Inspection on 20/11/08 for Heathcotes Care (Hucknall and Watnall)

This inspection was carried out on 20th 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heathcotes Care (Hucknall and... 10/08/06

Heathcotes Care (Hucknall and... 21/02/06

Heathcotes Care (Hucknall and... 20/09/05

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Heathcotes Care (Hucknall and Watnall) 220 Watnall Road Hucknall Nottingham Nottinghamshire NG15 6EY     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: Susan Richards     Date: 2 0 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 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: Heathcotes Care (Hucknall and Watnall) 220 Watnall Road Hucknall Nottingham Nottinghamshire NG15 6EY 01159636379 01159638222 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Keeley Ward Type of registration: Number of places registered: Heathcotes Care Ltd care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is 12. The registered persons 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 are within the following categories: Learning disability - Code LD Mental Disorder - Code MD. Date of last inspection Brief description of the care home Heathcotes comprises of two large detached houses situated in an established residential area of Hucknall and Watnall on the outskirts of Nottingham. The home is within a few minutes of local amenities including a garage, shop and public house. Accommodation in each house provides for up tosix people with a learning disability in single rooms. The majority of these have en suite lavatories and washbasins, although Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 0 12 12 Brief description of the care home two also provide an en suite shower facility. There is also shared bathing, dining, lounge, laundry, and kitchen facilities in each house and large gardens accessible to residents. 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: The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. For the purposes of this inspection we have taken account of all the information we hold about this service. This includes our annual quality assurance assessment questionnaire (AQAA), which we ask the home to complete on an annual basis in order to provide us with key information about the service. We also received survey returns from most of the people who use the service, from some staff who work there and also two relatives of service users that live there. Comments that were made by peopole who use the service, included, Care Homes for Adults (18-65 years) Page 6 of 32 I like living here. The staff support me. I dont have any problems with them. I do jobs in the house and I enjoy swimming and going on holiday. At this inspection we used case tracking in our methodology, where we looked more closely at the care and services that two people receive. We spoke with people and observation of staff interactions with them, looked at their written care plans and associated health and personal care records and also at their private and communal accommodation. We spoke with staff about the arrangements for their recruitment, induction, training, deployment and supervision and we examined related records. We also spoke with the manager, about the arrangements for the management and administration of the home and we examined associated records. All of the above was undertaken with consideration to any diversity in need for people. The minimum weekly fee charged by the home is fourteen hundred pounds. These are determined in accordance with individuals assessed needs and may include a local authority contribution for those eligible. Further information about fees and what they cover can be obtained directly from the home. What the care home does well: What has improved since the last inspection? What they could do better: Fully consider peoples capacity to consent within the scope of the Mental Capacity Act 2005 and their capacity to consent recorded within their care files. So they may be properly supported to make key decisions about their lives. Ensure that the homes quality audit of medicines systems is fully operational in order to promote best practise. Ensure that full complaints records are kept in the home and are made available for inspection. Ensure safe access for people via the dining room patio door in the Watnall House into the garden and improve decor in communal bathrooms. Include communication skills and Mental Capacity Act training for staff in the homes training plan. Ensure they receive training in first aid and report writing, including incident reporting and that a minimum of fifty per cent of staff have at least NVQ level Care Homes for Adults (18-65 years) Page 8 of 32 2 in care. Ensure good practise with regard to incidents of aggression that may occur in the home by way of internal incident report and post incident review records. 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. Peoples needs and individual aspirations are suitably assessed. Evidence: At our last key inspection we judged that peoples individual aspirations and needs were suitably assessed. In our annual quality assurance questionnaire that we asked the home to complete they told us that they ensure a thorough admission and assessment process for people. And, about how they aim to make further improvements in this area over the coming months. At this inspection people told us they were asked if they wanted to move into the home and were provided with information to help them. We also saw how the home are developing their approach to assessing individual service users potential compatibility with others already living at the home. And how service users are involved in determining a more person centred approach to their individual needs Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: assessment. These tell us that peoples individual aspirations and needs are suitably assessed. Written records that we examined, including individual needs assessment information were comprehensive and we could see where improvements were being made aimed at promoting compatibility with others living in 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. Peoples risk assessed and changing needs are reasonably well accounted for. Evidence: At our last key inspection we judged that peoples changing needs and goals were identified, although support plans did not effectively prescribe how these would be achieved. And, although people were supported in making decisions about their daily lives, they were not best protected due to the lack of clear risk management plans. Because of our findings at that inspection, we made one requirement about risk management care planning and also one recommendation about developing key areas of individuals support plans. The requirement was found to be complied with at this inspection and the recommendation is partially achieved. In our annual quality assurance questionnaire that we asked the home to complete, they told us that peoples rights to make choices about their lives and their Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: independence is suitably promoted via their written care plans, reflecting their individual daily living preferences and with suitable arrangements for their ongoing review. At this inspection most people told us