Inspection on 10/12/08 for Hazel View

This inspection was carried out on 10th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hazel View 29/12/06

Hazel View 06/02/06

Hazel View 08/08/05

Hazel View 31/01/05

Hazel View 07/06/04

Hazel View 01/03/04

Hazel View 06/11/03

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Hazel View 21 Huckleberry Close Purley on Thames Reading Berkshire RG8 8EH     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: Stephen Webb     Date: 1 0 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. that people have said are important to them: They reflect the things 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: Hazel View 21 Huckleberry Close Purley on Thames Reading Berkshire RG8 8EH 01189427608 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): martinl@purleyparktrust.org Purley Park Trust Ltd Name of registered manager (if applicable) Roberta Detenon Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 5. 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 category: Learning Disability Code LD Learning Disability over 65 years of age - Code LD(E) Date of last inspection Brief description of the care home Hazel View is one of the three original outlying houses within the Purley Park Trust, and is now one of eight separate small units within the estate. There are also communal facilities, including gardens, a club house and horticultural facilities. Purley Park is in a residential area close to Purley and a mini bus is available for local transportation. The unit accommodates five adults of either gender, with a learning disability, in a pleasant unit providing each service user with their own bedroom. Communal accommodation consists of a shared lounge/kitchen/dining area, with Care Homes for Adults (18-65 years) Page 4 of 32 care home 5 Over 65 0 5 Brief description of the care home comfortable furnishings, toilets and a bathroom. One service user has an en suite. Fees vary depending on the level of care being received and currently range from six hundred and thirty eight to eight hundred and two pounds 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection included an unannounced site visit from 9.45am until 4.00pm on the 10th of December 2008. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversation with the manager, operations manager and briefly with two of the residents. The inspector also observed the interactions between residents and staff at various points during the inspection. Inspection surveys were also completed and returned by one of the residents, Care Homes for Adults (18-65 years) Page 6 of 32 (completed by the keyworker based on their understanding of the residents communication) and by one staff member. The inspector also examined the premises during the inspection, including the bedrooms. Feedback from the resident survey and verbally during the inspection, was positive and some of their comments and observations of body language and interactions have been included within the report. The majority of the staff members feedback was also positive, though the limitations of the single staffing of late shifts and at weekends were raised. What the care home does well: What has improved since the last inspection? The three requirements arising from the previous inspection have all been addressed. A new quality assurance system has now been established and a recent round of surveys circulated to residents, next of kin and care managers. Care Homes for Adults (18-65 years) Page 8 of 32 Action has also been taken to address previous inspection recommendations. The recruitment of a team leader will provide improved managerial support to the manager and staff within the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users are provided with the necessary information to enable them to decide on the appropriateness of the home. The trust undertakes a detailed assessment of the needs and wishes of a prospective resident to identify whether they can be met within the home. Evidence: The service has an appropriate Statement of Purpose and Service User Guide which provides relevant information about the Trust and Hazel View. The home receives assessment information on a prospective resident but will also undertake its own assessment which includes examining whether the needs of the prospective resident are consistent and compatible with those of the existing resident group. Copies of preadmission assessments were on the two case files examined in the course of this inspection. The manager explained the newly revised preadmission assessment and care planning Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: tool which had recently been introduced, though this had yet to be used in this home. The format will gather more detailed information on self-care abilities, preferred routines, management of finances and lifestyle and activities preferences. The assessment process includes a visit to the prospective resident where they are living, followed by an individually planned transition if it appears that the needs of the individual can be met and are consistent with those of the existing residents. This would include visits and overnight stays, perhaps supported by an existing carer if necessary. The service also works to maintain and build upon appropriate family and other links. The service undertakes a reassessment where it feel that the needs of an individual may have changed, to identify changing needs and ensure the Trust receives appropriate resources to meet these. 