Inspection on 24/02/09 for Innes House

This inspection was carried out on 24th February 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Innes House 27/02/07

Innes House 30/01/06

Innes House 23/06/05

Innes House 04/08/04

Innes House 06/05/04

Similar services:

Hillside

Applegarth

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Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Innes House Flora Innes House 16 High Street Byfield Northants NN11 6XH two star good service The quality rating for this care home is: 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: Rajshree Mistry Date: 2 4 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. They reflect the things that people have said are important to them: 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. 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Innes House Flora Innes House 16 High Street Byfield Northants NN11 6XH 01327260234 01327263840 info@soldenhillhouse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Solden Hill House Limited Name of registered manager (if applicable) Ms Ann-Marie Patricia Rose Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 9 0 care home 9 learning disability Additional conditions: All service users have a learning disability and up to 1 person with an associated mental disorder To include 1 existing named service user over the age of 65. Date of last inspection A bit about the care home Innes House is situated in the village of Byfield to the south west of Northamptonshire. The village is accessible by public transport, although visitors may find the journey difficult, as public transport is infrequent. The home has its own transport, and people using the service can access the community facilities in the village or in the nearby towns of Daventry and Banbury. People using the service are provided with day care at the nearby Solden Hill House. Innes House is one of two owned by Solden Hill House Limited and is managed by Miss A M Rose. Innes House provides accommodation, meals, personal care and support for up to 9 people with Learning Disabilities. The premises consist of a large detached House set back from the main road providing all single bedrooms. There is a lounge, a large kitchen/dining room and a music room. We received confirmation of the range of fees from the Registered Manager of Solden Hill House. The fees are between: £563.38 to £1082.65 per week, which excludes personal expenditure such as toiletries. People considering using Innes House, are encouraged to contact the home directly. The full details of the home and any specific requirements can be obtained from the home in the form of the Statement of Purpose and the Service User Guide. This information can be viewed on the homes website. The latest Inspection Report from the Commission for Social Care Inspection is available at the home. 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 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We as written in this Inspection Report means The Commission for Social Care Inspection. As part of this inspection, we looked at the Annual Quality Assurance Assessment (AQAA) completed by the home and sent to us. This information is sent each year and tells us what they think of the service they provide. We also looked at the other information sent to us. We sent eight Have Your Say About Innes House surveys to the people who use the service, their relatives and the care staff. We received seven surveys back from the people using the service and one from a relative. We did this key (main) inspection by visiting Innes House on Tuesday 24th February 2009 at 3.15pm. The visit lasted 4 hours and we found out about the service given to the people using Innes House. We talked with four people; we looked at how peoples lifestyle at home and asked staff about how they help people to make sure their needs were met. We also looked at the care plans, medication records and other records that told us how people are helped by the staff. This is called case tracking. We also saw records showing people have their health care needs met by other professionals such as the General Practitioner or the Psychiatrist. We looked at some of the policies and procedures in the home. Policies are rules about how to do things. Procedures tells people how to follow the rules. We spoke with the staff and looked at their records that tells us what skills and training they have to support the people who live at the home. What we have written is based on what we saw and what we were told on the day of the visit to the home. What the care home does well People who live at the home are asked how they like to live their life at the home. This means the different things that they want to do at home and in the community. People can tell staff about the things that they use to do and want to continue to do like going to the day centre or the college. People are asked what help they need from the staff when they are living at the home. This means how staff can help them to be as independent as possible and be safe at the same time. People make daily choices about their lives. They can go to college, day centres, work, horse riding and swimming. People can go to do arts and crafts, join in with entertainments or social events at the other care home close by. People can also socialise with the other people living at the home or visit family and friends. People have a good choice of meals. Some people like to help to make drinks and meals. Some people make up their own pack lunches for the next day. Staff are friendly and support people living at the home. People are happy to be helped by the staff. People told us they speak with the staff or their key worker if they are unhappy or have a complaint. People said they feel safe at home and with the staff that work there. People have their own bedrooms. The bedrooms are decorated and show things that are important to people such as pictures and photographs. Staff are trained to help people and care for them. Staff know how to help people to make sure they try to do as much for themselves safely. This helps people to be more independent. Staff records and certificates shows the training they have done. What has got better from the last inspection Information about peoples health needs is easy to read. There is now a medical profile, made for each person living at the home. This is a list of all the medication that people take. This is easy to read and helps the staff to make sure people have the right medication. Checks are carried out to make sure people are not at risk. This