Inspection on 29/09/08 for Jasmine Lodge

This inspection was carried out on 29th September 2008.

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

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

Other inspections for this house

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Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Jasmine Lodge Station Road Northiam East Sussex TN31 6QL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michele Etherton     Date: 2 9 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Jasmine Lodge Station Road Northiam East Sussex TN31 6QL 01797252097 01424651641 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Selva Mani Heffernan Type of registration: Number of places registered: Hastings and Rother Primary Care Trust care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 6. The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home 6 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: A key unannounced inspection of this service has been undertaken. This has taken account of information received by us about the service and from the service since its registration under another Primary care trust in April 2008. Including an Annual Quality assurance Assessment (AQAA) completed by the manager. The AQAA has been completed to a reasonable standard and provides us with some of the information we need, some areas would be improved by more supporting evidence to illustrate how the service has addressed previously identified shortfalls and current and future plans. The inspection includes an unannounced site visit to the home on 29th September Care Homes for Adults (18-65 years) Page 5 of 34 2008 between 9:30 am and 16:00 pm. During our visit we undertook a tour of the premises and spoke with the manager and staff on duty, we met all residents but owing to their special communication needs we have been unable to consult directly with them to obtain their views about the service but we spent time observing some of their daily routines and the support they receive from staff with those. Survey responses have been sought from residents and other stakeholders and some limited responses have been received, and these have been helpful in the compilation of this report, we will endeavour to analyse and incorporate any further survey information that arrives before the final report is issued. As a new registration but not a new service all key standards have been assessed except that relating to recruitment of staff, this is to be assessed by a CSCI representative separately and will take an overview of recruitment practice for all care Homes registered with the PCT. Other standards have also been assessed where outcomes from our inspection findings have become apparent. During our visit we examined a range of documentation including support plans and risk assessment information, menu records, medication records and storage, staff supervision and training records, complaints, and health and safety information. In arriving at our judgment we have tried to be proportionate in considering compliance with regulation and outcomes for residents alongside overall risks and impacts of identified shortfalls. What the care home does well: What has improved since the last inspection? Staff have told us that staffing levels and continuity for residents has improved and that they feel better supported and conditions of work have improved under the new PCT. The home has been provided with a computer, access to the INTERNET and a designated vehicle for the home, the manager and staff welcome these improvements. AQAA information tells us that: Prospective residents receive a full assessment of need, and that the home continues to work towards the development of more person centered support plans, and planning meetings. The home provides residents with a full range of activities and these are more tailored to individual residents needs and interests. The AQAA tells us that recording of activities and daily routines has improved, and that residents access to routine health care appointments has improved and staff are more health aware. The AQAA also tells us that an improved complaint format has been introduced and staff have increased training and opportunities to express their views about the service. Staff tell us that repair and maintenance schedules have improved overall Care Homes for Adults (18-65 years) Page 7 of 34 Some new furniture has been purchased and a programme of upgrading is underway What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with information about the service and the terms and conditions of their stay but this is not always up to date and needs greater clarity. Systems are in place to ensure prospective residents are assessed prior to admission but these may not always be adhered to. Residents are provided with information about the terms and conditions of their stay but this may not always be accessible up to date or be consistent in the information it gives Evidence: Each resident is provided with a folder that they keep in their bedrooms this contains a range of information including Statement of purpose and user guide documentation, the service has developed some of the information into more accessible format using picture references, however there is a need to ensure this format is suitable for all residents and not rolled out across the board. We noted that Statement of Purpose information we viewed now needs amending to reflect the change in provider and contact details for CSCI, we also noted that the content of the Statement of Purpose is Care Homes for Adults (18-65 years) Page 10 of 34 Evidence: still not compliant with schedule 1 of the care homes Regulations 2001 there being some omissions of information. Contract and licence agreement information is in place but again needs updating to detail the change of PCT, disparities between the two documents regarding resident responsibilities for some costs i.e transport need reviewing as does the accessibility of contract information and these are recommendations. All but one of the present residents have been in placement for some years, the newest resident was admitted to the home in 2007 and the manager advised that a transition plan for the move to the home was completed, however we found no