they can do what they want during the day and all said they could at weekends. Further discussion with staff and examination of peoples care plans told us that restrictions on peoples freedoms are in accordance with their risk assessed needs and in consultation with them. Care plans that we saw were recorded in a person centred style and were provided in a format that service users could more easily understand as well as a standardised format. There was written evidence of regular reviews and that key staff had read and understood them. Care plans that we looked at were fairly comprehensive in addressing care interventions required, which accorded with peoples risk assessed needs, including individualised procedures where people are likely to be aggressive. Health action plans were being introduced for each service user, which included information about their one to one communication support needs. However, we are advised via recent satisfaction surveys that the home had conducted with outside professionals and relatives/supporters of service users and also from feedback directly to us, that staff did not often change their communication style to suit, when interacting with residents. We spoke with staff about staff their training arrangements, including relating to peoples specialist communication needs and looked at the homes training plan. This told us that many staff had not undertaken training and instruction in this area. (See also staffing section of this report). Some people told us about some of the decisions that they make about their lives, which were reflected in peoples risk assessment and care planning records. Information was available in the home for staff about the Mental Capacity Act 2005, although staff that we spoke with were not conversant with this. Health action plans that are being introduced go some way towards considering peoples capacity to consent to these, however, their actual capacity to consent and make significant decisions about other areas of their lives, including final requests associated with death and dying and financial arrangements was not recorded in their care plans, which tells us that this may not have fully considered. Care Homes for Adults (18-65 years) Page 14 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities for peoples social and educational development are reasonably well promoted, together with their rights and responsibilities within their daily lives. Evidence: At our last key inspection we judged that people had opportunities to engage in suitable activities, both within and outside the home, maintain their personal and familial relationships and to take responsibilities within their daily lives. We also said that people were provided with healthy meals, which they enjoyed. In our annual quality assurance questionnaire that we asked the home to complete they told us they have continued to ensure the above and also about ways in which they intend to build on their existing practise, with emphasis on ways of improving communication links with peoples families. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: At this inspection people told us about some of the activities they engage in during the day and at weekends. These included individual social, leisure and educational activities and responsibilities for household tasks. A number of residents were out at college during the day of our visit, which included access to cookery, library and literacy skills. One person was engaged in household tasks and reading during the day of our visit and told us that she regularly enjoyed swimming, reading, holidays and helping to choose menus. She also said that residents meet with staff once a week during which they discuss the coming weeks menu arrangements. Two other residents were proud to have received a formal award from a local community trust for voluntary environmental work they had undertaken and one of those was also making progress with regards to their independent access to the community. Links with friends and families are recorded in individuals care planning records and people are provided with keys to their own rooms in accordance with their risk assessed needs and choices. Recent feedback obtained by the home via satisfaction surveys in relation to the arrangements for peoples occupation and leisure were overall positive. Care Homes for Adults (18-65 years) Page 17 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. Peoples personal and healthcare support needs are well met. Evidence: At our last key inspection we judged that peoples personal and healthcare needs were well met in accordance with peoples preferences and assessed needs. We made a quality recommendation relating to medicines record keeping practises that were found to be achieved at this inspection. In our annual quality assurance questionnaire that we asked the home to complete they told us that they have continued to ensure peoples personal and health care needs are met and that this is now achieved in a more person centred way using individual support plans. They also told us that they aim to improve further over the coming months by way of identified staff training and by introduction of suitable healthcare information booklets for service users. At this inspection people told us about suitable arrangements for their personal support by way of a key worker system and also to enable them to access relevant Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: outside health care professionals, including their own doctor where necessary. Individual needs assessment and care planning records that we looked at accounted for peoples preferred personal support arrangements and their health inputs, including some arrangements for routine health care screening. Individual health action plans were being introduced for each service user, providing comprehensive person centred and holistic support interventions necessary to maintain a persons optimum health. This includes a consent form and a record as to individuals capacity to understand their plan. We looked at some recent satisfaction survey returns that the home had conducted with service users, their relatives and representatives. Overall feedback date indicated that people are usually well supported. One placing authority representatives commented that our client is now much healthier, safe and secure and with positive outcomes. Although, there were some areas that people completing those surveys had identified where they felt improvements could be made. Discussions with staff and examination of relevant individuals personal support plans and the health action plan initiative tells us that the home is acting positively to address issues raised and in the service users best interests. We also found that the arrangements for the management and administration of peoples medicines to be overall satisfactory, with one area where there was a quality issue in terms of the way in which a medicine was recorded. In July 2008 external management had introduced a recording format for ensuring regular internal quality auditing of medicines practises, although to date these had not been undertaken. Discussions with staff indicated that they they were not clear as to whose responsibility it was for their completion. 