Inspection on 29/06/05 for IW Cheshire Home

This inspection was carried out on 29th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

IW Cheshire Home 13/06/07

IW Cheshire Home 10/01/06

IW Cheshire Home 08/02/05

IW Cheshire Home 12/10/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 IW Cheshire Home Appley Cliff Popham Road Shanklin PO37 6RG Lead Inspector Janet Ktomi Unannounced 29th June 2005 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service IW Cheshire Home Address Appley Cliff, Popham Road, Shanklin, Isle of Wight, PO37 6RG Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01983 862193 10983 866211 Leonard Cheshire Mrs Helen Stedman Care Home 13 Category(ies) of Physical disability (13), Physical disability over registration, with number 65 years of age (6) of places IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 8/2/2005 Brief Description of the Service: Appley Cliff (IW Cheshire Home) is a residential home for up to thirteen people over the age of 18 years. The provider is the Leonard Cheshire Organisation, which is a leading provider for disabled people in the United Kingdom. Mrs Helen Steadman manages the home. The home is situated on the edge of Shanklin Old Village and is approximately one mile from the main shopping area, the post office, bus and train station. The home has extensive views of the English Channel and is adjacent to Ryleston Gardens. The gardens are for public use and have a bandstand, mini golf and café. The home is on two levels and has a passenger lift. All thirteen of the homes bedrooms are for single occupancy, none having en-suite facilities. There is one assisted bath and one assisted shower room. The home has plenty of communal areas including a lounge, conservatory, activities room and dining room. Smoking is only allowed in the conservatory or gardens. The home has gardens that are well maintained and easily accessible to the service users. Twelve of the bedrooms are for permanent service users with the other being used for booked respite care. Day care is offered to a maximum of two people each day. IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first unannounced inspection of this inspection year, core and additional standards were assessed. Core standards not assessed during this inspection will be assessed during the second unannounced inspection. The inspection lasted five and a half hours during which a full tour of the building was undertaken. Discussions were held with the registered manager, service users and staff on duty. Most of the service users living within the home were met during the inspection and gave the inspector their views about the service. All the service users stated that they were happy living at the home and liked the staff. Records and documentation identified in the report were viewed. What the service does well: What has improved since the last inspection? All requirements made following the previous inspection undertaken in February 2005 have been complied with. New carpets have been laid in the hall and one service user’s bedroom. A new boiler has been fitted in the upstairs assisted bathroom. The kitchen has been refitted. IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 and 5. The home provides appropriate information to prospective service users or their representatives. Pre-admission assessments detail service users’ needs and ensure that appropriate people are admitted to the home. EVIDENCE: The Statement of Purpose covers all of the areas required by the Regulations and Standards. Each service user has a copy of the Statement of Purpose and Service Users’ Guide. Additionally there is a brochure regarding the aims and objectives of Leonard Cheshire, this specifically covers the services offered by the Isle of Wight Home. The inspector saw these documents. Service users or their representatives sign to confirm that they have been provided with copies of the service users’ guide and statement of purpose. The fees are assessed prior to the placement and agreed according to the care needs of the service user. The Statement of Purpose includes the provision of day care, this is provided for a maximum of two day care service users per day. There has been one admission for long term care since the previous inspection. The assessment information and care plans in respect of this service user were seen. The assessment begins with a visit to the prospective service user by either the manager and/or the care supervisor. Information is gathered from the service user, the relatives, professionals and medical specialists. The prospective service user agrees the information gathered during the assessment and is involved in discussing how specific needs will be met. The IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 9 manager and care supervisor considers the information and how these needs will fit in with the needs of the existing service users. The views of existing service users are also considered. A care plan is written as a result of the assessment process and negotiations about any restrictions on service users take place prior to the placement being offered. All service users have a care manager and they are involved in the decision-making with social services assessments and placement forms being seen in the service user’s personal file. Discussions with the manager indicated that the home would only offer a placement if the staff have the skills and the home the equipment to care for the prospective service user. Service users’ care plans were viewed during the inspection, these demonstrate how service users’ needs are being met. This includes the involvement of specialist workers such as District Nurses and appointments with clinics and specialists as appropriate. Chiropody, Opticians, Dentists and GPs are accessed with the home providing transport and support. The registered manager is a second level qualified nurse who has virtually completed a course to convert to first level nursing registration and has knowledge and experience of the service users and their needs. Care staff spoken with had a clear understanding of their roles and confirmed that training was available to meet general and specific service user needs. Discussions with the manager indicated a clear understanding of service users the home was able to provide a service for and those whose needs it would be unable to meet. Service users stated that they felt their needs were appropriately met at the