is called risk assessing. This helps the staff to make sure people are safe in the home and know how best to help people. There is a new activity called: Eurythmy, which people can do. This is exercise to music. People can do this as a group or on their own. This activity is done at the other care home close by. People are helped to eat a healthy diet. Some bedrooms and the kitchen have been decorated. Some carpets and flooring has been replaced. There is a new alarm and lock fitted to make the home secure and safe for people. Staff have received information and training to help them look after people safely. The policies and procedures that staff followed have been checked and updated. People are asked about what they think about the home and what could be made better. What the care home could do better The information telling people how to move into the home should be made easier to read and understand. Pictures and words used in the care plans would help people to understand what is written. This would help people to have more say about what they want to do and how they want staff to help. The information about Innes House and the complaints procedure should be made easier to read and understand. It could include pictures and easy read words. The questions asked in the surveys about the home could be made easier to answer. The answers from the surveys should be checked with the information people get about the home. This would show if people receive the service that they are told they will. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Rajshree Mistry 33 Greycoat Street London SW1P 2QF 02079792000 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 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 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 . People consider using Innes House have their care and support needs assessed and have opportunities to visit the home to ensure these can be met. Evidence: We read the information people receive about Innes House, which includes the Statement of Purpose and the Service User Guide. The purpose for Innes House is clearly set out known as the aims and objectives. This helps people to choose if Innes House is the right place for them. The information tells people about what services are available to them, the type of facilities, social and leisure opportunities and the skills of staff that support the people living using the service. It sets out the process of how people are involved in choosing the home and how people can make a complaint. We wanted to find out if the information about Innes House is available in alternative formats. We spoke with the person-in-charge, who is the Registered Manager for another service within the group and is currently overseeing the management of the Innes House in the absence of the Registered Manager. They told us there is a website that people can look at if they have access to the internet and a brochure for the home. It was recommended that consideration should be made to develop information about the home in alternative formats on paper as well, such as in easy read words supported with pictures and symbols to convey messages. The information gathered from the self-assessment tool completed by the home before the site visit stated there was a robust admission process including a full assessment of clients needs and Advocate and support services are encouraged. We read the care files of the four people we case tracked. The care files had copies of the assessments of needs completed by the Care Management Team. The assessments of Evidence: needs were detailed and looked at the holistic needs of individuals, including people that are involved and important to them, such as family, college, work, health and social care staff. It also had details about individual routines, preferences, interests and goals. This showed individual needs and routines were made known so that they could be supported by the staff at the home. The care files had signed contracts of stay, with the terms and conditions including the agreements from the local authority that financially support individual. This demonstrated a formal agreement was in place. The contact details for Advocates for the people using the service are detailed to ensure they are supported. This shows the service recognises the value of Advocate for people using care services. We saw records of visits made by people before they decided to move to the home. This was supported by comments received from the people using the service, directly and through the survey responses, saying they did visited the home to have a look around. This showed people had the opportunity to visit and to test drive the home to see if it was the right place for them. The comments received in the surveys included: Yes I came first to look round I like it here Im happy here Staff we spoke with said many people had been living at the home for a few years and had got to know individual preferences and routines. Staff confirmed they have written information about new people available to them, which ensures they are kept informed as far as possible. The staff shared the issue where they have had no introduction to a new person that had moved to the home, which could have a negative affect to the individual. Whilst this may have been an isolated incident, the service could look at how staff are introduced to new people considering using the service in advance such as at the initial visits. 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 . People living at Innes House make personal decisions and choices about their lifestyle and are supported by staff. Evidence: We read the care plans for the people we case tracked. The care plans outlined the level of care and support needs of individuals. Although the care plans were not written in a person centred way, which means from the view-point of the individual, their preferences, routines and choice of lifestyle was made known. The care plans included Advocacy support from family and specific support provided by health care staff. Each care plan included the activities attended by the person such as the day centre, Tertiary College and Eurythmy (music and exercise therapy) at the sisterhome within the group close to Innes House. This supported what people told us about their daily life and experiences and the responses in the surveys. Staff on duty said the key-worker develop the care plan with individuals. They said care plans are explained to people and some people can read with some help. The care plans also have information about the support from