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. The needs and goals of residents are reflected within their new care plans together with some evidence of how individuals prefer to be supported, and are subject to regular review. Residents are supported to make decisions in the daily lives to promote their rights and dignity, and are supported to take appropriate risks within a risk assessment framework. Evidence: The manager described the new care plan format which had recently been introduced for each resident. The format contained good detail on significant contacts, individual needs, relevant risk assessments and an essential lifestyle plan, (also recently reviewed), which provided information about the known wishes, preferences, likes and dislikes of the individual regarding how they are supported. One of the essential Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: lifestyle plans needed updating to reflect some recent behavioural changes and the manager had planned to address this. The files examined contained evidence of a cycle of care plan reviews and in one case a clinical review was also present. The daily records for each service user now include a goal plan progress sheet to record progress made on agreed individual care plan goals. There was some evidence of the inclusion of information about residents involvement in decision-making and their preferences with regard to how they are supported, though this area could be further expanded. Staff were observed to address individuals choices in various matters such as meals preferences and needs, and activities, and interactions were respectful of individuals dignity, with prompts and suggestions being made discretely. One resident is able to self-manage small amounts of his own money at a time, and this is provided for and appropriately monitored. Where the home manages funds on behalf of residents, appropriate individual records are maintained though receipts are only kept for any major expenditure. It is suggested that any expenditure on behalf of residents should be receipted to ensure that the service is always able to demonstrate appropriate financial safeguards are in place. Each resident also has a named bank account for the majority of accumulated funds and the cheque books are held by central accounts (on-site), for safe-keeping as none of the residents would be able to manage these without support. Within the house a day-to-day balance of individuals personal allowances is securely retained for ready access, to support shopping trips etc. A brief examination of recorded expenditure and discussion with the manager indicated an appropriate balance between what is funded from within fees and what additional items a resident might be expected to pay for. Assessments of capacity under the Mental Capacity Act are included within the risk assessment to support decision making on individuals capacity to manage their own funds. The manager receives a monthly updated from the finance team on individual bank balances. The individual goal plans also enable the rights and dignity of residents to be furthered through setting developmental goals to support the acquisition of new skills. Examples seen included making hot drinks and baking a cake, and this aspect can be devloped further. Any identified cultural or spiritual needs are also provided for to respect the dignity of individuals. This includes supporting attendance at church services and bible studies classes for some residents. The funeral preferences of residents are also recorded, where known as further evidence of the work to address individual spiritual/cultural wishes and dignity. Observation and limited feedback from residents indicated that they felt very much at home and relaxed in Hazel View and interacted warmly with staff. There was evidence of appropriate humour and positive interaction between residents and staff and between the residents themselves. Files contained recently updated risk assessments, which included some of the Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: necessary information on how identified issues should be addressed, to enable staff to adopt a more consistent approach. Risk assessments had review sheets attached. Care Homes for Adults (18-65 years) Page 15 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to take part in a wide range of activities, both on and off-site and cultural or spiritual needs are also provided for to ensure a fulfilling lifestyle. Involvement in the local community is also supported. Staff encourage and support relationships with family and friends to maintain and develop social contacts. Residents are encouraged to take part in daily routines as much as they wish to be, and are consulted about the menus, which provide a varied and healthy diet. Evidence: The files examined both contained an individual activities timetable detailing the current regularly scheduled activities. In addition residents are involved in spontaneous activities as well as being engaged with household routines and tasks. The Trust provides in-house day care provision as well as horticultural therapy, and Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: Thames Valley University run a range of on-site activities in the estates communal clubhouse. These include workshops on money and communication skills and drama sessions, and one resident attends an off-site college course on computing. Other activities available include cooking, drumming (off-site workshops), computing, art sessions, Monday Club, theatre trips, meals out, swimming, bible studies group, golf and bowling. Two residents visited the golf driving range during the inspection. The bowling sessions are very popular across the various services at Purley Park so individuals go on a rotation basis. One resident is taken to Reading home games to watch the football. Seasonal events include a pantomime performance by a local school and a school carol concert. One resident is funded for additional one-to-one activities sessions on a regular basis by the local authority. Cultural and spiritual needs are also provided for with bible studies and church attendance historically being well supported.Feedback from residents was that they had enjoyed the trip to the golf driving range, and one said he liked living in Hazel View and liked going to church. One older resident tends to prefer to spend more of his time relaxing in the house, and likes to watch TV. One of the residents was taken out for a drive in the morning, by staff, which she enjoys, and another went to horticultural therapy. It was evident that the residents felt very much at home in Hazel View and had positive interrelationships. Existing relationships are encouraged and supported by the