Inspection on 27/01/09 for Meadow View Nursing Home

This inspection was carried out on 27th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Meadow View Nursing Home 01/04/10

Meadow View Nursing Home 10/10/08

Meadow View Nursing Home 12/08/08

Meadow View Nursing Home 17/10/07

Meadow View Nursing Home 11/12/06

Meadow View Nursing Home 19/12/05

Meadow View Nursing Home 24/08/05

Meadow View Nursing Home 31/01/05

Meadow View Nursing Home 08/09/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Meadow View Nursing Home Church Lane Calow Chesterfield Derbyshire S44 5AG The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jill Wells Date: 2 7 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 35 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Meadow View Nursing Home Church Lane Calow Chesterfield Derbyshire S44 5AG 01246270235 F/P01246270235 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Enable Care & Home Support Limited Name of registered manager (if applicable) Neil Blake Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 24 0 care home 24 learning disability Additional conditions: Date of last inspection 1 2 0 8 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 35 A bit about the care home Meadow View is situated in the village of Calow, approximately three miles to the north east of Chesterfield within a residential area close to local amenities and public transport. The home provides nursing and personal care for up to twenty-four adults with moderate to severe learning disabilities, some also having significant physical disabilities. The home comprises of four bungalows, each accommodating six residents. The bungalows are linked, although each has its own separate kitchen, lounge, dining, bathing and toilet facilities. They also have their own garden areas, which have seating provided. Single bedroom accommodation is provided throughout, with six bedrooms per bungalow. The home is fully accessible for wheelchair users. There are several transport vehicles, including wheelchair accessible vehicles. The fees charged by the home at the time of the inspection visit was £1340 per week. Fees are dependent on individually assessed needs and any funding via local authority and primary care trust, including for the purposes of the free nursing care element of the fee. There are additional charges for personal toiletries and hairdressing. The cost of transport is charged separately. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 35 How we did our inspection: The quality rating for the service is two star. This means the people who use the service experience good quality outcomes. This is what the inspector did when they were at the care home The inspector visited the home. Read the last inspection report. Care Homes for Adults (18-65 years) Page 7 of 35 Met with people living and working at the home. Read surveys sent back from staff and relatives. What the care home does well Care Homes for Adults (18-65 years) Page 8 of 35 The home was safe for people using a wheelchair. Peoples care plans were in good detail. Training was being provided for staff. Care Homes for Adults (18-65 years) Page 9 of 35 Peoples were seeing their doctor and other health professionals when needed. There is transport provided. What has got better from the last inspection A great deal has improved since the last inspection visit. People are going out more often with help from staff. Care Homes for Adults (18-65 years) Page 10 of 35 There are more staff at the home. There are new baths and kitchens. A new acting manager is at the home who is helping to improve the service. Care Homes for Adults (18-65 years) Page 11 of 35 Staff are working together better and morale has improved. What the care home could do better Information about the home could be given in ways that are easier to understand. The contract/terms and conditions is not clear about what is and is not included in the fee. Care Homes for Adults (18-65 years) Page 12 of 35 New staff had not had moving and handling training before they assisted people. Independent advocacy could be used more. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 13 of 35 If you want to speak to the inspector please contact Jill Wells CPC1 Capital Business Park Fulbourn Cambridge CB21 5XE 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 14 of 35 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 15 of 35 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 . Peoples needs are fully assessed prior to admission, with trial visits arranged, so the individual and the home can be sure the placement is appropriate. A clear and transparent contract/statement of terms and conditions is not provided so that people can be clear about what is and is not paid for. Evidence: The service user guide had been revised since the last inspection visit. This was not yet in any alternative formats to make it easier for people to understand. The manager explained that this work was planned. There had been no new people admitted to the home since last inspection visit. However from checking peoples record it was evident that assessments had been done on admission and had been recently reviewed. The statement of purpose said that trial visits were offered and staff confirmed that potential new residents would visit, often several times, before a decision was made that the home could meet their needs. Individual written contracts/statement of terms and conditions were in peoples files. Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: However some were not fully completed and none that were seen had been signed by the resident or their representative. The occupancy agreement stated that, any entitlement to mobility allowance will be dealt with separately. It is understood that this is a standard sentence in agreements for all the providers homes. The manager explained that individuals pay their mobility allowance to the provider for the cost of the transport provided. This was not clear or transparent in the contract/statement of terms and conditions. A relative of a resident had concerns that mobility allowance was being paid, but they felt that the resident used the transport facilities infrequently. Two peoples financial records were seen. These showed that they had purchased their own furniture, bedding, curtains, curtain pole and towels. The manager thought that these had been purchased to make their room more personalised, however she confirmed that these two people would not be able to understand the idea of personalising their room. The homes terms and conditions said that these were included in the price. Care Homes for Adults (18-65 years) Page 17 of 35 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 . Peoples individual needs were well recorded with clear guidance for staff to follow so that that