Inspection on 08/10/08 for Heathcotes Care (Sawley)

This inspection was carried out on 8th October 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 (Sawley) 23/04/08

Heathcotes Care (Sawley) 25/04/07

Heathcotes Care (Sawley) 22/08/06

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 29/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Heathcotes Care (Sawley) 1 Bradshaw Street Sawley Nottinghamshire NG10 3GT     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: 0 8 1 0 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 37 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 37 Information about the care home Name of care home: Address: Heathcotes Care (Sawley) 1 Bradshaw Street Sawley Nottinghamshire NG10 3GT 01159721376 Telephone number: Fax number: Email address: Provider web address: enquiries@heathcotes.net/sawley@heathcotes. net Name of registered provider(s): Name of registered manager (if applicable) Heathcotes Care Ltd Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Heathcotes Care Home is located in a quiet residential area of Long Eaton on the Derbyshire and Nottinghamshire border. The home is a purpose built and provides personal care and support for up to six adults with learning disabilities and who may have complex needs and associated challenging behaviours. In its Statement of Purpose the service aims are stated as being based on the principles of Valuing People as identified within the governments white paper as a way forward in improving the lives of people with learning disabilities. The home comprises of two floors with each floor having spacious bedrooms, each with its own en-suite facility. There are communal dining area, lounge, kitchen, bathroom, two showers and level access to an external garden to the rear of the property. Car parking is available at the front. The home is within a few minutes walk of local shops and amenities and within easy reach of the cities of Derby and Nottingham. People are provided with personal care and support from a team of care staff led by an acting manager and with external Care Homes for Adults (18-65 years) Page 4 of 37 6 Over 65 0 Brief description of the care home management support. Up to date details as to the range of fees charged and what they cover was not requested at this inspection. This information can be obtained directly from the home and their service information. Care Homes for Adults (18-65 years) Page 5 of 37 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 and some staff who work there. At this inspection we used case tracking in our methodology, where we looked more closely at the care and services that two of those people receive. We did this by talking Care Homes for Adults (18-65 years) Page 6 of 37 with them, observation of staff interactions with them, looking at their written care plans and associated health and personal care records and by looking 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 acting manager and regional 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 What the care home does well: What has improved since the last inspection? At our last key inspection of this service in April 2008 we judged the overall quality rating of the service to be poor. As a result of this, the home was included in our improvement strategy. We told the provider what they needed to do to improve the service and why and asked them to provide us with an improvement plan, which they did. In July 2008 we carried out a random inspection of the home to look at their progress in complying with the requirements we made in our report from our key inspection and their improvement plan. As a result of the homes failure here to ensure sufficient stafing arrangements, including induction and specified training, we issued a statutory requirement notice to the provider. This told them that they must comply with requirements stated there within a specified timescale, or risk prosecution. We also made a further three requirements at that visit relating to safeguarding people, record keeping and incident procedures. At this inspection we found that considerable work had been undertaken and with most of the requirements made at our key and random inspections complied with. With the exception of one area relating to staffing arrangements as specified on the statutory requirement notice. However, as this was partially complied with and with consideration to the substantial progress made by the home in improving its service, we agreed an extended timescale for completion of this area. We will continue to monitor their compliance with this via our inspection process. Areas of improvement have included, A review of the key service information, admissions and needs assessment criteria, aiming to improve the matching process and to ensure that people are not admitted to the home, or do not remain in the home when their needs cannot be met there. Care Homes for Adults (18-65 years) Page 8 of 37 Development of the care planning format, which remains ongoing and compliance with requirements made about medicines practises. A review of staff deployment, induction and training arrangements, with significant progress to date in ensuring that the latter are rolled out to staff. Review and development of safeguarding procedures and including training for staff. Significant improvements have been made in the management and administration of the home. These include the introduction of a total quality assurance and monitoring system. 