff receive the appropriate training to meet their needs. A thorough recruitment procedure is in place to ensure, as far as is possible, the health, safety and well being of the residents in their care, although this is not always followed in practice which could compromise the health, safety and welfare of those using the service. Evidence: The contents of a sample of staff personnel files evidenced that robust procedures take place when recruiting and selecting staff to ensure the service users health, well-being and security. Application forms are completed, references are collected face-to-face interviews are undertaken. Relevant POVA (protection of vulnerable adults) and CRB (criminal records bureau) checks are undertaken to ensure the persons suitability with working with vulnerable people. Of the files seen, one failed to contain a recent photograph for which a requirement has been made within this report. Upon appointment all new members of staff undergo induction training and complete all their mandatory training before undertaking their role unsupervised. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: There are policies and procedures in place around the recruitment and selection of staff however there was evidence of poor practices taking place. Face to face interviews are undertaken, references sought and checks are undertaken to ensure prospective staffs suitability to work with vulnerable adults within the care field, however, one staff members file evidenced that a full employment history had not been sought and one reference had not been supplied on letter headed paper or accompanied with a company stamp and there was no evidence to suggest that verification of authenticity had been sought. Likewise the second member of staffs file viewed contained one reference in which verification had not been sought. A requirement has been made within this report to address these shortfalls. Users of the service are involved in the recruitment and selection process to ensure their opinions are taken into account when selecting any new staff. All new staff, including any agency staff, are provided with an induction period and undergo all the necessary training to ensure they have the skills and knowledge to undertake their roles competently. However, whilst viewing two staff personnel files, it was apparent that their food hygiene training was in need of updating, one of who was provided with the training in 2002 and the second member of staff undertook the training in 2005. These findings were discussed with the manager who assured us that he was aware of the need for updating the food hygiene training for staff and that it is presently in hand to book such training. Staff are supervised and supported informally on a regular basis. However evidence within the staff personnel files viewed during this inspection highlighted that there has been a slippage in formal staff supervision and is not taking place the required four times per year. Likewise there was no evidence on those files viewed to suggest that the staff had been provided with an annual appraisal of their work. The manager was aware of these issues and assures us they will be undertaken appropriately. We discussed these findings with the manager, who was aware of the shortfalls in this area and requirements and recommendations requirements have been made within this report to ensure that staff are formally supervised at least six times a year and an annual appraisal of their work is undertaken. 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 management and administration of the home promotes continuity and good overall care and support for the people who live there. Evidence: The registered manager has been registered with the Commission for Social Care Inspection since 2006 and as of yet has not achieved the registered managers award. He continues to update his skills and knowledge and has recently undertaken training around drug abuse, alcohol abuse and updated his training in infection control and fire awareness. Information provided to us in the completed self assessment and through discussion during this visit informs us that he is coming up for retirement and will therefore be looking to appoint a manager for the service. Monitoring visits are undertaken regularly by a representative of the service to assess the quality of the service being provided and reports of these visits are drawn up and forwarded to the home. Evidence of such visits were available for us to view in the home. Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: We discussed health and safety issues and saw appropriate maintenance records relating to maintaining a safe environment for those living there. There was evidence of weekly fire alarm tests being undertaken, a monthly test of the emergency lighting, up to date gas safety certificate and a fire equipment maintenance certificate were in place. Refrigerator and freezer temperatures are being checked and documented on a weekly basis and cooked food temperatures were being recorded. A fire Inspection was undertaken in June of this year, resulting in three requirements, two of which the registered manager informs us have been dealt with and one remaining requirement in relation to the maintenance of the sprinkler system, which we are informed has been passed on to the property service part of the organisation who is in liason with the fire officer regarding the outstanding requirement. The service have recently updated their fire risk assessment. The registered manager is available in the home on a daily basis to deal with issues as they arise and has an open-door policy that encourages people see him without the need to make an appointment. Care Homes for Adults (18-65 years) Page 27 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 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 Requirement Timescale for action 1 23 18 Ensures that suitably trained 01/12/2008 staff are on duty at all times to ensure the service users are not placed at risk. Regulation 13(6) of the Care Homes Regulations 2001 requires that (6) The registered person shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. 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 34 19 Ensure that: 1. references that are not provided on letter headed paper are retrospectvely followed up and verified to ensure their authenticity. . Regualtion 19(c) of the Care Homes Regulations 2001 requires that: The registered person shall not employ a person to work at the care home unless he is satisfied 28/02/2009 Care Homes for Adults (18-65 years) Page 29 of 32 on reasonable grounds as to the authenticity of the references referred to in paragraph 5 of Schedule 2 in respect of that person, and has confirmed in writing to the registered person that he is so satisfied. 2 34 19 Ensure that: staff personnel files contain 1. A recent photgraph of the staff member 2. A full employment history Regualtion 19(1)(b) (i) of the Care Homes Regulations 2001 requires that: The registered person shall not employ a person to work at the care home unless: subject to paragraph (6), he has obtained in respect of that person the information and documents specified in (i) paragraphs 1 to 6 of Schedule 2. 31/01/2009 3 36 18 Ensure that staff are formally supervised at least six times a year. Regulation 18(2) of the Care Homes Regulations 2001 require that: The registered person shall ensure that persons working at the care home are appropriately supervised. 28/02/2009 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 20 Ensure to document any medication errors and any actions taken to ensure that users of the service are not placed at risk and to allow for a clear audit trial of medication that has been administered to those using the service. Cease the practice of sharing towels in communal washing/bathing facilities and provide paper towels to avoid the risk of cross contamination and protect the health and welfare of those using the service. It is strongly reccommended that staff are provided with an annual appraisal of their work. 2 30 3 36 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. 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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