individual needs and preferences were met. Evidence: Three peoples files were seen. Each person had care plans that were reviewed monthly. They were very detailed and individualised and gave clear guidance to staff. For example one persons care plan around their social and emotional needs said, can become tearful when speaking to family, needs staff support at these times. There were individual records linked to each care plan to assist with the monthly review. One person that had no verbal communication had a communication chart. This gave clear examples of when the person does a particular thing, what it was thought was meant by this and what staff should do in response. These included positive and negative forms of communication. The care plans included individualised procedures for people likely to be aggressive or self harm. Record showed that a specialist behavioural nurse had been involved when required for support and guidance. A new worker spoken with said that they had read each persons file who they worked Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: with, as well as receiving guidance from established staff about individual needs. It was evident from observations that staff attempted where possible to encourage people to make decisions for example whether they wanted to go a walk or spend time in their room. Staff spoken with were aware of each persons non-verbal communication to help them understand their needs and wishes. Risk assessments were in place concerning peoples health for example pressure areas and nutrition. There were also specific risk assessments relating to each individual for example one person had tried to pull a fire extinguisher off the wall and a clear risk assessment and action plan was in place if this occurs again. A behaviour management plan was also in place for one person. Staff spoken with were aware of the importance of confidentiality. A new staff member said that this issue was discussed with them in their induction, including what should and should not be shared with relatives. A care manager from Social Services spoken with said that some residents may benefit from more independent advocacy involvement. Care Homes for Adults (18-65 years) Page 19 of 35 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 . The range of activities and standard of meals offered was good, which met the needs and wishes of people living at the home. Evidence: Staff spoken with during the inspection visit said that some but not all people had the opportunity to attend a day/resource centre. This gave them the chance to maintain and develop social, emotional and communication skills. Several residents were getting ready to go by minibus to a day centre at the start of the inspection visit, and it was evident that they were looking forward to this. Activities record showed some kind of activity taking place for each person on a daily basis. However some of this was limited for example, 10 minute walk around the bungalows and, a ride around without any indication of where, or the purpose of this. This however was a big improvement from the previous inspection visit where Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: activity records were very poor. The manager said that these records were, work in progress and staff needed to be more aware of the importance of recording all activities that were provided and in sufficient detail. During the inspection visit a number of activities and stimulation provided by staff were seen. This included staff spending one to one time with a person looking at a book, another staff member making signs and posters with three residents and a nurse spending one to one time with a person on a beanbag. Two people also went out with two staff members to a park and another person went shopping with staff followed by lunch out. Records showed that birthdays and other special occasions were celebrated, however one persons money records showed that they had purchased their own birthday cake. The manager said that this should have come out of the housekeeping budget. The sensory room was available and regularly used. Some people used the facilities at Ash Green specialist hospital for example sensory therapy sessions. A staff member spoken with said that they now accessed an evening wheelchair exercise group which several people attended and enjoyed. Staff from the local specialist learning disability hospital visited the home on a regular basis with musical instruments and encouraged residents to take part. Several people had designated hours for one-to-one work. Some of these hours would involve taking the person out, as well are spending time with them in the home. Staff were observed communicating well with individuals, including signs of genuine affection between some residents and staff. Regular themed evenings were arranged. They had recently celebrated Chinese New Year, where people made Chinese lanterns, Chinese food was eaten and Chinese whispers was played. Staff said that this was enjoyed by most residents. A celebration for Valentines day and St Patricks Day was planned. Photos were now displayed around the home of these events. There was a 4 week menu in each bungalow. Staff said that these were planned, taking into account individual likes and dislikes. There was a new file in each kitchen providing staff with guidance on nutrition, providing support at mealtimes and a dietary assessment for each person indicating their likes, dislikes, any risk issues and special dietary requirements. Although specific choice was not provided at each meal time, staff said that if someone showed signs of not enjoying a meal, an alternative would be provided. Food records showed that there were occasions when alternatives had been provided. Fresh fruit and vegetables were available and staff confirmed that this was always the case. Staff were observed assisting several people with their meal, however there were not sufficient staff available for everyone to have a meal at the same time. Peoples nutritional needs were assessed. One person who had gained weight recently had been placed on a healthy eating plan. Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: Eating aids were available to support people who could be more independent at mealtimes. A staff member in our survey expressed concern that the budget of 30 pounds per person per week, had not increased for a number of years and was not always adequate. The manager said that this was due to be looked into. Care Homes for Adults (18-65 years) Page 22 of 35 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 . Peoples health and personal care needs are met and the principles of respect, dignity and privacy are put into practice for people living at the home. Evidence: During the inspection visit three peoples records were seen. These evidenced that peoples health care needs were met. Doctors were contacted when necessary as well as other health care professionals for example physiotherapy, speech and language therapy, dental and optical services. One persons review highlighted the need for a hearing check, and this was quickly arranged. Several people had epilepsy and there were clear guidance and records of date, time, duration and type of seizure. Nurses spoken with had a good understanding of peoples health needs. An epilepsy nurse specialist wrote in our survey that staff contact the service regularly to update regarding peoples progress and to check any medication changes. The specialist said that they had provided staff with training in specific areas around epilepsy. She believed that staff knew residents well and were able to respond pro-actively if they suspected a change in the persons health. There were clear daily records of personal support provided for example bathing, hair washing, shaving and teeth cleaning. Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: There were technical aids and equipment to support residents and staff, determined by professional assessments. Peoples preferred daily routines were recorded and individualised. For example one persons records said, likes breakfast of Weetabix before their shower and likes to be told that they smell nice after their shower, shave and aftershave. After the last inspection visit, due to concerns around medication a specialist pharmacy inspector visited the service in October 2008. This visit highlighted significant improvements in medication storage, recording and administration. Therefore medication was not inspected on this occasion, however the two recommendations made in October concerning review of homely remedies and review of the overall medication policy were discussed with the manager.She confirmed that this had been done. At the last inspection visit there had been concerns about lack of respect, dignity and privacy for residents from some staff. Since this inspection visit there were records to show that senior managers had regularly visited the home and spoken with staff about this. Person centred care and planning training had also been provided. Observations during this inspection visit showed a significant improvement in the way that all staff now respect people as individuals. Care Homes for Adults (18-65 years) Page 24 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . There are appropriate systems and training in place to ensure that the service respond effectively to any complaints or allegations of abuse in order to protect people living at the home. Evidence: Since the last inspection visit there had been three safeguarding adult referrals made to Social Services. One was between two residents, and the others were allegations against members of staff. The provider has dealt with the allegations appropriately and other relevant professionals were involved. Staff have either received safeguarding adult training and refreshers or were booked on a course to do this. Staff spoken with were aware of the whistle blowing policy and their responsibilities if poor practice was seen. Five relatives responded to our survey. Everyone said that they knew how to make a complaint if they needed to, although one said that they could not remember. There was one complaint in the homes complaints record. This was from a neighbour, but on further investigation from the manager it was not related to the service. Care Homes for Adults (18-65 years) Page 25 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People live in a safe, well-maintained and comfortable environment, which encourages independence. Evidence: Since the last inspection visit an environmental audit has been completed to highlight any areas that need repair or upgrade. There was a large amount of work recorded on this audit and this was work in progress. New specialist baths have been fitted and two kitchens have been refurbished with plans for the other two to also be done. The manager said that new flooring was planned. Some windows had been replaced due to broken seals causing condensation, and others were planned. The manager confirmed that the raised flooring had been improved. New cupboards in bathroom areas needed to store incontinence pads were also due to be fitted. Although the service was registered for 24 people, it was four connected bungalows. Residents could spend time in other bungalows, although there was some restrictions with baffledoor handles. Residents have their own room and these were personalised with televisions and music systems if appropriate and some people enjoyed having sensory lights in their room for stimulation. Peoples individual financial records showed that some people had purchased their own furniture, curtains and bedding (see conduct and management of the home). Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: One person who was prone to throwing furniture had fully fitted furniture in their room so that the area was safe. Consideration had been given to this in the communal areas to minimise incidents, however it was thought to be impractical. Care Homes for Adults (18-65 years) Page 27 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The recruitment practices and staff training programme were good and ensured that people were protected by competent, well-trained staff. There were sufficient numbers of staff to support the people who use the service. Evidence: At the last inspection visit in August 2008 there were concerns around staffing levels, staff training and morale. Since the last inspection there has been significant improvements in all of these areas. The manager spoken with said that there had been a high level of sickness over Christmas and New Year but this had now improved. Short-term sickness was now being monitored. She stated that staffing levels did not go below 10 staff on duty in the day, with a minimum of two nurses. She aimed to have 12 staff on in the day with 3-4 of them being nurses. At night there was one nurse and 4 support workers on duty. When someone phoned in sick this no longer seemed like a crisis as there were more relief staff available. On the day of the inspection visit one person had gone home sick after the start of their shift, and this still left adequate staff on duty to meet peoples needs. There were 20 additional hours per week per bungalow described as mobility hours. These were hours used to take residents out. The manager and staff explained that these were not being fully used. They were having difficulty recruiting staff to these hours as the pay was less than for support staff. Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: Several comments were made in our surveys. A relative said, There are not always enough staff to take advantage of the vehicles to take people out. A staff member wrote that there should still be, more relief staff. Another staff member wrote, low staffing levels are due to sickness, we have sufficient staff employed. Another comment was, a lot of staff are dedicated and will come in or change shifts at short notice to cover shifts. Staff spoken with seemed to have a clearer idea of their role and the direction that the service was moving in. A nurse spoken with said that now work was delegated better and nurses were clearer about their roles. There was more consistency between the four bungalows, sickness was being monitored better and morale had improved. Staff confirmed that they had been on a number of training courses recently. This included training in managing challenging behaviour, person centred care and planning, handling information and enabling inclusion. A support worker who had recently started confirmed that the first three days of their employment was spent reading peoples records to help them have a better understanding of residents as well as talking to staff and observing practice. They confirmed that they had started a learning disability qualification course, and completed the person centred care course. They explained that it helped them understand the importance of promoting independence and not doing things for people automatically. They had not yet completed a moving and handling course, although they had worked at the home for almost 4 months. They explained that moving and handling was discussed with her by a nurse and she did not do moving and handling without a second person. This was discussed with the manager. She confirmed that another new person had not received moving and handling training or had any time spent with the nurse assessor. Record showed however that most people had done mandatory training or were due to attend refresher courses. Staff confirmed that now regular staff meetings took place. One worker said that, we now work better together, the manager checks we are doing our job right, but in a supportive way. Several staff confirmed that they were receiving regular one-to-one supervision. One supervision record was seen to confirm this, however some supervision records were being kept in the nurses personal lockers and were not accessible to the manager. Two staff files were seen. These were newly recruited staff. All relevant checks had been undertaken including two references and a criminal record bureau check. Several positive comments were received by relatives about staff. These included, staff appear to be dedicated, hard-working and caring and, in my opinion the staff in the home to a very good job. Care Homes for Adults (18-65 years) Page 29 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is well managed, and the home continues to develop and improve the quality of life for people living at the home. Evidence: At the time of the inspection visit the registered manager was off work. There was an acting manager, who had been in post since October 2008. She was a qualified nurse and has had experience of managing another service. She has made significant improvements to the service as a result of the poor rating received at the last inspection visit. Staff spoken with said, a lot has changed, there is more consistency, residents are going out a lot more, sickness is now being monitored, work is delegated better and staff morale has improved. Another worker said, you can go to the manager, she gets things done. We are doing more training now. A relative wrote in our survey that, since the acting manager has been in place things have improved remarkably, the place seems to run more smoothly. The service manager responsible for the service visits on a regular basis and Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: completes monthly reports of their findings. Senior managers have also met with staff to discuss what needed to be improved and how this should be done. Records required by regulation were maintained and up to date. There had been a notice served by the environmental health officer concerning poor management of risk to exposure of legionella and inadequate moving and handling refresher courses for staff. Records showed that there was now a system in place for managing risk of legionella and the manager confirmed that staff had either attended or were booked on a moving and handling course. The manager explained that general risk assessments concerning health and safety and the environment were not up to date when she started in post. She is in the process of reviewing and updating these. Accidents and injuries were recorded and reported. There were clear lines of accountability within the home and within the external management. Care Homes for Adults (18-65 years) Page 31 of 35 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 35 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 5 16 23/02/2009 The provider must ensure that adequate furniture, bedding and other furnishings are paid for by the provider unless the service user or advocate has expressed a wish to purchase their own and this is clearly recorded. This is to ensure that service users money is spent appropriately. 2 35 13 New staff must be provided 24/02/2009 with moving and handling training before they use equipment or assist with a persons moving and handling needs. This is to ensure a safe system for moving and handling people. Care Homes for Adults (18-65 years) Page 33 of 35 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 2 1 5 The service user guide should be in alternative formats to assist people to understand the document. The contract/statement of terms and conditions between the home and the service user should be clear and transparent concerning payment of the persons mobility allowance to the provider. This should be signed by the service user or their representative. This is to ensure that information provided is clear to interested parties. Consideration should be given to assessing each persons potential need for independent advocacy. This should be made available to anyone that may benefit from this. Activities records should be in more detail to evidence that people were provided with activities and stimulation to meet their needs. The mobility hours allocated to each bungalow should be reviewed to ensure that these hours are being used to assist people to go out if they choose to and improve the quality of their life. Supervision records should be fully accessible to the manager at all times to ensure that they are able to monitor supervision practices. Work should continue on reviewing and updating the general risk assessments concerning health and safety and the environment to ensure that people live and work in a safe environment. 3 7 4 14 5 33 6 36 7 42 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!