home. The home has an admissions policy that was seen during the inspection and should ensure that new service users are able to undertake introductory visits to the home prior to admission. In the case of the most recent admission, a relative visited the home and the service user declined to visit although the offer and transport was available. The home has one bed providing respite care and some of the service users received respite care at the home prior to a permanent placement. There is a minimum of three months trial period, detailed in the terms and conditions of residency. Unplanned admissions are unlikely due to the complex needs of the prospective service users, however, if it is a service user that knows the home well and has attended the home for either day care or respite care it could be considered if there was a vacancy. The home has one respite bed that is commissioned by the Isle of Wight Social Services Department. The permanent placements are all funded or partially funded and there are contracts in place with the purchasers. In addition each service user has a written terms and conditions of residency document, an example being seen during the inspection. The contract specifies the care to be delivered and the cost of that care. Service users or their representatives sign and receive a copy of the terms and conditions of residency. These are reviewed on an ongoing basis. Each placement is reviewed by care managers IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 10 at least annually to ensure the home is meeting the individual service users’ needs. IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9 and 10. All long term and respite care service users have individual care plans detailing how health, personal and social needs will be met. Care plans, service users and staff spoken with confirmed that health needs are met, that staff treat service users with respect and that privacy and confidentiality are upheld. EVIDENCE: Four care plans including that of the most recent admission to the home were seen by the inspector. These were very detailed. The service users’ files are organised under headings and each heading identifies the needs and how these will be met. The service user is involved in developing the care plans (evidence of their involvement includes their personal statements) and sign the care plan. Files contain photographs, medical cards, personal details, preferences, hobbies and interests. Up-dates of assessments were recorded and are carried out by the key workers for each service user at least every three months and more often if care needs change. The information available enables new staff to understand the needs of the service user and how best to meet these. Staff interviewed confirmed that they have access to the care plans, and use them to inform them of the necessary tasks. Risk assessments IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 12 are recorded and any restrictions on service users would appear to be thoroughly discussed and agreed with the service user. The manager and staff at the home are very keen to encourage service users to make their own decisions. Service users confirmed that they are encouraged to make decisions about day to day and longer term issues. The home has an activities and volunteers co-ordinator who could fulfil some of the roles of independent advocate with the manager being aware of how she might access external advocates if necessary. Evidence seen in care plans showed that service users had been involved in their assessments and planning of how identified needs would be met. This involves a form identifying whether the service user is happy to be cared for by male or female care staff, if they prefer baths or showers. There are records to show who the service user is happy to consult with when making a decision. The home will therefore not disclose any information, even to parents or partners, if the service user has not given their permission to do so. Care staff were clear about confidentiality and disclosing information including an understanding of when they may need to pass on information to a senior member of staff such as adult protection issues. Care plans demonstrate risk assessments where service users have chosen to undertake activities which may pose a danger to the service user. The home is aware of the balance between individual service users’ choice and minimising risk. All bedrooms contain a lockable facility operated either by a key or number code. Neither the manager or care staff are appointees for any service users. IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 16 and 17. The home provides service users’ social and leisure activities in a flexible and varied manner. A varied, nutritious diet is available which meets individual needs. Service users are provided with opportunities to make choices and to have control over their lives. EVIDENCE: Independence is encouraged and an assessment of the intervention required is made at the point of placement. The home aims to encourage mobility and maximize individuals’ abilities. In discussion with the staff it was clear that the balance of care, and encouragement for independence, is understood and taken seriously by the staff. Service users’ spiritual needs are identified in care plans and support to attend church could be provided. The home has an activities co-ordinator who aims to provide individual and group activities of interest to the service users. The activities organiser stated that she aims to organise activities around individuals’ specific needs and wishes. Service users confirmed that they are offered a range of things to do. Service users have a range of specialist equipment to move independently around the home and the IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 14 manager stated that referrals are made to specialists such as speech therapists for communication aids. Service users are supported to attend external activities including church, carriage driving, shopping, pubs and places of interest on the Island and mainland. The home has a collapsable hoist that can be used during external activities. There are no service users currently employed or going out of the home to attend training courses. The manager confirmed that she is familiar with opportunities for external day services and would ensure service users are aware of these. Should a service user wish to attend external services the manager would