evidence of assessment or transition information on the current file as we would expect, although we have seen this information in use in other PCT homes, we were unable to ascertain in this instance that the resident in question had received a satisfactory assessment of need and that their present support plan had been developed as a result of that assessment. Residents have limited verbal communication and were helped to complete survey responses by relatives and other representatives, the feedback about their experiences of coming to live at the home indicated that two out of the three who responded were consulted about the move and a third had to move following the closure of their previous home. The responses received suggest that enough information was provided about the service before the residents moved in. Care Homes for Adults (18-65 years) Page 11 of 34 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. Residents benefit from more personalised support plans and risk assessments but some omissions in information may compromise the consistency and quality of support and impact on well being. Residents are encouraged to make some decisions and choices but it is not always clear with important decisions how this has been made. Evidence: We looked at support plans for four people, these are more detailed and reflective of individual routines, they are supported by a range of guidelines and staff are familiar with these. We noted in daily records for one resident reference to staff checking for redness of the skin and separate guidelines and a risk assessment are also in place it would also seem that staff have responded appropriately to the development and treatment of Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: sore areas but the support plan and Health action plan make no reference to these matters, and no waterlow assessment is in place. The support plan shows evidence of review but has not been amended to reflect a recent incidence of pressure areas. We looked at another plan and noted that a resident is to have pureed meals, we observed lunchtime at the home and clearly the staff ensure the resident receives a pureed meal but we are concerned that the presentation of this is not in keeping with current best practice and have reflected on this elsewhere in the report. We found the content and detail within support plans to be more individualised but these would have been improved by additional guidance for staff about behaviour that some residents experience and how these are to be managed. We noted some omissions of actions agreed within health Action Planning meetings being transferred to the day to day routines within support plans in one case this had an impact on the health of the resident in maintaining a diet that helped with a digestion problem but was not made clear within the support plan. In another we noted that staff are ensuring a resident rests during the day and this is in keeping with identified risks and risk reduction measures but no reference to this part of the daily routine is made clear within the support plan and may not be applied consistently if staff are unfamiliar with the resident. We recommend that every effort is made to ensure that decisions that impact on residents support and care routines made within reviews, life plan and HAP meetings are routinely incorporated into support plan information to ensure this is implemented. Our observations and examination of resident records highlighted that residents are encouraged to make simple choices and decisions in their daily routines but their participation could be greatly improved by use of picture and object reference material, there is also a need for the service to make clear how decisions about important and complex issues in a residents life have been taken where the resident them self may lack capacity to decide. We looked at risk information for some of the residents and found this to be more person centered but not routinely reviewed also we noted no cross referencing between identified risk and a support plan to show how staff support the resident to reduce risk as part of daily routine although guidelines are in place but no reference is made to these is the support plan to inform staff. It is recommended that all risk assessment information is routinely reviewed in line with frequencies of support plan review and other planning meetings and that where risks are identified some cross reference is made within support plans to inform staff and ensure they follow the necessary guidelines. Asked what the service does well a staff members response is day to day care of Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: individuals and planned support via comprehensive PCP care plans Care Homes for Adults (18-65 years) Page 14 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with opportunities to participate in a range of activities but the amount and variety can be inconsistent. Residents are supported to maintain links with important people in their lives. They are encouraged to exercise choice and their independence promoted. They enjoy a varied diet that takes account of their likes and dislikes but they could participate better if they were provided with more accessible information to help them. Evidence: We looked at activity planners for four residents each had an external or internal activity arranged each day in addition to some housekeeping tasks we looked at a specific period on activity planners against daily records maintained for individuals by staff. We found that whilst residents are being provided with some opportunities for interesting external trips and activities as well as regular outings for shopping, the Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: number of activities actually recorded in daily records is considerably less than those proposed by the weekly planner, it is not made clear always in records why activities have not proceeded as planned but clearly staffing levels, reduction in support from MCCH staff and driver availability are all limiting factors. Between a period of 4 weeks we found that four out of five residents we looked at actually experienced half of the planned external activities and one out of five experienced 3/4 of the planned activities for them over that