Inspection on 10/01/08 for Hazelwood

This inspection was carried out on 10th January 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hazelwood 11/01/07

Hazelwood 27/01/06

Hazelwood 18/08/05

Hazelwood 28/10/04

Hazelwood 04/08/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

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33 St John`s Church Road

Dovedale Court

Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Hazelwood 9 Church Road St Leonards-on-sea East Sussex TN37 6EF     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: Michele Etherton     Date: 1 8 0 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Hazelwood 9 Church Road St Leonards-on-sea East Sussex TN37 6EF 01424423755 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Graham Robert Jack Type of registration: Number of places registered: Graham Robert Jack care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Service users must be aged between eighteen (18) and thirty (30) years on admission Service users with a learning disability only to be accommodated The maximum number of service users to be accommodated is three (3) Date of last inspection Brief description of the care home Hazelwood is a privately owned establishment offering a safe environment for 3 young adults with a learning disability. The home offers 24-hour care in a homely environment. The home does not provide nursing or disabled access. The home is located in St Leonards-on-Sea within easy walking distance of both shops and the seafront. The home has its own vehicle with local transport facilities nearby. All bedrooms are decorated to individuals choice and needs, with all having en-suite bath and toilet facilities. The rooms are of good size and are personalised by the Service Users. Some rooms have sea views. The communal areas are adequate in size. The home benefits from a large back garden, which service users partly use for growing Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 3 Brief description of the care home vegetables and developing horticulture projects. An annual holiday outside of the home environment is offered to Service Users [service users] who choose both the destination and who to travel with. Information on the range of fees charged is within the homes current statement of purpose/service user guide and ranges from #482 to #945 per week. Charge?s for extras includes personal items such as toiletries and clothes, part of the basic cost of annual holidays, and hairdressing.. Inspection reports are not routinely sent out to families and advocates after each publication although a copy is kept on display in the reception area of the home and can be obtained via the manager. A service user guide containing the most recent inspection report is sent to any interested person [or their representatives] looking to move into the home. Care Homes for Adults (18-65 years) Page 5 of 34 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: A key unannounced inspection of this service has been undertaken, this has taken account of information we have received from the service and about the service since the last inspection. This includes an Annual Quality Assurance Assessent (AQAA) completed by a senior staff member and not the provider/manager;we found this had not been completed to a satisfactory standard and did not provide us with all of the information we need, this would be improved by more supporting evidence to illustrate how the service is operating on a day to day basis, how it is planning to address identified shortfalls and current and future plans. Our inspection of this service includes an unannounced site visit to the service on 18th December 2008 between 9:30 a.m and 14:30 p.m. During which time we toured the Care Homes for Adults (18-65 years) Page 6 of 34 premises, and consulted with staff on duty. Unfortunately the residents were unwell with colds on the day of our visit, therefore we were only able to meet two residents briefly during our visit as they wished to remain undisturbed in their rooms which we respected. Surveys have been distributed to staff , residents, advocates and other stakeholders but to date returned Survey responses have been limited and confined to residents and one advocate only, their contribution has been helpful in the compilation of this report. All key standards have been assessed in addition to those where outcomes became evident during our visit. During out visit we examined a range of documentation including support plans, risk assessment information, menu records, medication records and storage, staff supervision and training records, complaints, accident and health and safety information. In arriving at our judgement we have tried to be proportionate in considering compliance with regulation and outcomes for the residents alongside the overall risks and impacts of identified shortfalls. What the care home does well: What has improved since the last inspection? The AQAA tells us that since the last inspection the service has increased staffing to facilitate improved opportunities for residents to access the community and specific activities particularly after return from day centre during the weekday. The service has been active in supporting a programme of medication reduction for one individual. Staff have attended positive behavioural support training, and protection of vulnerable adults training, in addition to some other mandatory courses. Staff have worked with one resident to enable them to be more independent in their Care Homes for Adults (18-65 years) Page 8 of 34 personal care routine. And with other residents generally to ensure they all understand the complaints process. Some minor repairs have been undertaken including the repair of an office window and the flushing system in a residents ensuite toilet, garden furnisture has been refurbished. A vehicle is now available to staff for the collection of residents in an emergency from e.g day centre, although advocate responses suggest this would benefit residents if this was available more exclusively for the residents and staff of the home more routinely. The Service has initiated house meetings with day centre management to ensure lines of communication are maintained for the benefit of residents. 