staff where appropriate and staff try to maximise family contact, by supporting regular letter, telephone and email contact where possible. Some visits to family are also supported by staff, who may also provide transport. The development of friendships is also supported through external community involvement such as the church and Monday Club. Residents have the advantage of a safe on-site community within the Purley Park Trust estate within which they can often move about freely, without the need for constant staff support; as well as accessing the external community, with any necessary staff support. Levels of support are established through risk assessments which are reviewed where necessary. Menus are planned weekly with the residents based on the use of pictures of popular meals to facilitate resident choice. One resident is given a copy of the weeks menu to support him and reduce anxiety levels. Staff maintain an overview of healthy eating issues and try to add heathy elements wherever possible as well as addressing any specialist dietary needs. One resident requires a soft diet and this was observed to be provided for, discretely, during the inspection. Residents take some part in food shopping and preparation, but this is relatively limited. One resident in particular, like to help with the washing up. The residents very much enjoyed the lunch of scrambled egg on muffins which was prepared by the staff member on duty. Care Homes for Adults (18-65 years) Page 17 of 32 Care Homes for Adults (18-65 years) Page 18 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have access to information about individual residents wishes and preferences about their care to enable them to offer support in accordance with their wishes. The physical and emotional healthcare needs of residents are met by the staff with support from external healthcare professionals where required. Although none of the residents is able to manage their own medication, the home operates an appropriate system to manage this on their behalf in a safe way. Evidence: The files contained evidence of support from external healthcare professionals where necessary, including a psychologist. Where appropriate, files contained guidance on managing epilepsy, and the care plans also included relevant healthcare issues in relation to day-to-day care. Two files had new Care Pathway documents in place in relation to healthcare issues, the other files were due to be similarly updated where applicable. The care plans contained some information for staff on the preferences and wishes of individuals with regard to how they are supported, though there is room for further development of this aspect to maximise consistecy of care. Where relevant, the files also contained guidelines on managing specific behaviours, and one file was due Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: to be updated to include guidance on a recently emerging behavioural issue. The support observed being given by staff during this inspection was delivered calmly and in a way that was respectful of residents dignity. Choices were also offered. Staff have received training in Makaton and some Makaton signs are being used increasingly to aid non-verbal communication, together with pictures and photos. The manager demonstrated awareness of some of the possible patterns and pitfalls associated with supporting choice, for residents who are non-verbal, and indicated some of the ways in which staff work to address these; such as offering a limited range of options at one time, swapping the order in which options are offered, and allowing individuals sufficient time to process the options before having to make a choice. Residents files have a separate healthcare section which includes details of individual healthcare needs, any allergies, and records of health-related appointments on separate records sheets. In the case of one resident these records are not complete as the residents next of kin take them to some of their medical appointments, though it would be prudent to ensure that at least the dates of any such appointments are recorded, together with a note that the resident was supported by their next of kin. The records otherwise included evidence of appropriate routine healthcare checks. A copy of a clinical review was also present within one file. Details of any identified endof-life / funeral arrangements were also seen on file. None of the residents is able to manage their own medication but the service has an appropriate system in place to manage this on their behalf. Individual medication profiles include a photograph to confirm identity as on occasions staff from other services on the estate might administer or witness the medication. Where two staff are available, double signatories are required for each dosage administered, with the second person acting as witness. However, due to the lower staffing levels in the afternoons and evenings this is not always possible at these times. Two signatories are, however, used where antibiotics are prescribed. The homes medication systems were inspected by the pharmacist in August 2007. The Medication Administration Record (MAR) sheets include confirmation of the quantities of medication received as well as recording their administration. A returns log completes the required medication audit trail. A copy of each individuals medication profile is also readily available for night staff in case of hospitalisation, and any homely remedies used have been approved by the GP. 