period. Whilst it is acknowledged that residents are getting out into the community, there needs to be a degree of consistency and accuracy between what is a realistic range of activities to provide and this should take into account individual resident interests, aspirations, and wishes, whilst the participation of residents in domestic tasks is of value these should not be viewed as replacement activities when planned activities fall through and more thought should be given to providing more stimulating alternatives at these times. Discussion with individual staff and examination of some resident records informs us that staff are liaising with the relatives of residents on their behalf to discuss issues of welfare, there is also evidence of relatives attending life plan and Health Action Plan meetings at residents request, the manager and staff reported that where possible, the home supports residents to maintain contact with their families and friends and opportunities for tea visits to friends houses in the PCT group of homes has also been noted. Observation of staff interaction with residents and from our discussions with individual staff members we note that residents are supported to make simple decisions in their day to day routines but could be helped further in expressing their views and opinions by greater use of pictorial and reference objects. We understand from discussion with the manager and staff that an eight weekly menu rota is in place and that the menus are developed by staff from their knowledge of individual likes and dislikes. We observed residents in the kitchen observing meal preparation by a staff member, the kitchen does not have the facilities to enable residents in wheelchairs to participate more fully in meal preparation. Staff we observed are clearly ensuring that residents with specific dietary needs are supported in line with guidance, and noted one resident being provided with a pureed meal with all elements blended together, their food guidelines did not indicate the specific need for this and current best practice would indicate this should not be how pureed meals are presented other than exceptional cases, it is recommended that staff are made more aware of current best practice around specialist diets. Residents could be more involved in making choices and decisions around meals and menus by greater use of pictorial menus and prompts, food provided each day is recorded but provides little evidence of alternatives although in discussion staff and the manager reported that Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: they would respond by offering an alternative if a resident refused their meal, our examination of food records provided no evidence of this happening, individual residents records of food intake are not maintained so it is not possible at this time to make a judgment or audit individual nutritional intake, this has been discussed with the manager and agreed that daily records should make clear what residents food intake has been for the day and these are recommendations. Care Homes for Adults (18-65 years) Page 17 of 34 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. The physical, emotional and health needs of residents are generally well supported but will benefit from minor improvements to medication arrangements. Evidence: , staff we spoke with demonstrated a good understanding of individual residents needs and support. We looked at individual resident files and found support plans more individualized and reflective of residents personal preferences around personal care and support routines. The manager is aware of cross gender care issues and tries to always ensure a mix of staff on duty to afford choice. Our examination of resident files highlighted that residents are being supported and enabled to access routine health care appointments, where needs change evidence of specialist referrals and access to specialist appointments is noted. Each resident has a health action plan about which they and people important to them are involved and consulted. We looked at medication storage and found this satisfactory for the present resident needs, the manager is asked to be mindful that current storage would be inadequate should any resident be prescribed Controlled drug medication, and some thought Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: needs to be given to this to ensure storage of this type of medication can be facilitated in keeping with the relevant legislation. We looked at the medications stored and found that creams and liquids are not routinely dated upon opening and this is a recommendation, we also noted that some handwritten entries on medication record sheets were undated and unsigned, as the manager was unable to confirm that the receiver of medication and the person entering information on the MAR sheet will always be the same it is further recommended that all handwritten entries onto MAR sheets are signed and dated by the person entering the information. Otherwise the completion of Medication records viewed is satisfactory. Survey responses from health care related professionals who visit the home to see residents commented that: Staff act promptly whenever I have given advice or raised a health care problem. Asked what the service does well they responded that: Caring,committed and respectful They look after the residents really well they are always happy and cheerful well dressed and well looked after I always receive a very warm welcome and think the staff do a fantastic job with the residents Care Homes for Adults (18-65 years) Page 19 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A complaints procedure is in place but its accessibility for residents needs review and the recording system lacks confidentiality. Systems are generally in place to safeguard residents but would benefit from improved evidence that decisions have been taken in the best interests of residents Evidence: We looked at the complaints record, this is kept in the front entrance and is available to view, we feel the current system raises issues of confidentiality and this has been discussed with the manager with a recommendation to review how complaints are recorded to ensure confidentiality is maintained. The Service provides a pad for visitors to