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 37 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 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Revised service information, admission and review procedures should reduce the possibility of inappropriate admissions to the home, ensuring that peoples needs can be met there. Evidence: At our last key inspection of this service we judged that the service guide did not always best inform people in their choice to live at the home, and that peoples needs were suitably assessed. We made two requirements about information that needed to be provided within the homes statement of purpose and service guide. We carried out a random inspection visit in July 2008 and found that those requirements were met. In our annual quality assurance questionnaire completed by the home, they told us that they operate a thorough admissions process and that people are provided with the information they need to assist them in choosing the home. They told us about the Care Homes for Adults (18-65 years) Page 11 of 37 Evidence: improvements they have made since the last key inspection, which were evidenced at our random inspection. They also told us that they aim to improve their admissions process further by engaging independant advocacy and reviewing their matching process in order to ensure appropriate admissions to the home. At this inspection three people surveyed told us that they were asked if they wanted to move into the home, although two people said they were not. Three people told us that they were given enough information about the home before they moved there and three said they were not. However, the latter had lived at the home for some time prior to the improvements being made that are referred to above. Relatives that we spoke with, told us that they had been able to look around the home and had been given information before they had made the decision to choose this service. This was both written and verbal and included re-assurances that the service was able to meet the prospective residents needs. There was a written record in one persons care file to support that they had been able to visit the home on three occasions, including an overnight stay, before they were admitted. Their needs assessment information was not dated or signed by the assessor, although documentation suggested that this had taken place before their admission to the home. However, those relatives told us that the standard of care received had not met the expectations given to them pre-admission. The manager told us that the company had very recently introduced new admissions procedures, these were seen in the policy file and included a new policy, which directed staff to look at how compatible the placement would be, taking into account the needs of people who were already living in the home. There had been no new requests for admission to the home since this policy was introduced, which meant the policy was yet to be operated and will need to be monitored in order to ascertain its efficacy. Care Homes for Adults (18-65 years) Page 12 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans have improved, although do not always best account for interventions required by staff to asssist and support people in accordance with their individual capacity and decision making abilities, which may potentiate conflicting approaches to peoples care and support. Evidence: At our last key inspection of this service in we judged that the introduction of the revised care planning format proposed should promote a more person centred approach to peoples care and in their better interests. Although that this may not be realised without the right staffing arrangements to underpin this We made a requirement timescale for the home to complete the introduction of the new care planning format so as to promote consistency of care and provide staff with the information they need to assist them in supporting people who use the service. Care Homes for Adults (18-65 years) Page 13 of 37 Evidence: At our random inspection of the service undertaken in July 2008 this requirement was met. In our annual quality assurance questionnaire recently completed by the home, they told us that they promote peoples individual daily living choices in accordance with their risk assessed needs. They also told us that they have improved by engaging greater involvement for people from independanct advocacy, but feel they could further improve by developing their communication methodology for staff by way of training and materials provision. At this inspection two people surveyed told us that they always make decisions about what they do each day and two said they usually do. Staff told us that they are given up to date information about peoples needs and said that care plans are kept up to date and that they now sign to confirm they have read these. Each person had written care plans in their files. These comprised of two elements. A simplified and person centred care plan booklet, which included opportunity to record what is important to that person and ways in which they can achieve their goals and ambitions and a detailed comprehensive care plan, aimed at staff use, but which people had been asked to sign to agree. We discusssed this with the manager, as the language and terminology in the more detailed staff care plan would be hard for most people living at the home to understand to agree. We also saw that that peoples individual capacities to consent was not considered or recorded and that the detailed staff care plan was not person centred, which may potentiate conflicting approaches to peoples care. The manager agreed to consider these issues. Care plans with short term goals had recorded reviews, although longer term goals and health monitoring instructions were were sometimes being missed and did not have recorded reviews within previously identified timescales. (See also Lifestyle and Healthcare sections of this report). Staff were observed to support people in making decisions and people also told us about examples where they had been able to decide how to spend their day. Although there was little use of alternative communication methods from staff for people who were non-verbal, which may impact on their opportunity to make decisions about their daily lives. (see also staffing section of this report). Care plans were formulated in accordance with peoples risk assessed needs and reviews of identified risks were consistently recorded. One person told us they were supported to take some considered risks, such as going on the bus alone, unsupervised for short and familiar journeys, which was well recorded. Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: Care Homes for Adults (18-65 years) Page 15 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although people can take part in a range of activities, opportunities for their personal, social and educational development do not always accord with their choices, expectations and goals. Evidence: At our last key inspection of this service we judged that the full introduction of the revised care planning format should better determine peoples lifestyle opportunities with them. But that this may not be realised without the right staffing arrangmeents to underpin this. We recommended that peoples access to activities continued to be developed. In our annual quality assurance questionnaire completed by the home they told us that people are supported and encouraged to engage in social, leisure, eductional and work Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: based activities, to retain their independence and to maintain their personal contacts and family relationships as they choose. They also told us that they have started to look at how they can promote healthy lifestyles for people, although did not tell us how they aim to achieve this. At this inspection people told us that they they can usually do what they want during the day and at weekends. Although staff felt that the home could do better by provding a wider range of activities for people who use the service. Recent satisfaction surveys had been conducted by the home with residents, relatives, staff and other stakeholder and many returns were received. Those we sampled indicated that people felt improvements could be made in securing funding and targeted individual activities for people. The manager told us that they were planning to assist two people to attend college placements and also looking to support another person towards more independant living arrangements. Relatives and one of the service users told us that this was a clear expectation that these would be provided. However, their care files did not provide for a structured or pro-active plans for staff to follow to assist and support people in achieving these goals. People told us about some of their recreational and leisure time spent in the local and extended community. Examples include youth club attendance, local pub, shopping, day trips to the coast and a holiday, visit to and from friends and relatives, including overnight home visits. Activity plans were recorded, providing a programme of what each person would do during various parts of the day. Although we found that these did not provide an accurate reflection of what people were actually doing. Relatives told us that many activities seemed to be based around the home and immediate vicinity, with local walks often the only activity afforded. Records that we looked at suggested that this may be so and there di not seem to be good use made of local initiatives or clubs in supporting a diverse activity programme that was age appropraite. On the day of our visit we accompanied three people with staff support on a swimming activity regularly arranged. We were advised that these sessions were an opportunity for people to socialise with people living in other care homes owned by the same group, with two or three homes linking into this. However, staff did not know which people would be attending from other homes or the skill mix or gender of staff accompanying them. This impacted on gender supervision in changing rooms and there was confusion on arrival as to the times actually booked, which also impacted on the time people were able to spend in the pool. Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: People told us they helped in choosing food and sometimes with shopping and that they usually liked the meals at the home. One person we case tracked had written records kept as to their dietary intake, which accorded with their care plan, although we did not focus closely on meals and mealtimes at this inspection. Care Homes for Adults (18-65 years) Page 18 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are reasonably well supported to maintain their health and personal care needs. Evidence: At our last key inspection of this service we judged that people mostly received personal support in the way they prefer and their health care needs were being met. We made three requirements about medicines practises in the home. These were found to be complied with at our random inspection visit in July 2008, where we made one recommendation relating to medicines records and which is complied with at this inspection. In our annual quality assurance questionnaire completed by the home, they told us that peoples personal and healthcare needs are met. They told us about some of the improvements they have made over the last 12 months and also improvements they aim to make, which tells us that they are seeking to promote peoples independance with regard to their health promotion. At this inspection one person told us that staff help them to visit the doctors and Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: dentist. They said that they could attend appointments unaccompanied and that staff merely guided them during these visits. There was plenty of evidence in care files to show that people were linking in with their local G.P., for hospital appointments and to see community nurses. However, one person had a new health problem identified, that required monitoring by staff at the home and the community nurse, although there was no reference to this in the persons care file, including instructions for staff. Care Homes for Adults (18-65 years) Page 20 of 37 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. Recent measures and actions taken by the home, should ensure that people are effectively protected from harm and abuse. Evidence: At our last key inspection of this service we judged that people knew how to complain but were not sufficiently protected from harm and abuse. We made two requirements about related policy and procedural development concerned with safeguarding people and dealing with aggression and also staff training. At our random inspection of the service in July 2008 we found that one of the requirements we made concerning safeguarding procedures was complied with, but that relating to staff training in dealing with aggression was not. As a result of their failure to comply here, we served a statutory requirement notice. This is a formal legal notice, which told the service what they must do and when they must do it by. This is complied with at this inspection. Also at that random inspection visit we made two further requirements that all staff receive safeguarding vulnerable adults training and as part of their induction and we gave a timescale for this to be achieved by. We saw at this inspection by looking at records and speaking with staff that this is complied with. Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: The second requirement concerned the need to ensure that incident report records, including daily logs are accurately maintained and records that we looked at via case tracking showed us that they were being maintained, although the quality of these was variable. We also saw by speaking with management and by looking at associated records that this was being monitored via the homes quality assurance and monitoring systems. And there was an action plan in place to improve standards of record keeping here, which included staff training and reviewed accident and incident policy guidance for staff. (see also management section of this report re record keeping). The staff training plan showed that to date five staff had undertaken training in report writing with ten booked to attend this during September 2008 (see also staffing section of this report re staff training). Not all staff had signed to say they have read and understood the revised policy. In our annual quality assurance questionnaire completed by the home, they told us that their complaints systems and procedures have been developed to ensure that all complaints are listened to and acted upon. They told us about the improvements they have made to ensure people are protected from harm and abuse and how they intend to ensure these are maintained. They also gave us some information about the number of complaints they have received, since our last key inspection, including those referred and investigated under joint agency safeguarding procedures. This told us that the home have received ten complaints, including eight referred and investigated via joint safeguarding adults procedures. Three of these allege financial abuse of named services users, which are currently subject to ongoing police investigation, four allege physical abuse of named service users with three of these not substantied and one subject to ongoing police investigation, and one inappropriate use of restraint, again which is also subject to ongoing police investigation. The provider has notified us of all of the above separately in writing and kept joint agency investigations informed as to the measures they have taken to ensure peoples safety and protection. These measures are approved via joint agency investigation procedures as satisfactory. The remaining two complaints relate to staff attitude, one is upheld and the other is awaiting an outcome. Satisfactory records of these were provided at our visit detailing investigation, action and outcomes, where reached. At this inspection, people told us they know who to speak with if they are not happy and how to complain. We also saw that people are provided with information about Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: how to complain in a simple suitable format. Staff that we spoke with were conversant with their role and responsibilities concerned with dealing with complaints, safeguarding people and dealing with aggression. Care Homes for Adults (18-65 years) Page 23 of 37 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 continue to benefit from a clean, comfortable and safe environment, which suits their needs. Evidence: At our last key inspection of this service we judged that overall people lived in a safe and clean environment, which suits their needs. We made a requirement to assess potential risks to people in respect of their being no fixed emergency call system in the home. At this inspection we saw that there is a mobile emergency call system in place. In our annual quality assurance questionnaire completed by the home, they told us that people continue to be provided with a safe, clean, comfortable and homely environment, which suits their needs and that they are in the process of developing a sensory room for people. At this inspection most people told us that the home is always fresh and clean, although one said it sometimes is and people told us that they like living there. However, some residents and relatives told us that laundry gets mixed up, with people going home for overnight visits, with other peoples underwear and clothing. One relative felt this was an area that could be improved and said that the service user Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: often came home in clothes that were not weather appropriate or ironed and said that the service user would need support in this area. At our visit we also observed a service user telling a staff member that another service user was wearing her sweat shirt. Areas that we saw were clean and hazard free, comfortable and homely. We looked at two peoples bedrooms and these were clean and tidy. Furniture was well maintained and of good quality. One person told us they could lock their door from the inside if they needed some private time. They told us that staff helped them to clean their bedroom. We observed that maintenace people were undertaking some jobs around the home for a time, but were called to attend to a matter in another home within the Company before they could complete all outstanding tasks. The manager was told they would be back the following week to complete the jobs. The manager told us that the maintenance team cover five homes within the group and that they have a day per week allocated maintenance and routine repairs, but with more immediate attendance for more urgent maintenance. Care Homes for Adults (18-65 years) Page 25 of 37 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. People may be better assured that their needs will be met by staff that is effectively recruited, inducted, trained and deployed. Evidence: At our last key inspection of this service we judged that deficits in staffing arrangements did not promote a consistent or effective staff team or peoples best interests. We made two requirements that there must be sufficient staff on duty at all times and who are suitably inducted and trained. We carried out a random inspection visit of the home during July 2008 and found that those requirements were not complied with. We referred matters to our enforcement team and a statutory requirement notice was issued to the home. This is a legal notice, which told the home what they must do to comply and when they must do it by. In our annual quality assurance questionnaire completed by the home they told us that staffing levels are now maintained in accordance with peoples needs, who are well supported from trained