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. Residents and others have access to an appropriate complaints procedure through which any concerns are investigated and addressed. The provider has systems in place to safeguard residents from abuse, and is planning to improve safeguarding training to maximise staff awareness. Evidence: The service has an appropriate complaints procedure in place, which is also available in Makaton format. The complaints log includes one recorded complaint since the last inspection, which had been referred to the operations manager, investigated and appropriate action taken. The entry within the complaints log should be anonymised and cross referenced to the central confidential complaints record to signpost where the relevant information on its investigation can be found. The provider is advised to ensure that where any complaint contains possible safeguarding implications, it is referred promptly to the local safeguarding team for information, and for a decision to be made regarding who will lead the investigation. No complaints about the service have been brought to the attention of the Commission since the last inspection, for referral to the agency or local authority for their investigation. Two of the residents were able to confirm that they would speak to the manager or the operations manager if they were unhappy about something. Some residents would be likely to need the advocacy of a staff member or another person to support them to raise a concern. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: A copy of the current local multi-agency safeguarding procedure was available to staff within the home, and the providers own procedure is consistent with this. Staff currently receive accredited training on safeguarding every three years, though there is no other interim update of this training. Staff had last received this training in 2006 or 2007. In discussion with senior management it was agreed that in-house training updates on safeguarding would be considered on an annual basis, between accredited external training, to ensure that all staff remain fully conversant with the current issues and procedure at all times. No safeguarding issues have been brough to the attention of the Commission for referral to the local safeguarding team, since the last inspection. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a homely, comfortable and safe environment, which meets their current needs, and standards of hygiene within the home are good. Evidence: The home is a detached house on a landscaped campus with a number of other homes belonging to the Trust. This provides a secure on-site community to which many of the residents have free access, as well as the presence of the wider community beyond. There is also a communal clubhouse on site, which hosts a variety of activities and events, and tends to be gathering point for residents, as well as on-site horticultural therapy facilities. The house provides individual bedrooms for each resident, one of whom has an en suite shower and toilet, while others share the communal facilities also provided. Toilets and bathrooms are equipped with appropriate locks to provide privacy. The bedrooms were individually personalised and reflected the interests of their occupant. There is an open plan lounge/kitchen/diner which is comfortably furnished and homely, and within which residents can circulate freely. The standard of decor is good aside from one area of the lounge ceiling which requires Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: repair following some previous water damage. Residents have access to the kitchen and some make their own snacks and drinks and help with meal preparation and other household tasks. Residents are encouraged to hoover and clean their own bedrooms with support. The house was looking very festive with the christmas tree and other decorations. Two of the residents commented on having helped with these. There are no adaptations for disabilities aside from the availability of a ground floor toilet and as yet this still meets the needs of this ageing group. In the long term, there remains a plan to relocate the home in a new purpose-built house on the campus, though planning and other delays have meant that work on this has yet to be started. The new build would be equipped with the physical adaptations likely to be needed to support the needs of these residents. Outside the lounge is a patio area equipped with garden furniture, which is popular in the summer months. Domestic style laundry facilities are provided and standards of hygiene were good. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by a competent and appropriately qualified staff team who are able to meet their needs. Recent examination of the Trusts recruitment process indicates that it supports and protects residents. Staff receive an appropriate induction and core training to equip them to support residents, though more frequent safeguarding training updates would help to ensure that they remain up-to-date on these issues at all times. Evidence: The home is staffed by a small group of staff who have the appropriate skills and have received training to support them in meeeting the needs of the residents. As already noted, staff demonstrated their skills during the inspection in meeting the needs of residents in a calm and respectful way. The limited verbal feedback from two of the residents, as well as the body language observed, suggests positive relationships between the residents and between residents and staff. Most of the staff group have attained at least NVQ level 2, with the team leader and manager both having attained level 4 and the Registered Managers Award. Staffing is usually two carers throughout the morning and is often only one for the Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: afternoon and evening, though additional support from other houses can be summoned should it be required. The current staffing levels reflect the relatively low levels of support needs of the current group but this will need to be kept under regular review with local authorities as needs change. The Trust has been more proactive recently in seeking such reviews in order to ensure that funding provides for sufficient staff to meet needs. At nights there is no waking night staff needed throughout the night, but the on-site peripatetic waking night staff look in on the house three times per night. At present the team are operating half a post short of the staff complement of five full-time equivalent staff, but the manager anticipated being able to address this in the near future by combining this with another half a post due to retirement of the post-holder. The home also offers 3-day placements