health care staff. This showed the care plans were holistic and looked at all the areas of support required by individuals. We saw assessments of risks had been completed with individuals to ensure they were safe doing activities, which promoted their independence and wellbeing safely. There was clear guidance for staff to follow to ensure people were able to participate in activities in-house and in the community with minimal risks to themselves. We wanted to find out from the people using the service if the staff support them in Evidence: the way they want to be supported. Two people living at the home showed us their bedrooms, which they had their own key. They said they had privacy and responsible for keeping the room tidy. One person spoke about their healthy eating plan and showed us the types of food that they eat, such as low sugar products and their interests in horse-riding. Both said they keep in contact with their family, which promotes their well-being. Staff spoken with demonstrated a good awareness of peoples needs and support required. Whilst some people were more independent than others, they still needed some level of reminding to make sure their maintain as much independence as possible especially in relation to personal hygiene. People were confident and spoke positively about the support provided by the staff. We observed staff interact with people in a respectful manner, allowing the person to finish what they were saying. Staff were seen encouraging people by suggesting they have a shower before their meal. This was done sensitively and in a discreet manner, which people responded to well. It was evident there was a positive relationship staff had with the people living at Innes House that promoted their wellbeing. We saw people laughing and smiling and appeared to be content with their home life. This supported the comments received from the relatives surveys: We are not closely aware of ... life as we would like to be. But as far as we know ... needs are being met 100 People were seen emptying the dishwasher and later another person was checking the duty rota to see when they were due to help with the household task. People told us that they have a meeting on a Sunday and agree what household task and when they will do it. These include setting and clearing the dining table and filling and emptying the dishwasher. This demonstrated people made decisions and choices about what they want to do and supported the survey responses received. The comments received from the people that we spoke with and in the surveys included: Everything here is fine, I like living here I go to work and have to wear my badge with my name and photograph The information gathered from the self-assessment tool completed by the home supported our findings on the day of the site visit. Areas for improvements were identified included ensure reviews are carried out regularly and to re-decorate peoples bedrooms, living area in the next 12 months. This shows the service continues to look at improving the quality of provision and the home environment for people. 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 . People living at Innes House are supported to enjoy and experience a lifestyle of their choice and opportunities that promote their well-being. Evidence: We wanted to find out what lifestyle people experienced whilst living at Innes House. Staff arrived at the home in readiness for the people to return home from various activities such as work, college and day centres. People were greeted by the staff on duty. There was a buzzing atmosphere of activity and noise in the dining room as people spoke about their day. Some people wanted to know who we were and why were we visiting. This showed people were interested and inquisitive. This was good evidence indicating people felt this was their home. Some people living at the home spoke about the type of things that they do. A gentleman told us they go to work and showed us their identity badge with their name and photograph. He showed us his bedroom, which was clean and personalised with things of importance to them. He showed us photographs of his family members and said his parents will buy me the things I need. He said he goes to see his parents or goes out shopping with them. A lady showed us her bedroom, which was personalised and reflective of the things that they enjoy. She said I’ve got 6 rosettes and that’s me on my horse when I was younger and spoke about her big birthday celebration being planned. Both said they have keys to their bedrooms and feels this gives them privacy and responsibility. Having spoken with both individuals and hearing about the things that they do, it demonstrated that people have very interesting and busy life as they Evidence: do things of interest and keep in contact with their family. The information gathered from the self-assessment tool completed by the home stated enable service users to attend further education, explore employment opportunities and participate in local activities and social events in the community and holidays. This supported the responses received in the surveys, discussions with the staff, the people living at the home and through reading records. Staff told us that people benefit from being able to participate in the local community, work, education and social events close to the home. Some people often go to the sister-home close by for social events or to participate in the Eurythmy sessions, which is music and exercise. Staff spoke about how they support people on an individual basis. They gave us the example of how they supported a young lady by gradually building her confidence and is now attending college. Staff spoke about setting goals and care planning helps people to achieve their personal goals, which may be different to goals set by other people. We saw one person empty the dishwasher after returning home and another person setting the dining table in readiness for their meal. People told us they have certain things they had to do and want to do like setting the dining table, emptying or loading the dishwasher and keeping their bedrooms tidy. They told us they decide on a Sunday what household jobs they want to do and this is written down so people can look at it to remind themselves. The records we read showed people were supported to keep in contact with family and friends, People spoke about the important people in their lives and those that they visit or keep in contact my telephone or letters, such as their parents or other family members. Staff recognised the need to ensure people had