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. Peoples views are taken seriously by the home and they are protected from abuse. Evidence: At our last key inspection we judged that peoples views and concerns were listened to and acted upon and that they were suitably protected from harm and abuse. In our annual quality assurance questionnaire that we asked the home to complete they told us that people are encouraged to raised concerns and complaints and are protected from harm and abuse. They told us that they have been working to improve their management and monitoring systems in respect of complaints and protection, although felt that they needed to further improve in respect of reporting procedures relating to the occurence of serious incidents in the home and have introduced a revised procedure and format for the reporting and recording of incidents for staff to follow. They also gave us some information about complaints they have received over the last twelve months. This tells us that the home has received two complaints, including one allegation of financial abuse of a named resident, investigated via recognised joint agency safeguarding adults procedures. The information we hold about the home tells us that they have followed correct policy Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: and procedures concerned with the latter in terms of reporting to the relevant authorities and ensuring peoples safety. At this inspection we looked at the arrangements for the management and handling of peoples personal monies. Arrangements for safekeeping and record keeping in respect of these are satisfactory. We were advised by the manager that formal requests for individual capacity assessments have been requested via recognised procedures with regards to peoples financial arrangements. Although we did not see documentary evidence of this within peoples care records. We also examined the homes complaints record, which gave details of complaints that the home had told us about in their AQAA return. Records relating to the investigation, outcomes and action taken in respect of these were not available in the home, although we are fully informed as to action and outcomes relating to the complaint investigated via safeguarding adults procedures. We are advised that these were retained via the regional manager. People who use the service told us that they know how to complain and we saw that they are provided with information about how to complain in a simple format. Staff that we spoke with were conversant with the homes policy guidance concerned with recognising abuse and procedures to follow in order to safeguard people from abuse. They also confirmed that they received suitable and recognising training with regard to dealing with aggression from service users from an internal accredited trainer and the homes training records and plan reflected this. A recent serious incident that had occurred in the home, arising from an episode of physical aggression by a service user. Information we hold about the home tells us that suitable action was taken with regard to the reporting of this incident to relevant authorities. However, at our visit, there was no an internal incident report completed in respect of this, nor a formally recorded post incident review. (See management section of this report). 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. People benefit from living in an environment, which is clean, homely, comfortable, generally well maintained and which suits their needs. Evidence: At our last key inspection we judged that people lived in a safe, clean, homely and comfortable environment. We made one recommendation relating to the laundry flooring, which is seen at this inspection to be achieved. In our annual quality assurance questionnaire that we asked the home to complete, they told us that people continue to benefit from their environment, which is well maintained, well lit and furnished. They told us about some routine maintenance and decoration improvements that they have made, which they aim to continue with as necessary. At this inspection people told us that the home is always fresh and clean. We undertook a tour of both houses and looked at the private and communal areas accessed by people that we case tracked. All are provided with single room accommodation having en suite hand basins and Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: wcs, although one bedroom in each house also have a shower provided to their en suite. people told us that were satisfied with their own rooms, all of which were personalised and well furnished and decorated. And that they liked living at the home, which we saw was comfortable clean and well furnished and decorated. People had also enjoyed their involvement in painting a mural scene in one room being converted for use as a sensory room and they are provided with keys to their own rooms, which are master suited in accordance with their risk assessed needs and choices. However, we did observe that the patio door from the dining room into the garden in the Watnall House, had no ramp or steps down, with a fairly large drop into the garden. That the walk in shower room in the Hucknall house has no facility for people to hang their towels or clothing there and that communal bathrooms were stark and uninviting. The environmental health officer had recently visited the home and made a number of requirements and recommendations. Gardens are well kept and spacious, being eqiupped with football nets and a large trampoline, which one service user used during our visit. Bicycles are also available for people to use. 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. Overall people are reasonably well supported from staff that is effectively recruited, deployed and supervised and for the most part trained. Evidence: At our last key inspection we judged that people were supported from competent staff and protect from the homes recruitment policy. In our annual quality assurance questionnaire that we asked the home to complete they told us that staff is effectively recruited, inducted, trained, supervised and deployed. They told us about some improvements they are making in relation to staff roles and responsibilities and also by introducing the Skills for Care Common Induction standards for staff and implementing a formal workforce plan for the coming twelve months. They also gave us some statistical information that we asked for relating to service users accommodated and staff employed. At this inspection, people told us that staff treat them well and listen and act on what they say. Staff that we spoke with were conversant with their roles and responsibilities. They Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: told us that they are usually given training relevant to their role and that proper employment checks were carried out before they started. They also said that there are usually sufficient staff on duty to enable them to undertake their role. However, evidence that we have recorded under the Complaints and Protection section of this report tells us that some staff may not be conversant with and have not implemented the homes policy and procedures in respect of incident reporting. Although there were some variable responses with regards to individuals induction in preparing them for their role. We can see the action the home is taking in introducing recognised common induction standards should address this. Records that we examined in relation to staff recruitment, training, supervision and deployment were largely satisfactory. Although the homes training plan showed that there were some areas where staff training needed to be provided. These included first aid training and report writing. And communication was also not included in the training plan. Information provided by the home tells us that out of thirty staff, six have achieved at least NVQ level 2 or above, with ten staff currently undertaking these and with plans to enrol remaining staff to undertaken these. 