to police trainees as well as social care placements for schools. None of the current staff had been recruited since the last inspection, so recruitment records were not examined on this occasion. Past inspection of these records would suggest that the Trust operates an appropriately robust recruitment system. The Trust provides a coordinated induction and training programme for all staff with a mix of in-house and externally provided courses. The new training coordinator is an accredited trainer in several key areas and plans to broaden this further. As noted earlier, safeguarding training has been provided on a three-yearly cycle and senior management have been asked to consider providing an in-house annual update of this training. The training spreadsheet provided at the inspection indicates that other core training has been received by all staff. Staff are also supported through regular supervision and annual appraisals. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well-run home which is run with their interests and needs in mind. The views of residents and others about the quality of the service are sought to inform its future development, though some aspects of management monitoring still need to be improved to ensure that an effective overview is maintained. The health, safety and welfare of residents are supported by the homes systems and procedures. Evidence: The home is managed by an appropriately trained and experienced manager, who has attained NVQ Level 4 and her Registered Managers Award. The manager has also attended regular updates of core training to maintain her current knowledge as well as in new areas such as the Mental Capacity Act. The home now has a new cabinet to provide a secure yet readily accessible office space/desk in the absence of a dedicated Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: office. This contains various records and a laptop and printer/scanner to support record keeping. The manager receives periodic supervision from her line manager and attends weekly management meetings, which include the managers of the in-house daycare and horticultural teams. Within the home, the manager is now supported by a team leader, recruited recently, who will share management responsibilities and will also begin to share supervisory responsibilities in the new year. At present there is no overall management audit system in place though the manager thought that one was planned. A cycle of quality assurance surveys to residents, next of kin and care managers was undertaken recently, using a pictorial format to seek the views of service users. The results had yet to be collated and reported upon, and a copy should be forwarded to the link inspector on completion, as well as being made available or fed back to participants. There is an annual development plan for the home in calendar format, scheduling various works, expenditure and events throughout the year. Training needs issues are collated seprately by the training coordinator. The manager also produces an annual budgetary plan which identifies the priorities for expenditure for the following year, which is then passed to the chief executive for consideration alongside those from all of the Trusts services. Monthly budget updates are provided to the manager to enable ongoing monitoring of targets. The Trust is also required to undertake monthly Regulation 26 monitoring visits, but has had problems maintaining these at the required frequency, with no visits having taken place in about half of the months of the past year, yet in two months, two visits were undertaken. Some work has already been done to produce a schedule of visits and of the records to be examined. It is suggested that further work is undertaken to coordinate the resources of Trust governors and unit managers so that they are used efficiently to address this legal requirement for monthly monitoring. Home managers have recently begun to undertake some of these monitoring visits on each others homes, which should help to address the shortfall in visits and monitoring reports. Examination of a sample of health and safety-related service certification indicated that servicing cycles were up-to-date. Fire drills had been undertaken on a monthly basis recently and records were appropriately detailed. The homes fire risk assessment had been reviewed in November 2008. Current levels of resident mobility mean that fire door holdbacks are not currently required to facilitate their mobility about the building, but this may need to be reviewed in the future if the plans to relocate to a new build unit are significantly delayed. In the longer term, residents changing needs may not be able to be accommodated in this home due to the lack of a lift or sufficient space for other Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: adaptations which may become necessary. Accidents are recorded on the appropriate tear-off accident record and are filed collectively for management monitoring as well as within individual residents files. This was confirmed on examination of two of the care files. Levels of accidents since the last inspection are low and related only to minor injuries. Two completed accident forms remained on the pad, and the manager undertook to process these as a priority. Care Homes for Adults (18-65 years) Page 29 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 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 39 26 The provider must ensure 17/02/2009 that a reliable system of monthly monitoring visits is established and the resulting reports are copied to the manager for actioning any issues identified. To demonstrate that the day-to-day operation of the home is monitored as required, to ensure that residents remain safe and well cared for. 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 7 Consideration should be given to the retention of receipts for any amounts of expenditure of residents own funds, to enable the service to manage these transparently and fully evidence decision-making. 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. 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