make comments about the home and to register a concern if necessary but it is unclear where this information is to be placed to maintain confidentiality and this needs clarity. The Service has made progress in developing a more accessible version of the complaints procedure for most of the residents this is still unlikely to enable them to make a complaint for themselves and thought needs to be given to the way in which staff interpret distress anger and unhappiness in residents , the home may wish to look at advocacy services to establish whether incidents recorded should have been interpreted as complaints and this is a recommendation Systems are in place to ensure residents day to day finances are managed Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: appropriately and daily checks are in place, we oversaw this checking process and noted that cash sums and written records balanced. We noted that at one time or another most of the residents have spent large sums of their own money purchasing their own bedroom furniture, or pieces of specialist equipment whilst in most cases this would seem to have occurred under previous PCTs, we noted a recent purchase by a resident that has been recorded on a life plan meeting record to which family members were present, there is however, no record of the discussion regarding the proposed purchase giving a clear rationale for doing so or record of how the final decision had been arrived at, we would recommend that where residents lack capacity to make clear their wishes in these matters that all relevant agencies and relatives are jointly involved in the decision making process. Staff have training in adult safeguarding and there is evidence that the service is appropriately referring adult safeguarding issues, there are no current open alerts. Our examination of resident files highlighted that guidelines to inform staff how they should respond to behaviours are not always in place and attention needs to be paid to ensure staff practice is supported by agreed guidelines at all times. We have raised concern that one resident who has purchased a bespoke bed is effectively restrained once in the bed because of its design, there is no record of how the decision has been taken or that this was done so within a multi disciplinary meeting involving relevant agencies, there is no risk assessment in place for the bed or evidence of review of this equipment and whether it is still appropriate and we require that these matters are addressed. Care Homes for Adults (18-65 years) Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean comfortable and homely environment that will benefit from planned upgrading. Shortfalls in the specified servicing of essential equipment for support of residents could place the health and safety of residents and staff at risk. Evidence: We undertook a tour of the home and found it to be clean and tidy with no noticeable odours. The home will benefit from a programme of upgrading as some communal areas are in need of redecoration and carpeting is noticeably stained in some areas. Residents bedrooms are very tastefully decorated, provide interest and reflect individual preferences for colour and items or personal possessions of significance. We have expressed some concern at the amount of furnishings and equipment purchased by residents themselves and this is addressed elsewhere in the report. We also noticed that one resident has purchased a bespoke bed that highlights issues of restraint and has been addressed elsewhere in the report. Externally the home is well maintained and residents have use of a large spacious patio area and can access the garden by use of a path,staff told us that repairs and maintenance timescales have improved since the change of PCT. Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: we noted that one resident has a moulded toilet frame for their specific use and this is maintained in situ by means of a brake over one of the three communal toilets, this in addition to the removal of the standard toilet seat to accommodate this equipment means that other residents who may wish to use the toilet independent of staff will need to do so with the toilet frame in place, we do not consider this acceptable or that it promotes good infection control and would recommend this arrangement is reviewed. We looked at equipment used by residents and found that hoist equipment in particular to to be long overdue servicing, our discussion with the manager and staff highlighted a common misunderstanding that such equipment is to be serviced annually in reviewing the servicing record from the contractor we were able to demonstrate a clear expectation of servicing contractors that repeat servicing would be within 6 months, we consider this lapse constitutes a health and safety at work issue, the provider is required to ensure that all equipment used for the support and care of residents is serviced in line with manufacturers and servicing contractors guidelines. Staff we spoke with commented that repairs and maintenance are generally being addressed within satisfactory timescales and this could be evidenced from the maintenance reporting and completion noted in staff communication records, however we have noted that routine visits from housing association representatives to look at property issues may need to be more robust and wide ranging to ensure that the concerns of the manager and staff in relation to repairs and maintenance are fully addressed and the visits effective. We checked the fire log and found tests checks and servicing to be mostly satisfactory however some inconsistencies in the frequencies of some tests and checks were noted and this needs to be undertaken routinely without exception to agreed timescales, whilst fire alarm and emergency lighting equipment has been serviced we found no evidence for servicing of extinguishers although regular visual checking is maintained. The fire risk assessment has been updated but makes no reference to the fire safety Order Act 2005 and the manager is asked to discuss its suitability with the fire officer at their next visit which is imminent. Fire drills are being undertaken but records would indicate that these are not capturing all the staff who should experience a minimum of two drills