arrange this with care managers. Service users get advice about appropriate benefits and claims from the manager, care managers and family/friends. The home has two minibuses suitable for transporting people in wheelchairs. The home is now employing one driver and has a part time volunteer driver available in addition to two of the care staff who are able to drive the minibuses. Transport and support for medical and hospital appointments is provide free by the home with service users paying an individual amount depending on miles travelled for social and leisure activities. The home uses all local facilities such as medical services, hairdressers, shops, pubs and cafes. The manager and service users confirmed that all permanent service users are registered to vote and would be supported to do so either by postal votes or in person at the polling station. Care plans and service users spoken with confirmed that they are supported to participate in their local community. One service user has enjoyed a holiday in the New Forest with further holidays booked for next Easter. The home also participates in the Cheshire Home holiday exchange programme. The inspector was able to meet one service user who was on holiday at the Isle of Wight home whilst an Isle of Wight resident was staying at his home on the mainland. Smoking is only allowed within designated areas of the home. Service users at the home were all very complimentary of the food provided, stating that it was well cooked, with plenty of food available. The menus for the week were seen during the inspection along with menus for previous weeks, these indicated that a varied nutritious diet is available. Service users and the cook confirmed that they are involved in the planning of the home’s menus. Meals are taken either in the dining room or the lounge, whilst main meals are at set times breakfast times are flexible and meals may be saved for people who are not at home when meals are served. Service users confirmed that hot and cold drinks are available throughout the day and during the unannounced inspection service users were observed being provided with a hot drink in the middle of the afternoon. The home employs a cook who prepares both the main lunchtime and the evening meal. Special diets are catered for with equipment available to promote independence at meal and drinks times. IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 15 The manager confirmed that the service users are regularly weighed and if necessary specialist advice from dieticians would be sought. IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 and 20. Staff provide personal support to service users and ensure that dignity and privacy are maintained at all times. Medication is managed appropriately within the home. EVIDENCE: The privacy of service users is seen as a right by the staff. Service users choose their own clothes and hairstyles and are helped with putting on makeup if they wish. Care plans contained moving and handling assessments and details as to how individual service users should be moved and what equipment should be used. Care plans included a form detailing individual service user preferences as to whether personal care is provided by male or female staff. There is a key worker system in use within the home. The inspector was told by service users that staff support their personal care needs in a caring and dignified manner and feel the staff respect their privacy. The service users’ guide explains the rights of residents and how they will be upheld by the staff. Service user comment cards were returned prior to the inspection, all confirmed that service users felt their privacy was respected and that staff treated service users well. IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 17 The home has a policy and procedure for the safe storage and administration of medications and uses the Boots MDS system for the administration of medications where ever possible. The home has a policy and procedure for self administration of medication and assessments for this were seen within care plans. The storage arrangements for medications within the home are appropriate with stocks being stored in a locked cupboard and those in current use within a locked metal medicine trolley. A record is held of medication entering the home and that administered by the home’s care staff. There is a suitable recording method for medication administered by district nurses. Care staff responsible for the administration of medication have undertaken externally accredited training and have been assessed as competent by the manager. IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23. The home has a complaints policy with service users’ opinions sought and respected by staff. Staff within the home are aware of adult protection issues and follow the locally agreed procedure in the event of adult protection concerns. EVIDENCE: The home has a clear and thorough complaints procedure that is monitored through the Leonard Cheshire Organisation. Complaints are dealt with promptly and taken seriously. There is a complaints logging form that identifies the complaint, action taken and the service user’s satisfaction with the outcome. Service users spoken to were aware of how to make a complaint and knew how to access the Commission for Social Care Inspection. Care staff spoken with were aware of the action they should take should a service user or one of their relatives wish to make a complaint. The home has policies relating to adult protection, whistle-blowing and gifts to staff. In addition there is a quick access procedure for adult protection available for staff. Care staff confirmed that they knew their responsibilities with regard to protection of service users. Those spoken to felt they would be able to whistle–blow if necessary. Any allegations are taken seriously and are reported to the appropriate agencies. All the required pre-employment checks are undertaken to ensure that unsuitable people are not employed within the home either in a paid or voluntary position. IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 29 and 30 The premises is suitable for the existing service users providing all single bedrooms and appropriate bathing, WC, and communal space. EVIDENCE: The home is generally well maintained and provides appropriate accommodation for the service users. There is a range of communal areas, which are accessible to all service users. In addition