Inspection on 23/10/08 for Heronsmede

This inspection was carried out on 23rd October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heronsmede 24/10/06

Heronsmede 05/12/05

Heronsmede 05/07/05

Heronsmede 11/01/05

Heronsmede 14/10/04

Heronsmede 07/02/04

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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: Heronsmede 88 & 90 Straight Road Old Windsor Berkshire SL4 2SN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Dickens     Date: 2 3 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 32 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 32 Information about the care home Name of care home: Address: Heronsmede 88 & 90 Straight Road Old Windsor Berkshire SL4 2SN 01753855694 Telephone number: Fax number: Email address: Provider web address: susan.still@choiceltd.co.uk Name of registered provider(s): Name of registered manager (if applicable): Choice Ltd The registered provider is responsible for running the service Name of registered manager (if applicable) Ms Susan Ann Still Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category 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 Choice Ltd, an independent organisation, owns and manages Heronsmede which is a registered service offering personal care and accommodation for up to eight people, under the age of 65, who have a learning disability and associated challenging behaviour. The home is situated on a main road in Old Windsor with good access to local shops and amenities. Heronsmede is a detached house and bungalow that have been joined together by an extension to provide a variety of areas for residents to use. Care Homes for Adults (18-65 years) Page 4 of 32 8 Over 65 0 Brief description of the care home There is a large garden, mainly laid to grass, with various outbuildings that offer additional accommodation for service users to use for leisure and activities, including art and craft and a sensory room. All accommodation is in single bedrooms. The communal areas consist of two lounges, one dining room and a dining area. There is limited car parking in the front of the property. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was unannounced and took place over 6.5 hours. The inspection was carried out by Mrs. Helen Dickens and Mr. Tim Inkson. The Registered Manager, Ms. Susan Still represented the establishment. The Service Manager joined the inspection for the last hour. A partial tour of the premises took place and a number of files and documents, including three resident’s files and care plans, staff training and recruitment files, quality assurance information, and the annual quality assurance assessment (AQAA) were examined as part of the inspection process. Questionnaires were sent out regarding this service and the responses are included in this report. The inspector met all the residents who were in the home on the day of the inspection. Two members of Care Homes for Adults (18-65 years) Page 6 of 32 staff were also interviewed. The current fees at this home are 1518 to 2760 pounds per person per week. The inspector would like to thank the residents, staff, manager and service manager for their time, assistance and hospitality. What the care home does well: What has improved since the last inspection? There have been a number of improvements since the last inspection in October 2006, including the Requirements and Recommendations from the previous inspection have now been met. The reviews of care plans are now more regular and meet the NMS guidelines of 6 monthly reviews; health and safety issues identified at the last inspection have now been addressed, and there was evidence of proper staff recruitment checks at the home. Previous shortfalls in training had been addressed, and the manager had up-dated the homes fire risk assessment as requested. There are now photographs on medication records, and a more user friendly complaints procedure. Residents are now getting involved in the recruitment of new staff. A new care planning format has been introduced, as well as the new daily diary format mentioned above. Picture display boards in the hallway and dining room now give service users pictorial information about which staff are on duty and the meals for that day. Speech and language therapists have been working with residents, particularly on improving on the current communication arrangements. Residents are also starting to Care Homes for Adults (18-65 years) Page 8 of 32 be involved in the recruitment process for new staff. Some new furnishings and fittings have been provided as noted in the AQAA including replacing carpets, and some new bedroom furniture for service users. A new cooker has also been purchased. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be confident their needs and aspirations will be assessed before they are offered a place at Heronsmede. Evidence: No new residents have been admitted to the home since the last inspection. On average, current residents have been there for 10 years and their original assessments have been archived. The AQAA completed by the manager prior to the inspection outlines the admissions procedure. For example, a home visit would be made to the potential client by the manager of Heronsmede to discuss their needs and transition arrangements. Care Homes for Adults (18-65 years) Page 11 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning arrangements are well developed and residents benefit by the very detailed daily diaries which are kept at this home. More work needs to be done to ensure there is detailed guidance to staff about how residents wish their support to be delivered. Residents are encouraged to make choices and decisions and these are clearly recorded. Risk assessments are in place and residents are encouraged to lead active and independent lifestyles. Evidence: Three residents care plans were sampled as part of the inspection process, and the inspector looked in detail at the other documents and files relating to each residents needs and the care they were receiving. The manager said that this was a new care planning format, introduced earlier this year, and was working well. The residents files were very well organised and clearly set out. There were penciled photographs of each resident on their file. Records were kept about essential health Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: information and basic personal details, and each resident had a health action plan. The daily living skills of each resident, and the support they needed, were