and competent staff, effectively recruited and selected. They also told us about improvements they have making, which includes development of the Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: staff team, staff morale and relationships between staff and management. They said they aim to improve further by continuing to develop their staff team via an identified training provider and to achieve at least 80 percent NVQ training. They also gave us some numerical information about staff hours provided and existing NVQ training status of staff, which told us that six out of twenty staff have at least NVQ level 2 with nine currently working towards this At this inspection feedback from staff surveys was variable with some telling us their induction covered what they needed to know and some identifying gaps. This was the same with regard to staffs views as to whether they have the right support, experience and knowledge to meet peoples needs. However, discussions with staff and examination of training records at our visit told us that that overall satisfactory arrangements are being put into place to ensure that all staff do receive induction training and the training they need to meet peoples needs and to ensure their health and welfare. The induction training accords with recognised national standards and good progress has been made to roll this out to all staff to ensure all have received induction to the same nationally recognised standards. Although with further to complete. Given that there is a clear plan in place to effect this, together with the action and progress made to date to ensure that staff receive the training they need, we agreed to extend the timescale given for completion of the roll out of the common induction standards and training plan to all staff by 30 November 2008. Comments made under the Individual Needs and Choices section regarding no noted use of alternative communication methods by staff with people who are non verbal apply here. Makaton training is included in the homes training plan, with two people to date recorded as having achieved this. In addition issues relating to the quality of incident report writing by staff as raised in our report of our random inspection (see also management section of this report) are being tackled via planned staff training in report writing. Also at this inspection staff told is there are usually enough staff on duty to meet peoples needs, although that this is sometimes affected by short notice staff absence. However, discussions with the manager and staff and examination of records tells us that the management of this is satisfactory. We also looked via case tracking at the homes process for ensuring peoples care is reviewed in accordance with their changing needs. Associated information provided in respect of this, tells us that the management and monitoring of staffing arrangements Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: is improved. Staffing arrangements on the day of our visit were satisfactory and the personal staff records that we examined showed us that people were effectively recruited. At our visit we observed some staff speaking with people in a postive and supportive way. One staff member sat for a while encouraging a person to have breakfast. One person told us I like (named staff member), she looks after me. They went on to say that they got on well with staff who worked at the home. Care Homes for Adults (18-65 years) Page 28 of 37 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 improvements in the management and running of the home more effectively promote peoples health, safety and welfare, which if sustained should continue to promote their best interests. Evidence: At our last key inspection of this service, we judged that the home was not being consistently managed or run in peoples best interests. We sent the home a warning letter and told them we were including their service on our improvement strategy and we asked them to send us an improvement plan. This was received within the timescale we asked and was satisfactory in principle. We also made a number of requirements in our report of that inspection in relation to this outcome section. These related to the management and conduct of the home, quality assurance and monitoring and record keeping. At our random inspection of the service in July 2008 we found that those requirements Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: were met, although the quality of record keeping in respect of incident reports was of poor quality and we made a further requirement to ensure accurate record keeping in respect of these. At this inspection examination of selected incident records showed us that these are being maintained, but that the quality of their recording remains variable. The regional manager told us that this is being monitored and assured via a formal action plan. Records that we looked at told us that action is being taken to address this, including staff training in report writing via the homes training plan. In our annual quality assurance questionnaire completed by the home they told us that the home is now better managed and run, with robust quality assurance systems being put into place, including consultation with people who use or who have an interest in the service and an annual plan determining key service goals for the coming twelve months. They also told us that over the coming months they aim to embed these to seek continual service improvement. At this inspection staff told us that their manager regularly or often meets with them to give support and discuss how they are working, although one person said they sometimes do. Staff also told us that the way information is passed about people who use the service always or usually works and one said it sometimes does. However, clarification was provided regarding the latter statement, which indicated that a high staff turnover over the last twelve months had at perhaps impacted on communication systems. The acting mananager and regional manager have been in post since the week of our last key inspection. The acting manager transferred to the home from elsewhere in the company and is yet to submit his application for registration with the Commission. He advised that he has commenced the necesssary process to enable him to do this. Information provided since our last key inspection