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. Care Homes for Adults (18-65 years) Page 9 of 34 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 10 of 34 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 11 of 34 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. The needs of residents living in the home are routinely reassessed to ensure these can continue to be met appropriately, documentation to support this is not always clear. Evidence: The AQAA provided by the home in addition to discussions with home staff confirmed that no new admissions have been made to the service for over 5 years. Assessment information on the three existing residents has been reviewed previously and assessed as being satisfactory. Our examination of resident support plans confirmed that appropriate changes to routines and level of staff support are implemented in response to changes in resident needs however minor. The reassessment of assessed needs is not always made clear and no specific mechanism exists for this to happen in relation to existing residents other than through standard reviewing systems, the provider should consider therefore how current documentation can be improved upon to more clearly demonstrate reassessment of needs. Care Homes for Adults (18-65 years) Page 12 of 34 Care Homes for Adults (18-65 years) Page 13 of 34 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. Residents can be confident that staff understand their needs and have access to detailed information to help them, residents are encouraged to develop their skills, exert their independence within a responsible risk strategy. Evidence: We looked at the support plans of three of three residents , we found these to be exceptionally well detailed and individualized reflecting their preferred routines, there is evidence that these are updated in response to some changes in needs and support but the frequency of updating and review is not always evidenced with some of those plans we viewed dated as January 2008, staff we spoke with confirmed residents have both life plan and annual reviews but these are not always evenly spaced apart and there is no system for ensuring plans are updated a minimum of six monthly as we would recommend. Residents are encouraged to take an active role in the household and participate in Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: day to day routines e.g shopping, cooking. food preparation, helping staff walk their dogs. We noted risk information in place for individual residents this should also be routinely reviewed in line with similar frequencies or more often dependent on changes and levels of risk Care Homes for Adults (18-65 years) Page 15 of 34 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. Residents lead busy lives and are enabled to pursue their interests and hobbies, they are supported to maintain links with important people in their lives and make use of the community and its facilities, residents are encouraged to take a role in the household running but are not under pressure to do so, they benefit from a varied diet about which they are consulted and involved in its preparation Evidence: residents have access to day care, educational opportunities at the local college and access to sports and other leisure facilities, additional staffing at key times of the late afternoon/evening and weekends enables residents to enjoy individualized support from staff and opportunities to maintain or extend their community presence. Staff indicated that some residents are enabled to maintain links with important Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: members of their family or friends, residents are not offered their own room keys but capacity assessments in this area have not been established to support the rationale for this, and clearly this needs to happen. Staff and residents decide on what their evening meal will be and staff reported this will usually make use of food stuffs within the fridge and cupboards, records of food prepared and eaten are maintained but not on individualized basis so we are unclear what individual residents diets are like, and the home has been reminded of the need to make this information more clear. Care Homes for Adults (18-65 years) Page 17 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical personal and emotional well being of residents will be better supported by the suggested improvements. Evidence: Support plans make clear individual residents personal routines which can respond flexibly to the needs of residents dependent on their mood, needs and abilities on a day to day basis e.g one resident has a health condition that can impact on his mobility and how motivated he will be some days to do things for himself in regard to personal routines, staff provide support to the level he needs each time. We noted evidence of health contacts and access to routine and more specialized appointments, several residents have seizures and staff have received epilepsy training and routinely monitor seizure occurrence. Some communication problems are experienced by two residents but do not currently have access to speech and language therapists and this needs to be progressed on their behalf. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: Weights are recorded only where staff have expressed a concern regarding the weight or eating habits of an individual resident, we recommend weights are routinely checked and recorded a minimum of two monthly and more often where particular problems are identified. We found that since the last inspection the service is ensuring that medication is kept in a locked cupboard but we found that the key was left in the lock by the person on duty for a period whilst we were in the visit and then after wards in a place that is too easily accessible, the cupboard stores temperature sensitive medication next to a radiator but staff assured us that this is never switched on therefore temperature is maintained appropriately, this will need to be monitored should the radiator usage change. We found an opened bottle of lactulose in a store cupboard which staff advised is no longer used but had not been disposed of, the medication dated from June 2006. The senior staff member on duty was reminded of the need to date liquid medications, boxes of tablets and prescribed drops and creams upon opening for audit purposes and to ensure that out of date medications are discarded responsibly. We noted a list of signatures for administering staff some were for staff who had left and these had not been removed. We examined some MAR sheets and found these to be completed to a satisfactory standard with an appropriate use of codes, we noted two handwritten entries were both unsigned and undated by the person entering the information. Staff have all received training to a basic level in medication administration, the home is recommended to implement improvements to the highlighted shortfalls Care Homes for Adults (18-65 years) Page 19 of 34 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 are able to express their views and are listened to by staff, staff have an understanding of safeguarding issues and systems are in place to protect residents from harm but this could be compromised if shortfalls identified elsewhere in the service are not addressed. Evidence: The service has informed us through their AQAA information that no complaints have been received since the last inspection, and that staff have spent time with residents to ensure they have an awareness of the complaints process and feel able to express any concerns they may have. Residents survey feedback would seem to confirm this. An accessible version of the complaints procedure using words and pictures is on display in the home. Residents were unwell and in bed with colds on the day of our visit, we were therefore unable to test out what they might do if they are unhappy and who they might talk to about this. An advocate told us through a survey response that they felt the service had always responded appropriately if they had raised any concerns. We noted that the home maintains good records of individual resident possessions and monies, we checked two resident cash sums with records and found these to be accurate. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: Staff we spoke with confirmed access to up to date Safeguarding training, and have an awareness of monitoring behaviours and working to agreed guidelines, we noted protocols in place for staff to follow in respect of some behaviours, staff have received SKIP training although some updates are now overdue, physical interventions are not used currently but low level intervention has been used for one client previously and staff felt this needed to be re-instated to ensure the residents safety in an emergency, this is currently under review. Staff have been reminded of the need to ensure such decisions are made in a multi disciplinary forum and not solely by the home staff. Two adult alerts have been raised in 2008 and both are now closed. Staff undertake appropriate behaviour monitoring and this is analyzed by the deputy manager and relevant health professionals to determine staff practice in working with individuals. Staff have also received training in positive behavioural support. Care Homes for Adults (18-65 years) Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a spacious and comfortable home that would benefit from a sustained programme of maintenance repair and upgrading Evidence: Residents live in a large spacious and comfortable home that will benefit from a sustained programme of maintenance, repair and upgrading. Residents enjoy large spacious bedrooms with en suite facilities , and are able to reflect their personal interest and tastes in their personal space. Communal areas are comfortably furnished and homely, but all bedrooms and communal areas would benefit from attention to repairs and maintenance, we noted a makeshift repair using a carrier bag for a missing spindle on a staircase, the main lock to the front door had fallen off the night before having been loose for a while, a skirting board containing an electrical socket was loose and away from the wall, a loft hatch had been left open above resident bedrooms creating a down draft, the boiler in the staff toilet was accessible to residents, and we consider that works would seem to be arranged on a crisis basis rather than as part of a planned schedule. The last schedule of works recorded in the home is for the period 2006/2007 while most works Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: would seem to have been achieved no further schedules for 07/08 or 08/09 are in evidence, maintenance and remedial works are not being responded to quickly enough and the provider is required to ensure that a planned programme of works is in place that also address routine maintenance and repair in a timely manner. The fire log indicates that servicing and tests are being undertaken and staff are participating in regular fire drills, records of this would benefit from making clearer which staff have undertaken fire drills and confirmation that visual checks of fire equipment are also being maintained, and this is a recommendation Care Homes for Adults (18-65 years) Page 23 of 34 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. Residents continue to benefit from continuity of a small committed staff team, whilst outcomes for them remain generally good this could be undermined if ongoing limitations within the flexibility of and staffing complement for the home and in the standard of induction for new staff are not improved. Evidence: The AQAA information provided by the service informs us that the service has exceeded the numbers of NVQ 2 level staff and this has been confirmed in discussion with staff at the visit, who demonstrate a good understanding of the needs of individual residents and undertake to update their practice and knowledge. We looked at