set out in their care plans. Information on religion, sexuality and relationship needs were was also recorded. The care plans also covered night care including each residents usual sleep routine. Good records of when each care plan had been reviewed were also noted. More detailed guidance is needed for staff about how residents want their support to be delivered, particularly in relation to their personal care. This was discussed with the manager and service manager and it was felt that the new care planning format can be restrictive if hand written as there was little room to write about support needs in detail. The manager said she would ensure that from now on the care plans would all be typed, which would allow extra space to be created and more detailed guidance to staff could be included. Each file contained sections on Important things and How I will tell you things to help residents to be more independent and assist staff to communicate with them. Each resident has a communication passport which sets out in much more detail how to communicate with each resident and sets out their preferences and support needs in relation to communication. Residents are encouraged to make decisions and the communication passports contained good records of how residents may express their choices. The manager has introduced a system for recording the daily activities of each resident and three of these were sampled. They set out in some level of detail what the resident had been doing throughout the 24 hour period. These daily diaries provided a good record of the decisions residents had made for example in relation to whether they wanted to go out, the activities they had opted to take part in, and also what they had declined to take part in or do. Not only was the diary format well set out covering all the pertinent areas such as which staff were on duty, what medicines had been given, and what meals residents had eaten, but it also began with excellent guidance to staff about good record keeping. These diaries provided a full picture over a each 24 hour period and staff should be congratulated on the high standard of their record keeping in these diaries. Risk management plans were in place and these had been up-dated and added to when needed. Risk assessments were on file in relation to individual activities and residents are encouraged to have an active lifestyle including horse riding, cooking, going out for walks and to the airport to look at the aircraft, and going away on holiday. There were risk management plans in relation to health conditions and this included regular night time monitoring. Strategies for dealing with aggressive behaviour towards staff were also in place, and the manager said the home does not Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: use physical restraint on residents. The manager demonstrated the techniques and some of the equipment used to manage any aggressive outbursts from residents. On the day of the inspection one risk management plan was not being followed for a short period of time, as a member of staff had been called away to deal with another resident. This was discussed with the manager and remedied immediately. Further guidance was then given to staff by the manager to ensure this was not repeated. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit by being supported to take part in enjoyable and fulfilling activities, though more work is needed in relation to those residents who also have a sensory impairment. Community and family links are encouraged, and residents are supported to make choices about their daily lives. Residents are encouraged to eat healthily and mealtimes are enjoyable. Evidence: Heronsmede has an activities co-ordinator who works full time at the home and he was interviewed by the inspector. His role is to co-ordinate the overall activities plan including consulting with residents, arranging activities and ensuring the right mix of staff, including mini-bus drivers, are available. He also supports residents to attend activities and on the morning of the inspection had been out with one resident who was attending college. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: The activities of the three residents whose files were being sampled by the inspector were discussed. The co-ordinator had a good level of knowledge about how residents liked to be supported with learning and social activities. There were a variety of individual and group activities including going for walks, horse riding, trampolining, arts and crafts in the summer house, using the sensory room in the garden, and attending the Ravenswood village for activities such as computing and communication courses. Some residents also used the WAMSAD (disabled sports) facilities. Activity plans are in place and each residents daily diary records what residents did and anything they declined to participate in. The manager said they were looking at getting more training for staff in relation to supporting people with a vision impairment and this was discussed in some depth as the inspector felt that one resident in particular was not really reaching their full potential and would benefit by having more opportunities for development. The activities co-ordinator was particularly keen on having some dedicated training in relation to supporting people with a sensory impairment to get the most out of learning and social activities. Some suggestions were made and the manager was asked to follow this up. Community Links are good with residents being encouraged to use local facilities as much as possible. As already mentioned, some residents attend Ravenswood Village activities, and the WAMSAD disabled sports facilities. Residents at Heronsmede also attend a social club arranged by Choice Ltd with their other local homes, and residents went there on the afternoon of the inspection. The manager said this was popular with residents and they were certainly very happy and excited about going. People from Heronsmede use local shops and leisure facilities, and have a regular weekly takeaway on a Saturday. Staff are aware of local leisure and religious opportunities, for example one resident was accompanied to their place of worship to see if they wanted to follow that particular faith more closely. This home has its own transport and staff are made available to support residents in their social and learning activities, and this includes during the evening and at weekends by arrangement. Residents family and friendship links are encouraged by staff at