an understanding of friendships and relationships and would help people understand if they were asked. Staff told us people do go home to see their family or go shopping, which supported the comments received in the relative’s survey. It was evidence from observing people at home that Innes House was very much their home; they appeared to be relaxed and happy with their lifestyle and routines in the home. This showed outcomes for people were good. People are offered a good choice of meals, which is agreed with contributions and suggestions made by them. Meals are home cooked in the evening as most people take packed lunches or have meals at the day centre, college or place of work. As it was Pancake Day, people were looking forward to having pancakes, with a choice of lemon, sugar or syrup. A member of staff was preparing the pancake mix and was chatting to a number of people coming and going from the dining room. There was a friendly banter with staff as one person said, its nice to see you cooking for a change, laughing as they carried on sorting out the plates and glasses. Another person told us they have a special diet and eat low-sugar products to maintain their health, by their own choice. Staff spoken with said they were aware of peoples dietary needs and would ensure meals are prepared suitably for individuals. Staff said they do not always know if they Evidence: need to fetch basics such as milk, bread or sandwich fillings as information is not always passed on to the next staff members coming on duty. This results in staff having to rush out to buy items from the shop or collect supplies from the sister-home, close by. Some consideration should be made to improve communication to ensure there are sufficient stock of fresh essential food items in the home. The information gathered from the self-assessment tool and the survey responses received showed people have a good choice of meals that suits individual needs and dietary requirements. 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 . People living at Innes House have their personal and health care needs met by trained staff that promote independence and well-being. Evidence: The information we gathered from the self-assessment tool completed by the home, stated provide personal and health care support, enabling service users physical and emotional needs to be met; seek support from health care professionals as required and have a key worker system in place. People we case tracked described the support they received from staff and their independence to manage their personal hygiene. People told us they have appointments made to see the General Practitioner and are supported to attend these appointments. We observed people telling staff they wanted to have a bath. Staff told us some people just needed help getting in and out of the bath, whilst others were more independent of their personal hygiene. This was reflected in their care plans, showing the level of support and preferred routines and included specific direction for staff such as requires assistance with putting on the leg brace. This supported the comments received in the surveys from the people using the service and the relatives survey received, which included: At every public occasion there is nothing but praise from all the relatives including ourselves We have always been met with love and friendliness Staff told us they have a key worker system in place and demonstrated an awareness of peoples needs and the level of ability and independence. The care plans are Evidence: developed and updated by the key worker and includes the health and personal care needs, giving clear guidance for staff to support people and their references. It showed us that other health care staff such as the General Practitioner and the Community Psychiatric Nurse supports people. The daily report sheets read confirmed care plans and individual routines were supported and respected by staff, which promotes peoples their health and well-being. At present the care plans are in a written format and not person centred plans’, which means from the view-point of the individual. Whilst this may suit some people, consideration should be made to developing person centred plans and formats that suit the needs of people such as easy read words supported by pictures and symbols to convey messages. The Acting Manager who was present for a short while at the start of the site visit confirmed that medical profiles and diaries have been introduced. The medical diaries are of appointments made for health checks for people using the service. The care files listed the medication people were taking. This included the frequency, dosage and any known allergies and the contact details of the General Practitioner. This supported the information we gathered from the self-assessment tool completed by the home. All medication is stored in a locked unit along with the medication records. The medication is prepared by the Pharmacist into individual cassettes. The staff training records viewed, showed trained staff give people their medication. The policies and procedures for managing and administering medication were in place. We checked the medication cassettes against the medication records for the people we case tracked. All but one showed the medication and records were consistent and up to date. We found missing signatures on the medication records for one person and this was brought to the attention of the Acting Manager. Although they were unable to advise us as to why there was a missing signature, it appeared the medication had been given. After the site visit the Registered Manager of the sister-home close by confirmed the omission in the recording was raised with the staff team, the medication records are checked on a regular basis and individual errors in recording would be addressed with the individual member of staff. They told us further guidance would be issued to all staff to emphasise the importance of following the correct procedures. Two people we spoke with confirmed they receive their medication on time. We observed staff giving medication to people during the evening meal. This was done individually after checking the details, the medication and signing the records when the person had taken their tablets. This showed procedures were to a greater extent, followed. The information gathered from the self-assessment tool completed by the home, identifies areas for improvement. These include more regular reviews, audits of records, review of the policies and procedures and staff training. 