the staff rota this indicates that most shifts are covered within the small team of five committed and dedicated core staff, whilst this has improved from the last inspection and now facilitates improved opportunities for residents to access the community on a 1-1 basis. The staff have acquired regular shifts and arranged their commitments outside the home to fit around these, this leaves little flexibility for them to cover additional shifts at short notice. The provider is aware of these problems and has recruited two additional staff at his other home who he hopes will be able to provide more flexible cover for some shifts at Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: short notice, in addition to those covered by the provider himself. On at least one day per week all the residents are out at day centre, and the home is not staffed while they are out. In discussion with members of the staff team they indicated that their own commitments would make it difficult for them to cover in the event that a resident was unable to attend day centre on that day, in this instance albeit rare residents have been moved to the providers other home for the day, this is not an acceptable practice and must cease. The provider is required to ensure that the staff rota and staff complement is sufficiently flexible to accommodate changes in residents health and circumstances and is able to absorb normals levels of staff annual leave and sickness without undue impact on the residents or their daily routines. We looked at staff recruitment files and the home has ensured that appropriate level of vetting and checks has been undertaken however the content of staff files failed to comply with schedule 2 of the care homes regulations in that files lacked current photographs, evidence of personal ID and recruitment information failed to evidence that gaps in employment or verifications for reasons for leaving previous caring roles had been sought from applicants and the service is required to implement these improvements. In discussion staff confirmed that mandatory training has been completed for most staff however the newest staff member who has been in post for nearly one year, is still to complete all mandatory training,and none of the staff team routinely undertake moving and handling taring as all of the residents are generally mobile, however one resident has a health condition which does from time to time impact on his mobility and the level of personal support provided by staff, where even a minimal amount of moving and handling is provided we feel it is appropriate that staff update their knowledge and awareness of appropriate practice around the moving and handling, to ensure this is undertaken safely and also protects their own health and safety and this is a recommendation. We also consider that whilst the home has ensured that new staff undertake an induction into the service and the deputy indicated this would involve their acquiring a good understanding of individual residents and their needs, the induction is not in keeping with nationally agreed common induction standards as set by Skills for care, and the provider is required to revise the existing induction programme to ensure it complies with that established by skills for care for staff in care homes for learning disabled adults. Staff confirmed the home now has INTERNET access which makes it easier for staff to access information and keep updated about current thinking and best practice in relation to the health and welfare of residents. Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: Staff confirmed they feel well supported by each other and the deputy manager who ensures the staff team receive regular 1-1 supervision time with her but they did not feel generally listened to or able to influence service development overall although there are indications that at individual resident level their views are influential in the manner in which practice and support are delivered. Care Homes for Adults (18-65 years) Page 26 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The absence of sustained management oversight and input is beginning to impact on service quality and may compromise outcomes for residents. Evidence: The AQAA provided by the home has not been completed by the manager and is not to a sufficiently reasonable standard that tells us all the information we need to know about the service; its current operation, how it has improved in the last 12 months and identified areas for improvement and future plans. It is clear from discussion with staff and a review of records that the provider/manager spends a disproportionate amount of time at the other home he operates compared to this service. Whilst it is clear that the staff team are experienced and knowledgeable and the home has been stable for many years, the absence of management input is placing undue pressure on the staff who feel neither well supported, listened to or able to influence service development. We do not consider that the manager is currently fulfilling his role to oversee the performance and practice of staff or to ensure the Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: health and safety of residents is maintained in accordance with his responsibilities, and will need to revise the present arrangements. The deputy manager indicates that a quarterly review of outcomes for residents is undertaken and also a health and safety audit, this information is made available to the provider but is not published, and does not form part of a wider quality assurance system for self audit and review. Although opportunities are provided for residents to express their views to staff in different ways this information is not captured in any formal system of surveys or recording and cannot be evidenced as influencing service development. Whilst it is clear that the service has commenced the process for auditing its service this needs further development and must incorporate the views of residents and other stakeholders and we recommend this is progressed. The service has commenced