Heronsmede, and staff were knowledgeable on residents existing family contacts and their friendships. Residents files contained a section where a record can be kept of any support needs they have in relation to maintaining family relationships and friendships. Family contact varies from resident to resident but the inspector noted there were some very supportive relatives who took a great deal of interest in the care of their relative at Heronsmede. Daily routines at Heronsmede promote residents choice and staff were seen to be Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: respectful to residents and use their preferred form of address. Staff work hard to ensure they know how residents prefer to communicate, and each person who lives at Heronsmede has a communication passport which enables them to be better understood when making choices and decisions in their daily lives. Residents were seen to choose whether to be alone or in company, and the daily diary of each resident provided an excellent record of the choices they had made throughout the day. Meals are taken in two separate dining areas of the home and staff were on hand to offer support. The menu has been reviewed recently and the home has taken on a new cook who was enthusiastic about her role and described how they were working hard to ensure residents had a healthy diet. There was a small fruit basket in the kitchen for each resident, with their name on, and enough fruits to ensure they were getting their five portions of fruit and vegetables. The lunchtime meal on the day of the inspection was slightly different from that on the menu and was a pasta dish with corned beef and mixed vegetables. Residents were seen to enjoy this and most brought their empty plates back to the kitchen. The inspector sampled a spoonful of the pasta and it was found to be very tasty. The cook said she was trying to get more flavour into the dishes on the menu. Residents have input into the menus at residents meetings. There is a pictorial format available, even for the takeaway meals, for those residents who prefer to choose menus by looking at pictures. There was a display board for residents, with the day and date, a list of staff on duty with photographs, and what the menu was, in pictures, for that day. It was noted that staff sit down to eat with residents and both dining areas provided a very pleasant mealtime experience for residents. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive personal support in the way they prefer and their physical and health care needs are met. There are good arrangements in place for the administration of medication. Evidence: Three residents care plans were sampled and the manager demonstrated the new care planning format being used. They were clear and well set out. As already discussed, more detailed information is needed about how residents would like their support to be provided. Times for daily activities are flexible and the daily diary for each resident shows what time residents have chosen to get up, go to bed and take part in activities etc. Residents were all dressed individually and their rooms were personalised. Specialist support is arranged as needed, for example there is regular input from the speech and language therapist and the psychologist at this home. Communication passports set out the likes and dislikes of each resident and how best to communicate with them and understand what they need; this ensures continuity of support for service users. Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: There is a Health Action Plan for each resident which provides an overview of their health needs. Those sampled covered the main areas of health and aimed to promote healthy living through attention to oral care, keeping fit and active, continence, eyesight, hearing, and eating and drinking. As already outlined above, specialist support is given as needed and visits and assessments by visiting health professionals are clearly recorded. Risk assessments are in place where there are health related or behavioural concerns. A survey was returned to CSCI from a GP who has patients at this home. On the survey they ticked that individuals health care needs were always met by the home, and that staff always sought medical advice and acted upon that advice. This person went on to describe the service as a Cheerful, patient, intelligent, caring community. For their medication supplies, the home uses a monitored dosage system supplied by the local pharmacy. There were sample staff signatures on file for those who gave out medication and clear guidance to staff about the administration of as required medication. The staff need to record any prescribed creams on the MAR (medication administration record) sheet. The GPs permission has been sought regarding the administration of homely remedies. The MAR sheets sampled were up to date. The GP survey returned to CSCI ticked that staff always managed medication correctly. During the inspection there was some discussion about how the home manages and records medication that has to be discarded, and the current arrangements makes auditing difficult. The manager and inspector also discussed whether certain medication needed to be stored as controlled drugs, and the manager was advised to get guidance from the pharmacist and record that advice, together with any new arrangements. It was discovered that prescribed creams for one resident were not recorded when they were applied by staff and the manager said she would ensure this was the case from now on. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident their concerns would be taken seriously and that and allegations of abuse would be dealt with satisfactorily. Evidence: There is a complaints procedure in place at this home and a user friendly version is available. Staff listen to residents views and act on any concerns raised. Staff were observed to communicate well with residents and the communication passports assisted them to better understand what residents needed. Records are kept of concerns and complaints made to the home. One complaint raised to the service has been copied to CSCI and is currently under investigation by the provider. There is a safeguarding adults procedure in place and the home has a copy of the latest Berkshire multi-agency procedures. Staff do a formal course in adult protection and the manager said that only new staff have not yet done the course; the new staff cover this subject in their induction. It was suggested that the manager obtains copies of the local authority leaflet which summarises current safeguarding arrangements and has contact numbers, and this could be given to staff. The Annual Service Review in June noted that two safeguarding adults referrals had been raised in relation to this service and satisfactorily dealt with. A third matter has been raised since, and this too has been satisfactorily dealt with. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: Arrangements for assisting residents to manage their finances were looked at as part of the inspection process. It was noted and discussed with the manager ( and later the service manager) that for some activities, residents were paying towards the expenses of the member of staff who accompanied them. This matter will be discussed with the CSCI Provider Relationship Manager for the company, Choice Ltd, and the local safeguarding adults co-ordinator, and a Requirement to review these arrangements, taking into account advice received, will be made. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a homely environment which has been suitably adapted to meet the needs of the current residents, and is clean and hygienic throughout. Evidence: A tour of the premises took place and communal areas were found to be light, spacious and pleasantly decorated. New floor coverings had been provided which are non-slip and soft to walk on. New curtains and special tracks, where the curtains can easily be replaced if pulled down, had been fitted. Toilets and bathrooms contained aids and adaptations to assist residents with a mobility impairment, and had privacy screening and blinds on the windows. Residents bedrooms were personalised, and one bedroom had contrasting light and dark colours to assist a resident with a sight impairment. The manager was asked to ensure there were risk assessments in place where toiletries, particularly liquids, are left out in residents bedrooms. Adaptations had been fitted to ensure the safety and wellbeing of residents for example the TV was built into a strong cabinet, and there were security measures on the upstairs windows. The back garden is very well kept with neatly cut grass and a number of additional facilities for residents to enjoy. There is a summer house for arts and crafts which also Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: has a computer, and another building containing a sensory area with special lighting, mirrors and music. There were some bicycles for residents who are able to go cycling, some horseriding hats, and a small outdoor trampoline in the garden. The front of the home is also very well kept and looked very much in keeping with the other properties nearby. There is a garden shed used to store paints and white spirit and it was found to be unlocked during the tour of the garden. The manager looked into how this had happened as it had not been reported. She had the lock repaired before the conclusion of the inspection. The inspector also noted that the paving at the back of the property is very uneven and breaking up in places, and could pose a trip hazard to residents or staff. The manager was asked to carry out a risk assessment until the necessary repairs or replacement could be arranged. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by competent staff though more work is needed to ensure sufficient staff gain qualifications in care work. Recruitment practices are good and a shortfall identified during the inspection was quickly remedied. Training and development arrangements ensure residents needs are met by appropriately trained staff. Evidence: Residents are supported by competent and qualified staff who were observed to be approachable, and throughout the day residents were seen to go to them for support or advice. Each resident has a communication passport which assists staff and residents to communicate as well as possible, given the very individual needs of residents in this regard. There has been a lot of work on the cultural needs of residents and staff have been working with one particular resident in relation to increasing their opportunities to explore their religion and to attend places of worship. Staff have good relationships with other professionals and the GP praised the commitment of staff at this home. Of the 18 support workers, 6 have gained a qualification in care to at least NVQ Level 2. Whilst this is still less than the recommended 50 of care staff as set down in the National Minimum Standards, the AQAA states that 5 more staff are currently undergoing this qualification. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: Recruitment files were checked for two staff members. The manager said that residents are encouraged to be involved in the recruitment of new staff. Appropriate recruitment checks had been carried out including references, confirmation of why they had left a previous care employer, and full employment histories. However, one staff members POVAfirst check had been returned due to a discrepancy relating to their date of birth. This meant they had been working at the home without a check to ensure they were not on the list of those people deemed to be unsuitable to work with vulnerable people. The manager and service manager investigated how this had happened and assured the inspector that the staff member would not return to work until the POVAfirst check had been returned. Further discussion took place and the manager clearly understood what had been required and this had been a mistake relating to the companys HR department. Whilst this is still a serious matter, the shortfall was investigated and remedied immediately, and the company will now ensure such mistakes cannot be repeated. Training records are well kept at this home and a training matrix has been devised which enables the manager to identify the training needs of staff. Relevant training courses are made available to staff for example SCIP (physical intervention training), epilepsy and autism training, medication, risk assessments, and Makaton training. Staff have also had training on the Mental Capacity Act, values and attitudes, and antidiscriminatory practice. Mandatory courses for all staff included moving and handling, health and safety, fire, and protection of vulnerable adults. Currently there is no mandatory infection control training though the service manager said this is covered as part of other courses e.g. health and safety. The manager and service manager were asked to look at the Health Protection Agency website or take other appropriate advice to ensure that current training offered on infection control is sufficient, and if not, to address this as soon as possible. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit by the management arrangements at this home, and by the quality assurance processes that ensure their views are sought and taken into account. Arrangements for health and safety are well developed but more work is needed to ensure shortfalls are identified and dealt with in a timely fashion. Evidence: The registered manager is experienced and qualified for this role, and has completed her Registered Managers Award since the last inspection. There are clear lines of responsibility within the home and with external management through Choice Ltd. She is supported in her day to day role by a deputy manager and an assistant manager, and two senior support workers. The manager reports to the company service manager. A survey returned from a health care professional involved with this home noted that they had been ....impressed by the level of staff commitment and the background management structure of Heronsmede. The registered manger also undergoes periodic training herself and demonstrated that she had followed through and met the requirements and recommendations made at the last inspection. Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: The home has an annual development plan and annual surveys are sent out to relatives, staff and care managers. Residents also receive an annual questionnaire. Regulation 26 visits are carried out on behalf of the company by the service manager. Good records are kept about residents involvement in the day to day life of the home and in relation to choices they have made. Regular reviews of residents care plans are also carried out. This Standard requires the home to demonstrate year on year development for each resident. A care manager who has visited the home over many years noted on a survey to CSCI that the home had previously done well on this as they had accommodated residents with very complex needs who were ...now increasingly settled and content. However, one of the residents whose file was examined by the inspector showed that there was no recent evidence of development and this was discussed earlier in this report, and a requirement has been made in this regard. Health and safety arrangements are well developed at this home and include one person having overall responsibility, and a member of staff who does a regular health and safety check around the home. There are clear rules for visitors in relation to how they move around the home, and in relation to fire. The manager has downloaded the Safer Food Better Business pack from the internet and the home has now started using this tool to improve their food handling practices. There was evidence that records were being kept on cleaning, water temperatures, the temperatures of cooked meats and other hot food, and fridge and freezer temperatures. The Environmental Health Officer has not visited for two years and the manager was asked to follow up when the next visit was due. Regular safety checks are carried out and the fire alarm engineer was visiting the home on the day of the inspection to follow up on a fault with the fire alarm system. Staff training is given on health and safety and related subjects including fire safety, first aid and moving and handling. Risk management plans are also in place. However, on the day of the inspection a number of shortfalls were noted, which, if the current monitoring arrangements had been satisfactory, would have been identified and dealt with by the home. The paved area in the back garden around the sheds posed several potential trip hazards and a risk assessment needed to be carried out and acted upon. Whilst it is recognised that these repairs were not going to be done immediately, some immediate action IS needed to ensure the safety of people using this area. It was also found that the lock was missing from the shed in which decorating items had been stored. The manager ensured this was repaired before the conclusion of the inspection. One residents risk management plan was not being followed, and, whilst this was a brief lapse, the consequences could have been serious. This was remedied by the manager immediately and arrangements put in place to Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: ensure this did not happen again. The manager was also asked to ensure that arrangements for the prevention of legionella within the home meet with the Health and Safety Executive guidance to care homes which can be obtained from their website. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 11 12 Further work must be done, including training, on how staff can better support residents with a sensory impairment, especially in relation to social and learning opportunities for those with a sight impairment. This is Required to ensure residents with a sensory impairment can reach their full potential. 23/11/2008 2 23 13 A review must be carried out 23/11/2008 into the the practice of service users paying staffs out of pocket expenses. This is to ensure that service users are not being placed at risk of financial abuse or at risk of discrimination because of their financial status. Current arrangements for 23/11/2008 monitoring health and safety within the home must be 3 42 13 Care Homes for Adults (18-65 years) Page 30 of 32 reviewed to ensure that any shortfalls are identified and dealt with in a timely fashion. This is Required for the safety and welfare of residents. 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 6 Care plans should contain more detailed information about how residents would like their support to be delivered, particularly in relation to personal care. Any creams or lotions prescribed for residents should be recorded, when administered, on the MAR sheet in the same way that other prescription medicines are recorded. Following the risk assessment requested during the inspection, the manager should ensure that the paving and pathways at the back of the property are made safe, and repaired or replaced according to the findings of the risk assessment, and in a timely fashion. The service should consult the Health Protection Agency website or take other appropriate advice to ensure that current training offered to staff on infection control is sufficient, and if not, to address this as soon as possible. 2 20 3 30 4 35 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (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. 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