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 . People living at Innes House have their rights protected, confident concerns are addressed and protected from harm or abuse by trained staff. Evidence: We wanted to find out if people know to complain and the process for dealing with any issues or complaints received by Innes House. We saw the complaints procedure displayed in the home, which is included in the information people receive about the home. The complaints procedure sets out the process of how the concerns or complaints are investigated. The complaints procedure includes the contact details for the Commission for Social Care Inspection, but these need to be updated. The procedure is only available in written format and on the website and the home should consider making this more accessible to suit people using the service. The responses and comments received in the surveys and directly from the people using the service on the day, included people were confident to tell the staff if there was a problem or something that was making them unhappy. The comments received in the surveys included: Ive got no problems and if I did I would tell the staff I would speak to a member of staff We received a survey from a relative who expressed to us that telephone messages are not always passed on from staff to staff, shift to shift when necessary and could improve the communication. We shared these comments with the Acting Manager to look into, as it could become an issue or problem that would affect peoples health and well-being if information and good communication is not maintained. The staff spoken with and observed, showed a good awareness of peoples needs and actions that would indicate to them that there was a problem and would approach the matter sensitively. Comments received from the staff included Ive been working here Evidence: for many years and you build trust and you get to know people. From our observations, comments received from the people using the service and the relative’s surveys, it was clear that people were confidant to complain and felt staff listened and acted upon concerns. The information gathered from the self-assessment tool completed by the home stated there was one complaint. We read the complaints record, which detailed the nature of the complaint, the investigation process and the conclusion. This demonstrated the complaints procedures are followed. The Commission for Social Care Inspection received no complaints or expressions of concerns about Innes House or the care and support people receive. The staff spoken with demonstrated a good understanding of what safeguarding issues are and the types of abuse that could be experienced by people living at Innes House. Staff gave us an example of when the raised concerns with the management team regarding the well-being of a person living at the home, who needed more care due to deterioration in their health. Staff appeared confident and showed responsibility to act and report any suspicions or concerns that affect peoples health, safety and wellbeing. This ensures people are safe and protected by the staff that work at Innes House. People told us they get their money from the office at the sister-home, close by. We spoke with the Administrator who maintains the records of money, which is held in safekeeping for the people using the service. The Administrator described the system and showed us the financial records maintained for each person and for each transaction made, which is always signed by two staff and sometimes some people may choose to sign the records themselves. This showed peoples money was kept safe. Staff employed by Innes House undergo a recruitment procedure in line with the homes policy and procedure. Three staff recruitment files viewed all contained evidence that recruitment checks were carried out, such as two references and a criminal records bureau check (CRB) and protection of vulnerable adults check (POVA) to check the applicant is suitable to work with vulnerable people. Records viewed also showed staff had completed the homes induction training to ensure people using the service are supported by trained staff. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People live in a home that is clean, maintained and comfortable for them. Evidence: Innes House is situated in Byfield, a rural village, which is accessible by limited public transport. On the day of the site visit people using the service had not returned home from their day-time activities but arrived soon after. Innes House is a traditional property that has been extended over the years to create a homely environment for people living there. There is a large open plan dining room and kitchen and a lounge on the ground floor, which is set out to create a homely feel. Bedrooms are over two floors, are single rooms, which are close to bathrooms and toilets. The information gathered from the self-assessment tool completed by the home stated improvements have been made to the home environment with the replacement of the boiler and heating system, decoration in the kitchen and some bedrooms and the replacement of carpets and flooring. Innes House has a new security system and staff have been made aware of this. This shows there is an on-going programme of improvement. Two people we spoke with said they preferred to have a key to their bedroom. Staff told us most people prefer to have a key to their bedrooms. We were invited to look at two bedrooms, both were individually decorated, fitted with bedroom furniture, fixtures and personalised to reflect their interests. There were family photographs, ornaments, medals and rosettes from winning horse riding events. Comments received from people directly included: I like living here, I have my own room and my own things like the television and my desk. I hang my new gown on the back of the door and put my identity badge on the Evidence: chair for tomorrow. The home is clean, tidy and furnished to a good standard, with complimentary decoration and furnishings that create a homely family atmosphere. This supported to information gathered from the self-assessment tool completed by the home. We saw people were involved and responsible for keeping the home clean and tidy or at least their bedroom. One person said the cleaner cleans his bedroom, which he appreciated. One person was clearing up the dining table after the evening meal and loaded the dishwasher. This showed people treat Innes House as their home and take responsibility. People told us they have their laundry done by the staff and have their clothes returned to them clean and ironed. Staff told us they have access to protective clothing like gloves and aprons. Staff said they attend regular updates in training in infection control, food hygiene and health and safety, which was supported by the staff training records viewed. Other training completed by the staff from the records included moving and handling. At present noone living at the home requires any special aids or adaptations to help them with their mobility. The staff told us the decorator is due to paint the lounge and then the bathroom on the first floor. We saw preparation had already started in the lounge and staff were seen talking about visible cables from the television that should be made more secure following the decoration and possibly purchasing of new items for the lounge. This supported the information gathered from the self-assessment tool completed by the home, in which is also stated replacement of curtains in the kitchen, sitting room (lounge) and sleepover room. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at Innes House are supported by staff who have undergone good recruitment process and training. Evidence: People living at Innes House appeared to enjoy a positive relationship at home, with the staff on duty. People were relaxed and went about their evening routines, occasionally being reminded or suggestions made by the staff. We saw staff listening to what people were saying and responding to questions as to whether eggs would be put into the pancake mix. This supported the survey responses received from people using the service stating staff listen, acted and treated them well. People told us they have a key worker that supports them and is involved in their care planning and one-to-one social outing or activity. Comments included: ... is my key worker Staff told gave an example of how they helped to build confidence for one person, to return to college, through praise, support and encouragement. This showed staff recognised and valued the importance to promoting peoples experiences, opportunities and independence by the support they give. The comments received from people using the service and in the surveys indicated the staff had the right skills to support the people living at Innes House. There were two staff working in late afternoon and evening. Staff told us they work over three units within the service, which has helped them get to know everyone using the services in all three units. Whilst staff recognised the benefits some personal concerns were expressed with regards to communication and on-call. We discussed this with the Registered Manager of the sister-home, who confirmed that the contact details for the on-call staff is available at each home and no other staff had any Evidence: concerns with regards to communication and the on-call contact. The comments received in the relatives surveys were shared with the Acting Manager and the Registered Manager of the sister-home close by and included: We appreciate that with many demands on the staff that there isnt time or the necessity as far as they can see to pass on information Communication, communication, communication We wrote last inspection that telephone call messages are not always passed on from staff to staff, shift to shift when necessary Some details frustrate us; ... could do her laces up each holiday I have to re-teach her (it not maintained, shortage of staff). Now we get shoes with Velcro Staff told us they are told when and where they are working and staffing levels would increase at weekends as there is more flexibility of what people choose to do. We were unable to view the staff rota, therefore unable to assess the staffing levels for the service. Consideration should be made by the management team of Innes House to ensure staffing issues are addressed swiftly as it may impact on the quality of life and outcomes for people using the service. We wanted to find out how staff recruitment promotes the health and well-being of the people using Innes House. We looked at the staff recruitment records for three staff. All the files contained evidence of two satisfactory references, criminal records bureau (CRB) check and a protection of vulnerable adults (pova) check. This is a check to assess the suitability of the applicant to work with vulnerable people. This demonstrated staff recruitment follows the procedures and checks are carried out on applicants to ensure the right staff work at Innes House. We wanted to find out how training completed by the staff helped them to support the people using Innes House, giving them a better understanding of learning disability and to tailor the support as per individual needs. The induction training is an in-house training that looks at the policies, procedures and key training such as health and safety, fire, moving and handling, infection control and food hygiene. Consideration should be made to looking at training organisations such as Skills for Care to ensure staff receive training in line with the current best practice, look at specific disability issues and promoting peoples independence and well-being. We saw the staff training matrix that showed staff had received a range of training dependent on their responsibilities, such as medication training given to staff who would be responsible to give people their medication. Staff told they had recently had refresher training in epilepsy, fire, food hygiene and breakaway, specific training for staff working with people with a learning disability. The information gathered from the self-assessment tool completed by the home, indicated the health and safety and the manual handling training was overdue and would be arranged in the next few months. This showed staff training and skills update is monitored. Evidence: The information gathered from the self-assessment tool completed by the home, stated 5 permanent staff had attained NVQ level 2 and above in care. This equates to 23 and consideration should be made to ensure at least 50 of care staff have attained a minimum of NVQ level 3 in care. One member of staff confirmed she had the NVQ level 2 in care. Staff told us they have daily morning meetings, which provides them with an update on the well-being of the people using the service. The staff on duty told us they have had supervision meetings but expressed that these were not always timely. In light of this, the Registered Manager confirmed in writing to us that “supervisory meetings are held regularly, taking into account the availability of staff themselves”; “appointments are made” and “there is an open door policy”. We concluded that the staff had a good rapport and relationship with the people using the service. Staff recognised peoples strengths and the levels of support needed. This showed peoples independence and quality of life is promoted by the conduct of staff. 