keeping some records on computer, but the recent breakdown of the homes computer meant that support plan information could not be accessed to update it, back up disks had not been made, it is essential if the service is to try and work in a more paper free manner that appropriate safeguards and protocols are in place to ensure information is managed securely, appropriately and can be accessed and updated and we would recommend these arrangements are reviewed. We have looked at the accident records for the service and noted some admissions to A&E for one resident that we had not been notified of, we would recommend that the provider and staff remind themselves of their reporting responsibilities under regulation 37 of the care homes regulations 2001, and ensure future events are notified in a timely manner accordingly. The service has informed us in their AQAA information that health and safety servicing and checks have been undertaken and are up to date, but have been unable to confirm the last date when the electrical installation was serviced and when this is next due, from the condition of some fittings and wiring we are concerned that this may be overdue and require the provider to send CSCI confirmation of the last date the electrical wiring installation was checked by an electrical contractor and their recommended date for rechecking, if this is now overdue the provider is required to have the electrical wiring within the home checked within the timescale given. During our visit and from discussion with staff we noted that practice in respect of the security of keys to medication and staff recruitment information has become slack and this needs review and is a recommendation. Whilst we noted a previous development plan and works schedule for 2006/2007, and Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: the majority of this has been achieved, no further schedules are recorded for 2007/8 or for 2008/9 and yet our visit and tour of the premises clearly highlights areas of upgrading and repair are needed, we are not satisfied that such repairs are undertaken in a timely manner or that the health and safety of the residents is being sufficiently protected and we have required the provider to ensure that a programme of maintenance and repair is put in place and that repairs are managed in a timely manner. Care Homes for Adults (18-65 years) Page 29 of 34 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 34 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 24 23 The provider must ensure 30/01/2009 that a programme of maintenance and repair is implemented that: gives clear timescales for completion of works. Responds in a timely manner to emergency repairs or those that impact on the health and safety of residents. Can evidence sustained upgrading of the premises in response to changing needs of residents To safeguard the health and safety of residents and staff. To ensure residents live in a well maintained property that continues to meet their needs 2 33 18 The provider is required to ensure that the staffing complement and roster for the service is sufficiently flexible to accommodate changes in the health and 30/01/2009 Care Homes for Adults (18-65 years) Page 31 of 34 circumstances of individual residents and the everyday annual leave entitlements and average sickness levels of staff. So that there are always staff available to support residents in their own home and to facilitate external activities 3 35 18 The provider must ensure 30/01/2009 that new staff are inducted in compliance with skills for care common induction standards for staff working with learning disabled adults To ensure new staff are provided with the nationally agreed basic knowledge and competencies to fulfill their role effectively. 4 42 13 The provider must provide evidence to the Commission of when the electrical wiring was last serviced and the contractors recommended renewal date for this. if this is now overdue the provider must arrange for the electrical wiring to be checked again within two months from the date of inspection and provide evidence of this and the outcomes. To safeguard the health and safety of residents and staff 10/01/2009 Recommendations Care Homes for Adults (18-65 years) Page 32 of 34 These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 6 19 20 Service to evidence that support plans are reviewed a minimum of six monthly Provider to ensure resident weights are recorded regularly Provider to ensure that all handwritten entries on MAR sheets are signed and dated by the person entering the information. All medications outside of the MDS system should be dated on opening or commencement of use e.g drops, creams, liquid medications, boxes of tablets Out of date/out of use medications should be disposed of responsibly and in accordance with pharmaceutical guidelines 4 24 Fire log to make clear which staff have undertaken fire drills and this should not be less than twice annually. Fire log to make clear that visual checks of equipment are being conducted Automatic closures to be fitted to bedroom doors to avoid necessity of wedging doors open and compromising fire safety 5 35 All staff should receive training in the moving and handling of residents to maintain and promote the health and safety of residents and themselves. The provider must progress the development of an integrated quality assurance programme that takes into consideration the views of residents and other stakeholders and can evidence how this influences service development The provider should ensure that protocols are developed for the maintenance, security and accessibility of computer based records The provider and staff should remind themselves of their reporting responsibilities under regulation 37 of the care homes regulations 2001 and ensure that such notifications are made in a timely manner. The provider should review the present security arrangements for keys to medication and staff recruitment information 6 39 7 40 8 42 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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