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 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 reasonably well managed and run, although record keeping practises in respect of incident reporting procedures may not always promote peoples best interests. Evidence: At our last key inspection we judged that people benefitted from a well run home, with their health safety and welfare promoted and protected and their views accounted for. In our annual quality assurance questionnaire that we asked the home to complete, they told us that the home continues to be well managed and run in peoples best interests. That they have started to introduce improved governance and management systems and aim to develop and consolidate these via quality assurance and monitoring systems. At this inspection staff told us that they are usually given up to date information via internal communication systems to assist them in supporting people who use the Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: service. The registered manager told us about the training she has undertaken over the last two years, which is satisfactory and relevant to the needs of the service. There has been three changes of manager over the last twelve months. However, staff were keen to tell us that the return of the current registered manager, along with the support from external management has provided greater stability and consistency in care practises to the benefit of people who live and work in the home. We looked at the homes quality assurance and monitoring systems that have been introduced recently. These included reports of the monthly visits to the home from a representative of the registered provider, monthly service audits and satisfaction surveys recently sent out to service users, their relatives and represenatives. A number of returns had been received by the home at the time of our visit, which indicates overall satisfaction with the services the home provides. Matters arising are referred to under the relevant sections of this report. We also looked at the arrangements for safe working practises by talking with staff and examining some records. This tells us that overall these are satisfactory. Although a recent visit from the local authority environment health officer had resulted in a number of requirements being made, including relating to incident reporting and recording. At this inspection we found that there was no recorded internal incident report or post incident review record following a serious incident from aggression, which occurred in the home some months previously. Although the incident was reported to outside authorities, including the Commission and environmental health officer. One staff member had also formally raised concerns about this via the homes complaints procedure. (See also Complaints section of this report). We discussed this with the manager at our visit and also with the regional manager following our our visit. We also observed a potential hazard to peoples safety during our tour of the houses. This is referred to under the environment section of this report. 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 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 7 12 People must be properly 28/02/2009 consulted about their care. Capacity to consent must be considered fully within the scope of the Mental Capacity Act 2005 and individuals capacity to consent recorded in accordance with key decisions made. To ensure people are properly supported to make suitable decisions and choices about their lives. 2 22 22 A statement must be 31/01/2009 provided to the Comission containing a summary of the complaint raised by the team leader on 27 May 2008 and the action that was taken in response So that a determination of the outcome and action taken in response to this complaint is provided. 3 24 23 Necessary works must be undertaken to provide a 28/02/2009 Care Homes for Adults (18-65 years) Page 29 of 32 ramp or step(s) from the rear patio door into the garden in the Watnall House. So as to ensure safe access through that patio door for service users to and from the garden area. 4 34 18 The staff training plan must include training in alternative communication skills and methods relevant to peoples needs and provided to all staff. So that staff consistently communicate with individual services users in accordance with their assessed needs. 5 35 18 Staff must receive the training they need. In this instance roll out of the Skills for Care Common Induction standards must be completed for all staff, together with first aid and report writing training. So as to ensure that staff receive training appropriate to the work they are to perform and that people needs are met by appropriately trained staff. 6 41 17 A record must be kept in the 31/01/2009 home of any incident or injury, which may be detrimental to the health and welfare of a service user. So as to effectively account for any serious incident that 28/02/2009 28/02/2009 Care Homes for Adults (18-65 years) Page 30 of 32 may occur involving any service user. So as to provider a clear audit trail and to promote a post incident review of practise, which may assist in the prevention of future like incidents. 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 Hand written medicines instructions that are made by staff onto a service users medicines administration record sheet should be signed and dated by the person recording these and countersigned by a staff member witnessing these. Staff responsibility for the completion of the homes quality audit of medicines practises in the home should be clear identified and these should be completed as necessary. Where a serious incident occurs involving aggression by any service user, there should be a formal post incident review, which includes all staff involved and a record kept of this. In order to seek to prevent any re-occurence. There should be suitable provision in the ground floor walk in shower room in the Hucknall for people to hang their towels and clothing. Consideration should be given to providing suitable decor in communal bathrooms to make them less stark and more inviting and comfortable for people to use. Staff should always understand and implement the homes policies and procedures. In this instance with regard to incident reporting, all staff should sign to say they have read and understood these. At least fifty per cent of staff should achieve at least NVQ level 2 in care. 2 20 3 23 4 24 5 24 6 31 7 32 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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