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 . People living at Innes House live in a home that is managed and can contribute their views about the quality of the service they receive. Evidence: The information gathered from the self-assessment tool completed by the home, stated the Registered Manager has attained the Registered Managers Award and National Vocational Qualification (NVQ) level 4. Innes House is currently managed by an Acting Manager, who has also attained NVQ level 4 in health and social care. The Acting Manager is supported by the Registered Manager of the sister-home close by. We wanted to find out whether the changes in the management of the home affected the staff and the people using the service. People we spoke with related to the staff on duty and spoke about the key worker that supports them. Staff told us they were aware of their roles and responsibilities. Staff told us that the changes in management has had an affect of them, with regards to not being made aware of the emergency on-call contact and having to speak with colleagues at the sister-home to request information. The example shared by the staff highlighted the difficulty that occurs in an emergency, especially at night, if a person is not well and needs medical assistance. They also said communication between the staff and the management team could be improved. This was consistent with the comments received in the relatives surveys, saying: Communication, communication, communication We wrote last inspection that telephone call messages are not always passed on from Evidence: staff to staff, shift to shift when necessary. The records viewed relating to the people using the service showed there was a good relationship with the health and social care professionals. We saw people were having their care and support needs reviewed on a regular basis or sooner, if their needs changed. The staff told us they have daily meetings where information, updates and changes affecting the people living at the home are shared. This showed peoples health and well-being is monitored to promote and maintain their independence as far as practicable. This supported the information gathered from the self-assessment tool completed by the home. The information gathered from the self-assessment tool completed by the home, stated directors visits monthly. We did request to view the monthly visit report detailing the findings from the visit and any issues that require address. However, this was not made available or received by us at the time of writing this report. The Registered Manager of the sister-home, confirmed in writing after the site visit that the monthly visit reports are now available at the home. We wanted to find out how the views of people were gathered about the quality of the service they receive. Innes House has a quality assurance system whereby, people living at the home are given surveys to complete. The surveys are not available in alternative formats to suits the needs of the people using the service. The Registered Manager of the sister-home close by told us that surveys have now been sent out to the people using the service, their relatives and stakeholders such as health and social care professionals but not the staff, yet. We had discussed with the Registered Manager of the sister-home close by to consider measuring the results from the survey against the aims and objectives stated in the Statement of Purpose. This would demonstrate if the service is providing the quality as expected and peoples expectations of the service are met. The information gathered from the self-assessment tool completed by the home details the regular maintenance of equipment and checks carried out in the home such as heating, lighting, electrical and gas appliances, fire and fire equipment. People told us they have regular fire tests and staff maintain records of tests and checks carried out. Whilst the monthly visits carried out by the representative of the Responsible Individual also looks at the management and the home environment, we were unable to assess how issues identified at the recent monthly visits were addressed, as the monthly visit reports were not made available to us at the time of writing this report. However, from the evidence gathered, we concluded that the health and safety of people using the service is monitored and managed to ensure they are safe. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description Timescale for action 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 1 It is good practice to develop documentation and information about the home in alternative formats, such as easy read text supported with pictures and symbols, to suit the needs of people living at the home or considering using the service, to help them understand information easily. Care plans could be improved by making them person centred and available in alternative formats that suits the needs of people who contribute and influence the support they receive that results in outcomes that improve their quality of life. The complaints procedure could be more accessible and developed in alternative formats that would suit individual needs using easy read text or words, pictures and symbols. It is recommended that the numbers of staff that have attained or are in the process of attaining NVQ level 2 and above in care should be increased to meet the needs of the people using the service. It is recommended that the homes induction programme is reviewed and updated, considering the Skills for Care 2 6 3 22 4 32 5 35 training, which promotes the current best practice to ensure staff have the right skills and training to support the people living at the home. 6 39 The home should consider developing quality assurance questionnaires in alternative format to suit individual needs, where they can understand the questions with the use of easy read text, supported with pictures or symbols to express their opinion about the service they receive and experience. The homes quality assurance results should be measured against the Statement of Purpose to show if the expectations of the service are met, help identify areas of improvement and ensure the Statement of Purpose evolves as the service develops. 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. 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