of the service, together with staff and management discussions and examination of records showed us that there is a comprehensive quality assurance and monitoring system in place, including formal consultation with people who use the service and their representatives and other stakeholders. We saw some of the returns from satisfaction surveys sent out to people use use and have an interests in the service. Although these were not yet formally collated, matters arising from those we sampled showed postive overall indicators about staff attitudes and resident and staff relationships, although some indicators for improvement included the commitment of some staff, laundry and activities, Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: particularly for individual training and college placements. (see also lifestyle section of this report). Recent reports of the monthly visits to the home from a representative of the registered provider were seen and feedback recorded in these gained from their discussions with residents and relatives were reflective of the indicators from the satisfaction surveys described above. Management also told us about some of the measures they plan to introduce to focus on staff development, performance, supervision and support, which should assist in strengthening and developing the staff team and team leadership. We will continue to monitor progress with this via our inspection process. Staff told us about the training they receive in respect of ensuring safe working practises and records that we examined, including the homes training plan shows that there are satisfactory arrangements in place for this. Areas of the home that we saw were free from hazards, with the exception of the hallway flooring, which is identified and recorded by the home via its risk assesment procedures as being a hazard to people in terms of the risk of falls due to the type of flooring. We are also notified of a fall and injury suffered by a resident here resulting in their treatment at hospital. Action identified as being necessary to prevent further falls had not been fully completed. Care Homes for Adults (18-65 years) Page 31 of 37 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 32 of 37 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 10/01/2009 consulted about their care. Capacity to consent must be considered fully within the scope of the Mental capacity Act and their capacity consent to care recorded. This is to ensure that people are properly enabled and supported to make suitable choices and decisions about their lives. 2 12 16 People must be supported to 31/01/2009 take part in regular planned activities outside the home, which accord with their agreed goals, choices and expectations, including where appropriate college placements. with written care plans detailing clear instructions for staff to follow to enable these to happen. Care Homes for Adults (18-65 years) Page 33 of 37 So that their rights, goals, choices and expectations are upheld. 3 33 18 The staff training plan must include training in alternative communication methods relevant to service users assessed needs and provided to all staff. So that there are staff on duty at all times who can communicate with service users. 4 35 18 The roll out of Skills for Care 30/11/2008 Common Induction standards training plan must be completed for all staff. (Original timescale 30/09/08 with extended timescale agreed at this inpsection). So that peoples individual and joint needs are met by appropriately trained staff. 5 37 9 The acting manager must submit their application for registration to the Commission. So as to ensure that they do not continue to manage the home without registration in accordance with Sectiohn 11 of the Care Standards Act 2000. 6 42 13 Action must be taken as 31/12/2008 necessary to provide safe and suitable floor covering in the hallway at the home. 31/01/2009 28/02/2009 Care Homes for Adults (18-65 years) Page 34 of 37 So as to reduce and prevent unncessary risks to service users from slips and falls. 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 2 Individuals recorded needs assessments should be signed and dated by the person completing them and reviewed at agreed intervals following their admission, which should also be recorded. Care plans should provide clear and concise instructions for staff so that they can be easily and accurately updated and account for peoples known long term goals in accordance with their choices and expectations. Alternative forms of communication should be used in the planning and delivery of peoples care to assist them in making informed choices as to how they live their lives. NMS 12 also applies here. Opportunities for personal development should be clearly determined within peoples written care plans in accordance with their expectations, choices and agreed goals. Clear arrangements should be in place to ensure that group activities at local community facilities are effectively coordinated and organised in peoples best interests. Records should be kept by the home in respect of the any prescribed monitoring of a persons health care status in accordance with the instruction from their health care practitioner concerned. The home should continue to closely monitor staff practises in relation to safeguarding people and in dealing with aggression. Staff who have not already done so, should sign to say they have read and understood the revised accident and incident policy guidance. A review of laundry procedures should be undertaken with a view to ensuring peoples clothing is not mixed up with others and that they wear their own clothes at all times. At least 50 percent of care staff should achieve a minimum of NVQ 2. 2 6 3 7 4 11 5 13 6 19 7 23 8 23 9 26 10 32 Care Homes for Adults (18-65 years) Page 35 of 37 11 38 Ethos and leadership in the home should be continue monitored and developed via supervision in order to sustain and promote clear direction and leadership for staff and service users to understand. The results of satisfaction surveys should be published and made available to service users and their representatives/interested stakeholders. 12 39 Care Homes for Adults (18-65 years) Page 36 of 37 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 © (2008) Commission for Social Care Inspection (CSCI). 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