to the dining room, lounge and conservatory there is an activity room with computers, reference books, games, puzzles and art and craft materials. There is also a large garden and a public park very close by that the service users like to make use of. There is a passenger lift in order to access the upstairs rooms. The home is bright and attractive with a range of art work by service users displayed in the hall. A large conservatory area gives wonderful views across the bay. The home has a no smoking policy with staff and service users allowed to smoke within the conservatory and garden. Since the previous inspection in February 2005 the home has replaced carpets in the hall and one service user’s bedroom and a new kitchen has been fitted. A new water heater has been fitted for the upstairs bathroom as the previous system resulted in a long wait for hot water in this bathroom. IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 20 A number of service users offered to show the inspector their bedrooms. All service users are accommodated in single bedrooms, none have en-suite facilities but all contain washbasins. Bedrooms seen had all the necessary furniture and fittings to meet the standards. The rooms have been fitted out with the individual service user in mind and include aids and adaptations. The service users have personalised their rooms and have many possessions of their own. Service users said they have a say in the decoration and furnishings of their room. Service users spoken to were pleased with, and proud of, their rooms. The carpet in one bedroom, identified to the manager, is in need of attention as, although it is relatively new, it has become damaged (probably by moving and handling equipment) and may present a risk to staff or the service user. There is one bathroom and one shower room with the necessary equipment to support service users. The home has a shower chair that is very flexible and can be controlled by most service users. Care plans contained information as to service users’ preferences for showers or baths. All bathrooms and WCs have lockable doors. The manager explained that part of the pre-admission assessment identifies aids and adaptations that the potential service user may require. These are then provided in advance of the service user arriving. The equipment for each service user is recorded in the care plans and the maintenance arrangements and certificates are kept on the files. These were seen in a sample of files chosen by the inspector. The home has a range of hoists and transfer aids. There is a passenger lift to access the upstairs level. Wheelchair maintenance is undertaken regularly. All rooms have a call bell system. Multi positional electric beds are provided for all service users. On the day of the unannounced inspection the home was clean, tidy and free of offensive odours. The manager stated, and care staff confirmed that all staff have training on the control of infection and safe disposal of clinical waste. Information about infection control and hand-washing procedures were seen around the home together with supplies of liquid soap, paper towels and disposable gloves. There is a sluice on both levels of the home and laundry facilities that are appropriate and designed to prevent cross contamination. Radiator covers are in place and there are valves on taps to control the temperature of the water. The temperature of the water in the assisted bath is recorded. IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35 and 36. The home employs sufficient care staff to meet service users’ needs and ensures that care staff are appropriately recruited, trained, competent and supervised. EVIDENCE: During the course of the inspection the inspector observed that the interactions between staff and residents were warm, friendly, and appropriate. Staff demonstrated that they have a good knowledge of the varying communication needs of the service users. Pre inspection questionnaires completed by service users said that staff treat service users well and that they feel well cared for by the staff. All staff have job descriptions and discussion with the staff showed they had a good understanding of their individual roles and responsibilities. There are employment agreements written by Leonard Cheshire organisation, which states clear expectations of employees. The home has a comprehensive induction package that ensures that staff know and support the main aims and values of the home. The tasks of the staff are closely linked to the individual care plans and the senior staff ensure the service offered meets the needs of service users by observing practise, supervision and records. Staff receive training on an ongoing basis and those spoken with were clear about the IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 22 limitations of their skills and how and when to seek advice from senior staff or health professionals. During the inspection service users described the manager and care staff as friendly, kind and helpful. Also stating that they felt able to discuss concerns or complaints with staff or the manager. During the inspection the interactions between staff and service users were warm and friendly with each listening to the others opinions and thoughts. Many of the staff have worked in the home for a number of years. The manager confirmed that care staff have undertaken introduction, core and update training to enable them to appropriately meet service users’ needs. Specific training to meet identified service users’ needs is arranged by the manager when a need is recognised. Care staff spoken with confirmed that training opportunities were frequently available and staff were actively encouraged to attend training. The home does not use agency staff with existing staff or the home’s own bank staff covering any additional shifts as required. Duty rotas, care staff and the manager stated that there are four care staff on duty in the morning, three for the afternoon and evening with two awake staff at night. In addition to care staff the home employs catering, domestic, administration, drivers and activities staff. The home has its own bank staff and does not use external agency staff. The manager reported low rates of staff turnover and sickness. Service users and staff spoken with during the inspection felt that there were sufficient numbers of staff on duty to meet service users’ needs. The home has a recruitment procedure that should ensure