annually, the provider is recommended to make improvements in the areas highlighted. Care Homes for Adults (18-65 years) Page 23 of 34 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. Further improvements are needed to stabilize staffing levels and ensure residents daily and planned routines are adequately supported. There is a commitment to the formal training of staff and good progress made in this area but shortfalls have developed in the updating of staff in mandatory areas key to their support of residents. Staff have opportunities to meet together and with their manager but frequencies of this need improving. Evidence: AQAA information provided tells us that supervisions are now held every 2 month although there is acknowledgment that frequencies need improving for these and team meetings, we are also advised that staffing levels have increased and there are improved training opportunities for staff, there has been improvements to the involvement of managers and residents in the recruitment of staff, and a number of staff are involved in NVQ2 and LDAF training with some staff also given permission to pursue NVQ3 training. During our visit we spoke with staff and the manager who confirmed that staffing levels have improved and we looked at staff rotas to support this, we found that on most weekdays there are 3 staff on duty but often the manager is counted as a third Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: and not supernumerary, at weekends the home is working often with just 2 staff to a shift, staff we spoke with said this was manageable but clearly impacts on what activities can be provided to residents at weekends, we would recommend that staffing levels are reviewed to ensure that a minimum of three care staff are on shift in addition to the manager in order that residents daily routines and planned activities are not compromised routinely by under staffing. Staff recruitment files are to be separately assessed. Staff and the manager commented on improvements in the recruitment process indicating that the manager and residents are more actively involved in this process. We looked at staff training, individual staff training profiles have not been established but an up to date matrix has been developed, we found that although staff have completed mandatory training in the past updates for this are overdue for most staff in one or two areas, with 3 staff out of date in first aid, 4 staff out of date in moving and handling, 3 staff including the manager are out of date in their fire training,and nine staff including the manager are out of date in infection control training. All staff are in date with food hygiene training In other areas key to supporting the needs of this vulnerable resident group i.e communication, epilepsy and adult safeguarding between three and six staff are are out of date in their training. Whilst day to day competency of staff is satisfactory it is important that they undertake regular updates to ensure the support they provide residents with is compliant with current best practice and protects their own and resident safety, and this is a requirement. We noted team meetings are being held a staff member told us that although new she had recently attended a meeting and felt well supported and able to raise matters within the meeting. In a survey response staff commented that they thought the service could improve in that to offer all clients the best they can so more training and support for care staff to pass onto clients they also commented when asked whether staff had the rights skills and experience that staff need: Ongoing training for all care staff is mandatory and can be supported to take extra training if needed We looked at supervision records for staff and found that whilst there has been some improvement in frequencies these are occurring for most staff an average of every four months although the manager reported to us that she has during team meetings Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: provided a group supervision but independent records of this could not be provided we would recommend that all staff receive regular supervision at least six times annually and that this should include an observational element. Care Homes for Adults (18-65 years) Page 26 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well run but shortfalls in some key areas means that the health safety and welfare of residents may not always be protected or promoted in their best interests. Evidence: We found the AQAA provided by the home to be completed to a reasonable standard but lacked sufficient detail to inform us how previously identified shortfalls have been addressed if at all. Staff tell us they feel supported and listened to. We spoke with the manager and staff who all felt that improvements had taken place since the change of PCT but delays in progressing some issues continue to be frustrating, and clearly delays in establishing staff training programmes, equipment servicing contracts, and limits on spending on staff are outside the control of the manager. We noted that regulation 26 provider visits are happening regularly and are improved Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: in quality and length, in view of our findings from inspection in respect of some of the equipment and training shortfalls noted in the home, in addition to issues in respect of omissions in some documentation, the format of such visits should be revised to ensure they are sufficiently wide ranging in what is looked at in order to be effective. A system of resident consultation using quality audits is being introduced and some of these were noted for some residents, the usefulness and effectiveness of this method bearing in mind the capacity of some residents will need to be assessed and further changes made to ensure this has some value as an exercise. The analysis of these sessions and how they influence service development is still to be developed and a report published, the service also is still to implement a programme of internal audit and review of systems and this is a recommendation on this occasion We have noted from the AQAA information that many of the policies and procedures that should be in place are not these having been archived following the change of