Inspection on 06/02/09 for Heron House

This inspection was carried out on 6th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Heron House St Augustines Sweechbridge Road Beltinge Kent CT6 6TB     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: Mary Cochrane     Date: 0 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 33 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 33 Information about the care home Name of care home: Address: Heron House Sweechbridge Road St Augustines Beltinge Kent CT6 6TB 01843830220 01843830228 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Family Care Homes Ltd Name of registered manager (if applicable) Mrs Sharon Homewood Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 5. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Heron House is a detached property situated in the quiet rural village of Beltinge which is between Canterbury and Margate. The home is within walking distance of local village amenities and the sea. There is bus service which stops out-side the house. The home does have its own company vehicle. Family Care Homes Ltd are the registered owners and have a number of other services in Kent. Care Homes for Adults (18-65 years) Page 4 of 33 care home 5 Over 65 0 5 Brief description of the care home Heron House is registered to provide accommodation, personal care and support for up to five adults with learning disabilities. The house has been renovated to a high standard. It is arranged over 3 floors. There is a lounge and kitchen/diner on the ground floor and 2 bedrooms. The second floor has 3 more bedrooms. All of the rooms have en-suite facilities this includes a shower in 4 of the bedrooms. To the front of the property there is parking for up to four cars. The managers office and staff sleeping- in area is on the 3rd floor. The current fees for the service at the time of the visit range from £1,250 to £2,500 per week. Information on the homes services and the CSCI reports for prospective service users/relatives will be referred to in the statement of purpose and service users guide. Care Homes for Adults (18-65 years) Page 5 of 33 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 1 star. This means the people who use this service experience adequate quality outcomes. Heron House is a new service and this was the 1st inspection at the home since it opened in October 2008. The visit to the service was an unannounced Key Inspection which took place over one day. The registered manager was available throughout the day. The people living at the home and the staff on duty were helpful and co-operative throughout the visit. The visit included talking with people living in the home and the care staff. General Care Homes for Adults (18-65 years) Page 6 of 33 observations were made during the day of how people are supported. We had a look around the home and various records were inspected. We observed how staff supported service users during social activities and when offering care. We looked at and discussed service users individual support plans and their risk assessments and saw some polices. We also looked at staff training records and the homes quality assurance. An annual service assurance assessment (AQAA) was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Information received from the home since the last inspection was used in the report. We also took into account the things that have happened in the service, these are called notifications and are a legal requirement. What the care home does well: What has improved since the last inspection? What they could do better: Everyone living at the home needs to have a contract on their files that so they can see and know what they are paying for. Each service users has a care plan but these need to be developed to give staff all the information they require to support and care for the service users in a way that suits them best. The support plans need to identify and meet all their needs. Plans need to help people to live a fulfilling life. This will promote independence and autonomy for service users while keeping them as safe as possible. Plans need to be used by the staff as a daily working document. Care Homes for Adults (18-65 years) Page 8 of 33 The home needs to evidence that service users are involved and have more choices about what they do. The service needs to make sure that all the personal and health care needs of people are identified and met. This means that the health of the service users will be promoted and they will receive all the care that they need. This will improve and maintain their wellbeing. The home needs to enhance the daily lives of the service users who live at the Heron House. People need to be provided with the support, guidance and encouragement they each need to live a fulfilling, meaningful and active life. Activities need to be organised that meet individual needs and preferences. The planned activities need to take place. The management need to organise the staff rota to make sure there are enough staff on duty at the appropriate times to support service users to undertake planned activities on a regular basis. The staff all need to have the necessary specialist training to make sure they have the knowledge and skills to look after the service users 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 33 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 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Statement of Purpose and Service Users Guide provide sufficient information for service users and their family/advocates to make informed decisions about the homes ability to meet their needs. Service users know that the home will assess their needs and aspirations. Service users do not know what services they are paying for at the home. Evidence: The home has a statement of purpose, which includes a philosophy of care. There is a Service Users Guide, which is well written and informative. It contains all the relevant information about the home and how care will be delivered. The guide has just been developed into a format which is suitable for the service users. It contains pictures and symbols and are easy to follow and understand. The service users do not have easy access to the guide so do not have the information to tell them what the home has to offer. The manager said that this issue would be addressed. Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: We looked at the initial assessments of 2 people living at the home. The company have a procedure where potential service users are assessed by the client care department. The manager told us that she is not always involved in the assessment process but does usually go to meet the potential service use prior to them coming to visit the home. The assessments we saw contained detailed information needed to assist in making a decision as to whether or not the home would be able to look after the person. All areas of support, care and intervention are looked at. The assessments contained the information that was needed to start developing a care plan. We saw that none of the service users have contracts and terms and conditions of residency on file. We were told that these are kept at head office. This means that the people who use the service have no information available to them about what they are paying for. We were told this information would be made available to the service users. Care Homes for Adults (18-65 years) Page 12 of 33 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. There are short- falls in the planning, implementing and risk assessing the changing needs of the people who use the service. Service users are able to make some decisions about their lives but this needs to be developed further. Evidence: Each of the people living at the home has a care plan. We looked at 3 care plans to see if information from the initial assessments had been followed on into the careplans for service users and staff to use. The plans contained some of the information needed to meet personal care needs of the service user. But the plans did not reflect the support and care identified in the initial assessments. Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: We have taken into account that the home is a new service and that people have only been there a short time. But we did see that the service was not adhering to their own service user induction plan. The specific needs of individuals were not prioritised and managed effectively and consistently in the way that would best suit the service users. Service users plans did not cover all aspects of health and social care, medical needs, specialised needs, behaviour management and interventions. Part of the plans were individualised and attempts had been made to make them person centred but there was gaps in the information. The support/care plans were kept in the office on the second floor of the home and we could see they were not being used as a daily working document. Daily reports are kept separately and are written at the end of each shift. We found that relevant information concerning visits to doctors surgeries and other specialist services had not been recorded in the daily records so we could not trail what had happened at an appointment. Care plans had not been updated to reflect changes in support and care. We could not see how changes made to peoples care are being monitored to make sure they are effective and beneficial. Information about service users is often passed verbally or through the communication book. We looked at this and found that it is breach data protection regulations because it records individuals personal information with other peoples information. The book contains the information that should be written in daily reports and care plans. The company does recognise the rights of the service users to take control of their lives and make their own decisions and choices. We saw that people were able to make choices about what they did within the home. However service users are limited in their choices especially with regards going out and being involved in normal daily activities. The home needs to be able to demonstrate and evidence that service users are able to make decisions and choices about how they want to live their lives inside and outside the home. There are some risk assessments in place, but these were not accurate and tailored for identified individual risks. We looked at some risk assessments but from speaking to people and observing situations in the home they did not give a true picture how risks could be effectively managed. The risk assessments are not robust enough to keep risks to a minimum while allowing service users to live a fulfilling and active life as possible. Care Homes for Adults (18-65 years) Page 14 of 33 Care Homes for Adults (18-65 years) Page 15 of 33 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. People who use the service are limited in what they do throughout the day. They need better arrangements to enable them to participate in fulfilling activities. Family links are encouraged and maintained wherever possible. The home provides a choice of healthy, nutritious meals. Evidence: At the time of our visit to the home we saw that only one person had an activities programme in place and this was mainly restricted to activities within the home. There were some basic activities occurring within the home and on a few occasions people had gone for rides in the car or for a walk to the local village but this was done on an adhoc basis. None of the people living at the home were attending the companys day centre or accessing other facilities in the wider community. From looking at surveys Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: and speaking to people we found that the service users are not being supported to develop their skills and interests to help them in live a fulfilling,active and stimulating life. Their aspirations and goals are not being met. We were told that people living at the home need to do more. We saw from an initial assessment that one person enjoyed swimming and although the person had been at the home for some months they had not gone swimming. We saw evidence that people were encouraged and