that unsuitable people do not work within the home. This includes advertisement in local newspapers, application and equal opportunity forms, two written references and an interview. Interviews are recorded and include one service user living at the home who has received training in recruitment procedures. All staff have enhanced Criminal Record Bureau and Protection of Vulnerable adults checks. All staff are provided with written job descriptions and terms of employment along with additional relevant information in the staff handbook. The manager confirmed that all volunteers at the home undergo a similar process as for paid staff. The staffing records for the most recently appointed member of staff were examined during the unannounced inspection. These confirmed the above procedure was in place. The home and parent organisation are very encouraging of staff undertaking training and provides study days and organise basic training days. There is a central induction programme that conforms to TOPSS recommendations and each member of staff has a training profile that is reviewed at least annually. The induction programme is worked through on a day to day basis with the supervisor assessing competence, then staff attend a follow up day with the parent organisation before they are officially ‘signed off’ the induction programme. Training includes equal opportunity and disability awareness IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 23 training. If a service user has a particular need the organisation will provide specific training to help the staff gain the skills to manage those needs. The staff spoken to confirmed that they are supported to learn. Care staff spoken with confirmed that regular supervision takes place, with two staff receiving supervision during the unannounced inspection. The manager and senior care staff have undertaken supervision training and all staff are allocated to a named senior staff or the manager for supervision. Supervision is undertaken every 2 – 3 months and is recorded in the staff file. Supervision records are accessible to the manager and supervisor only. In addition to the planned formal supervision the staff can ask for one to one sessions with the manager and/or senior staff if they have issues to discuss. There are also meetings arranged to discuss particular service users or practises that can be seen as group supervision. There is an annual appraisal of each member of staff where career development is discussed. Information about the grievance and disciplinary procedures is provided to all staff via the staff handbook. Care staff have training in respect of physical aggression to staff and the home has policies in place for aggression towards staff. IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39, 40, 41, 42 and 43. The management arrangements within the home ensure that service users’ needs continue to be met and creates a homely atmosphere in which service users felt valued and are well cared for. EVIDENCE: The registered manager has virtually completed her general nursing conversion course and will soon hold the Registered General Nurse qualification. The manager stated that she has completed NVQ level 4 in management. The manager has successfully managed the home for a number of years and prior to managing the Isle of Wight Cheshire Home was a registered manager in another residential home. The Leonard Cheshire organisation is very active in auditing the service and provides feedback to the manager. Service users and relatives completed feedback forms and sent them to the inspector prior to the inspection. All IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 25 service users were happy to talk with the inspector, stating that they felt able to discuss concerns or suggestions with the manager or care staff. Service users have meetings that are chaired by an independent person, either the volunteer co-ordinator or a representative from the disabled peoples’ forum. The home has achieved the Investors in People Award. All policies and procedures required by the Regulations are in place and reviewed annually. Any changes in policy are discussed with staff and service users and changes noted and dated. The home also keeps an easy access copy of policies and procedures that may be required in an emergency such as adult protection and missing person. Staff spoken with confirmed knowledge of the home’s policies and procedures. During the unannounced inspection a variety of records was inspected. These included fire equipment safety check log, care plans, risk assessments, accident and incident records, Medication Administration Records, menus and food records, staff meeting minutes and duty rotas. All were found to be well maintained and appropriately stored. At the time of the unannounced inspection there were no obvious risks, other than one carpet identified to the manager, to health and safety of staff or service users. Staff stated that they receive training in manual handling, first aid, health and safety, fire awareness and food hygiene. Safety notices were seen appropriately positioned around the home and infection control equipment was available for care staff. Covers are fitted to all radiators. The home keeps all chemical cleaning items in a cupboard that was locked at the time of the unannounced inspection. Appropriate measures to ensure the security of the premises were in place and recruitment/employment and induction training procedures should ensure that unsuitable people do not work within the home and that care staff have the necessary skills. The relevant insurance certificates were seen during the unannounced inspection. The manager confirmed that the home is financially viable, being full at the time of the unannounced inspection. IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 4 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 4 4 x 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 4 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 IW Cheshire Home Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 3 3 H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 27 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations IW Cheshire Home H55H04_S12501_IW Cheshire Home_V218302)290605 Stage 4.doc Version 1.30 Page 28 Commission for Social Care Inspection Mill Court Furrlongs Newport PO30 2AA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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