PCT, it is essential that staff have access to reference information to advice and guide their practice and interim policies and procedure information should be in place whilst updates are sent and this is a recommendation. The AQAA tells us that servicing is up to date but our tour of the premises has already highlighted shortfalls in servicing of essential equipment used by residents and staff and a requirements has been issued for this elsewhere in the report. We looked at a sample of servicing information and found that. The home were unable to provide evidence of a recent gas safety check and have not made this available within 48 hours of the inspection as requested are required to ensure this has been undertaken and evidence provided to CSCI In view of the shortfalls we have identified both in the timely servicing of essential equipment and services, the mandatory training of staff, shortfalls in staffing levels and omissions of important information about some care needs, behaviours and expenditure of resident monies we do not consider that the health and welfare of residents is being sufficiently protected or promoted, and that the health and safety of staff may be compromised by shortfalls in equipment servicing and training. Care Homes for Adults (18-65 years) Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 23 13 The provider must ensure that where restraint is the only practicable means of securing the welfare of a resident the decision to do so is taken within a multi disciplinary meeting involving all agencies and that appropriate risk assessments , monitoring and review systems are in place This is to ensure that restraint is used only where it is the only means of safeguarding the residents welfare 30/11/2008 2 29 23 Equipment used for the support and care of residents must be kept in good working order and serviced in accordance with manufacturers guidelines So that the health and safety of residents and staff is maintained 30/11/2008 Care Homes for Adults (18-65 years) Page 30 of 34 3 35 18 Staff must receive updates for mandatory core areas of training in compliance with stated frequencies and also in compliance with PCT guidance, policies procedures and risk information To ensure the health and safety of residents and staff is maintained, and is in compliance with current best practice 30/12/2008 4 42 23 The provider must ensure that an annual gas safety certificate is provided To ensure the health safety and welfare of residents and staff is maintained 30/10/2008 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 Statement of Purpose and user guide information should be kept updated and in a format suited to the individual resident, content of documentation could be complaint with Schedule 1 of the Care homes regulations 2001 Terms and conditions information contained in contract or license agreement information should be consistent, be in an accessible format suited to the needs of the individual resident and make clear their responsibilities in respect of financial costs The service should ensure that information from other meetings and reviews is routinely transferred to support plans where this involves changes in support and care. risk information should be routinely reviewed and where risks are identified and assessed this should be cross referenced to the support plan to inform staff and ensure they follow the agreed guidelines for managing the risks 2 5 3 6 4 9 Care Homes for Adults (18-65 years) Page 31 of 34 5 17 Staff are to be provided with further training in respect of the provision and presentation of specialist dietary requirements of residents. The service is to develop pictorial menus and prompts to enable residents to participate more fully in menu selection. The service should ensure individual residents daily food intake is recorded for monitoring purposes 6 20 Cream, liquid and drop medication should be dated upon opening to ensure this is not stored beyond the recommended period after opening. All handwritten entries onto MAR sheets should be signed and dated by the person entering or changing the information. 7 22 The accessibility of the complaints procedure should be reviewed and how residents distress, anger or unhappiness is interpreted Complaints recording system needs review to ensure confidentiality 8 23 Behaviour guidelines should be established for known behaviours, reference to behaviours should be clearly stated in support plans and managment of behaviours should be reviewed on a regualr basis. Expenditure from residents monies in order to purchase items of furniture, furnishings or health care equipment by residents should be supported by a clear rationale with evidence that this has been discussed with relevant parties and agencies in a multi disciplinary meeting. To ensure that the frequencies of testing and checks of fire alarm and emergency lighting equipment is maintained and serviced To ensure all staff attend a minimum of two fire drills annually. To ensure that the fire risk assessment is compliant with the fire Safety order Act 2005. To review infection control measures surrounding the communal use of a moulded toilet seat specific to an individual resident Staffing levels should be reviewed to ensure that three staff are on duty in addition to the manager on day time shifts so that residents daily routines and planned activities are not routinely compromised by under staffing. 9 23 10 24 11 30 12 33 Care Homes for Adults (18-65 years) Page 32 of 34 13 36 All care staff and the manager should receive formal recorded supervision at least six times annually either individually or in a group, records of this should be maintained, supervision of individuals should incorporate an observational element. The provider should implement a system for the internal audit and review of the service and undertake analysis of resident feedback and evidence findings of quality assurance information through an annual published report and this should evidence how residents have been influential in service development. The provider should ensure that staff have access at all times to up to date polices and procedures to inform and advise their practice 14 39 15 40 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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