supported in doing their washing and keeping their rooms clean and tidy, but independence and autonomy was restricted. Staff told us that they are going to introduce and develop more activities for people and also make sure they have more access to the community. Service users and staff told us that they do have contact with their families and friends. They are encouraged to maintain family links. Some of the service users go home for periods of time. Family and visitors are welcome within the home at all reasonable times and no restrictions are imposed. We saw that care staff had good body language and communication skills. They were seen to talk and interact in a positive way; they involved and included service users in conversations. The staff on duty at the time of the visit were respectful and caring. Service users indicated that the staff are good. Service users can choose when they want to be in company or when they want to be in the privacy of their own room. The care staff at the home prepare the meals. There is a menu plan and the choices of food offered to the service users is nutritious varied and healthy. People have a choice about what they would like to eat. The staff keep a record of the food that is being offered and what is chosen and eaten by the service users. People told us that they liked the food. Staff did tell that on occasions service users do help prepare meals but we saw no evidence of this on the day of the visit or in the documentation kept by the home. Care Homes for Adults (18-65 years) Page 17 of 33 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. Service users cannot be sure that all their personal and healthcare needs will be monitored and met. The homes medication procedures protect the safety of service users. Evidence: We saw that some people did have support plans in place around their daily routines with regards to getting up and going to bed and personal hygiene. They explained the particular way that people like to have things done. We saw that care staff gave the people the support and assistance that they need while allowing them to do a much as possible for themselves. Each person living at the home has a key worker. When we looked at the health care records of the service users we found that some people had been to visit specialist services or their doctors but plans had not been up dated or reviewed to reflect the changes in their support and care. There was nothing in place to evidence how the changes were going to be monitored and what action Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: staff should take. We found that one person had no guidelines in place to tell staff how to manage their epilepsy. There was nothing written to show that the treatment had been recently changed. This was even more concerning as staff at the home had not received training in epilepsy. We looked for guidelines that should be in place for when service users presented with behaviours that might cause a risk to themselves or others. We found that one person had guidelines in place, but the other people at the home did not. We were told by the manager that guidelines were being developed at the main office. However there was nothing available in the home and staff were dealing with behaviours without direction and guidance. This means that staff might not know the best way to respond if a person does have a behaviour which is challenging. Approaches could be inconsistent and leave people at risk. The care staff at the home have received training in interventions but the information was not available to let them know how best to support each individual. Each service user is registered with a local doctor and any area of concern related to health is referred to them. There is contact with specialist services when needed. The home has a new drugs cabinet and fridge. The home needs to ensure that the drugs trolley is secured. Medication storage and administration records were viewed and discussed with a senior carer. There are clear guidelines for giving medication and medication is given to people in a way that is individualised and best meets their needs. The are no guidelines in place to direct staff to give medication when required. The staff who administer medication have received the necessary training and their competencies are checked. The people living at the home receive their medication as prescribed by their doctors. Care Homes for Adults (18-65 years) Page 19 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system and service users are protected from harm and abuse Evidence: The home have received no complaints since it opened in October 2008. There is a full complaints procedure in place and it is written in a format that might make it more understandable to people who use the service. Staff spoke about how they support people with communication difficulties to express themselves if they might have a problem. Staff said they have got to know individuals really well and can recognise what behaviours and facial expressions mean. The Manager said that service users are encouraged to voice their feelings throughout the day. She told us their views are listened to. She does need to look at ways some service users can communicate effectively without being totally reliant on the interpretation of the staff. There are clear guidelines in place for safeguarding adults. Staff were spoken to about safeguarding vulnerable adults procedures. They have had training in safeguarding and abuse awareness. They felt confident that they would report any concerns to the person in charge of the shift or the manager. They said they have good communication in the team. We spoke to some of the staff and they were clear about their responsibilities Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: with regards to protecting the people in their care. We saw there are safe procedures in place for looking after service users finances. The home has developed systems of managing service users personal monies, which protects them from abuse. The home provides a safe place for the storage of monies and valuables. The registered manager was able to audit trail and account for the service users finances. Care Homes for Adults (18-65 years) Page 21 of 33 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. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The home is comfortable and safe. The service users benefit from living in a bright airy and clean environment. Evidence: We looked around all of the home. The house has been totally renovated and refurbished to a high standard prior to it opening as a care home in October 2008. The home provides an environment that is specific to the needs of the people who live there. It is a pleasant and safe place to live and the communal areas and bedrooms are have ample space to allow people to move freely. The bedrooms have en-suite facilities. The service users are encouraged and supported to personalise their rooms and people have started to do this. The home is bright and airy. It is clean and tidy and smells fresh. Because everything in the house is so new some areas do feel a bit clinical. The Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: manager and staff are in the process of adding things throughout the home to make it feel more homely and lived-in. Service users have the aids and adaptations they needed to maximise their independence and to assist in their care. The laundry area has all the necessary equipment and facilities in place. Staff were aware of infection control procedures. Some staff have not received infection control training but this has been planned for in April. Care Homes for Adults (18-65 years) Page 23 of 33 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. There is not enough staff on duty at all times with the necessary skills and knowledge to meet the needs of the service users. Service users are protected by the homes recruitment practices. Evidence: At the time of the visit the home employed 6 full time staff, company flexi staff are used to cover shortfalls. We were told by the staff and the manager that this was not enough staff to do activities and take people out on a regular basis. The home have recently employed 2 new people and they should be starting work at Heron House as soon as their safety checks have been verified. We were told that once these new staff members have received their induction training the life styles of the service users will develop and improve. We looked at the duty rota for February 08. The duty rota was not clear about how many staff are on duty and what their roles and responsibilities are throughout the day. The area manager told us that at times throughout the week the manager works in a care worker capacity, which increases the numbers of staff dealing directly with individual service users. Sometimes flexi staff are used to fill gaps but this had not been recorded on the rota. The manager told us 2 of the service users Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: at the home are funded for 1 to 1 at various times throughout the day. The duty rota indicated that when staff are preparing meals, doing medication or when service users want to go out there are not enough staff to do all these things in a way that best suits the service users. The area manager told us she would make sure the rota is a true reflection the number of staff on each shift and their roles and responsibilities. The home operates a key worker system and staff were observed supporting and communicating with service users in a respectful and caring way. The staff said they have developed good relationships with the service users and are able to anticipate and meet the individual needs of the client group. The service users responded positively to staff and they said and indicated that they like the staff. The service users we spoke knew who their key workers were. 50 of the staff have achieved NVQ level 2 and above. The company have recruitment procedures which includes all safety and identity checks required by law for care homes. Two staff files were looked at to check this. New staff have induction training that includes the Skills for Care common induction standards. Staff do not work alone and unsupervised until their criminal records bureau check has been processed and they have had essential training for health and safety. We looked at the homes training matrix. We saw that most of the staff had received mandatory training and further training had been planned and booked to fill in any gaps. We did see that there was no records to show that any of the care staff working at the home had received specialist training in epilepsy or autism. This means that the staff may not be able to care and support people the best way possible because they do not have the knowledge to do this. Some staff were able to give us some information about peoples specific conditions but there were gaps in the information. Staff need this training to make that they have knowledge about specific conditions related to the service users they care for. The manager told us that staff supervisions have started. She said that everyone will have received six supervisions within a 12 month period. Care Homes for Adults (18-65 years) Page 25 of 33 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. There are shortfalls in the management and quality assusrance systems of the service. Required health and safety checks are undertaken. Evidence: The registered manager of the service has only held this position since the home opened last year. She has several years experience working with people with learning disabilities as a senior support worker in another home belonging to the Family Care Home Company. This was the first inspection she has done as a registered manager. The registered manager does have has an understanding of the key principles and focus of the service but we did identify shortfalls throughout the inspection process with regards the care and support for the service users. This means that some care needs have not been met. These shortfalls should have been identified and addressed by the registered manager. She is now aware of the shortfalls within the home and Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: told us that these will be addressed. The registered manager said she will be working to improve the service and provide an improvement in the lifes of the service users. The senior management of the company have told us they will be supporting her to do this. The manager is working towards completing her NVQ 4 and plans to have completed the managers award by 2010. All sections of the AQAA were completed and it did give a reasonable picture of the service although it was found at the inspection that some of the information was not accurate. The next AQQA will need to give more information on how the service plans to improve and how they are going to do this. Because the service is new, quality assurance questionnaires have only been sent to relatives. Replies have been received. The manager told us that questionnaires will be sent to service users, staff and other people who have an interest in the service. She plans to do this in the coming months. This information will then be collated and the outcomes passed on to those who have an interest in the service. The operational manager carries out the monthly required checks at the home. She also visits the home weekly. Some of the shortfalls identified in this report had been documented by the operational manager on the monthly required visits to the home. The quality assurance systems in place have not made sure that the areas of weakness within the home are pro-actively managed and improved for the to benefit of the people who live there. The home provides a safe environment for service users to live in and staff to work in. Good working practices ensure the home is free of hazards. The company has an induction programme which is in line with Skills for Care. Policies are in place to strengthen safe practices. All the relevant checks and inspection of equipment and systems have been undertaken and some were evidenced on the day we visited. Dates of all other recent services and checks were included in the AQAA. An accident book is maintained. Fire checks are being done. There home has also has completed a fire assessment. Care Homes for Adults (18-65 years) Page 27 of 33 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 33 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 6 15 The care plans need to contain the relevant information to meet the individual needs of the service users. They need to be used as a daily working document by the service users and staff. To make sure that all the needs of the service users have been identified and that there is an accessible plan in place to show how these needs are going to be met by the service. This will a. tell staff what they have to do to look after the person in the way they wish and have chosen. b. to make sure that any changes in service users care is identified and the appropriate action is taken. 17/04/2009 Care Homes for Adults (18-65 years) Page 29 of 33 2 12 16 Each person living at the home needs to have an activities programme tailored for their individual needs and preferences. To ensure that each of the people who use the service are offered the opportunity to engage in a range of activities that are likely to engage their interests and suit their preferences and abilities. To help people live a fulfilling and meaningful life. The service need to make sure that there are up to date plans and guidance in place to support peoples physical and emotional needs. Care staff need to have knowledge and understanding about the health needs of the service users. a. Promote and maintain the health of the service users and ensure there is access to health care services to meet assessed needs. b. To monitor for improvement or deterioration in health conditions so that the necessary action can be taken. c. To make sure care staff 17/04/2009 3 19 13 31/03/2009 Care Homes for Adults (18-65 years) Page 30 of 33 are aware and have an understanding of the health conditions of the service users they look after. They will then be able to identify any problems and report them immediately. 4 35 18 Staff need to receive 30/04/2009 specialist training so they have the knowledge and skills to meet all the needs of the people they are caring for. To make sure the service users receive the support, care and intervention they need in a way that best supports them while keeping them as safe as possible. 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 5 All people living at the home need to have a contract/terms and conditions, which is available to them. It needs to tell them what services they are paying for at the home and what is extra. The contract needs to be signed by the service user/representative and the registered manager. To make sure that people are allowed and supported to make choices and decisions about their lives. Individual risk assessments need to be developed and implement to ensure that all risks are kept to a minimum. Risk assessments need to assist and enable service users not restrict them. People need to be part of the local and wider community. People need to take part in leisure activities that they enjoy. 2 3 7 9 4 5 13 14 Care Homes for Adults (18-65 years) Page 31 of 33 6 7 33 37 The duty rota needs to accurate and reflect what the roles of the staff are during each shift. The registered manager of the service needs to make sure that the home is effectively managed on a day- to- day basis. She needs to ensure that the service users receive all the care and support that they need. She needs to make sure that there enough staff who have the training and competencies to support the people living at the home. The quality assurance and audit systems in place should make sure that any shortfalls within the service are identified and addressed in a timely manner. This will make sure that the service improves and will measure success in meeting the aims, objectives and the statement of purpose of the home. 8 39 Care Homes for Adults (18-65 years) Page 32 of 33 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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