Inspection on 27/03/09 for Meridian Walk

This inspection was carried out on 27th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Meridian Walk 14/06/07

Meridian Walk 18/05/06

Meridian Walk 21/11/05

Meridian Walk 16/06/05

Meridian Walk 28/10/04

Meridian Walk 06/05/04

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Edenvale

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Chatsworth Care - Dawson House

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Chatsworth Care - Tudor Lodge

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Meridian Walk 80 Meridian Walk Tottenham London N17 8EH     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: Jane Ray     Date: 2 7 0 3 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (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 32 Information about the care home Name of care home: Address: Meridian Walk 80 Meridian Walk Tottenham London N17 8EH 02083650023 Telephone number: Fax number: Email address: Provider web address: meridian.walk@heritagecare.co.uk Name of registered provider(s): Type of registration: Number of places registered: Heritage Care care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: Date of last inspection Brief description of the care home Meridian Walk is a purpose built care home in Tottenham, North London owned by Metropolitan Housing. The home is managed by Heritage Care based in, Loughton Essex and has homes in Newham, Norfolk, Westminster and Hertfordshire. Meridian Walk is registered to provide specialist support to six adults, male and female, with profound learning disabilities, some of whom also have physical disabilities. The home is very spacious and well equipped. It has two floors with a lift for wheelchair users. The residents bedrooms are spacious and all have en-suite facilities that are adapted to individual needs. The lounge, kitchen, dining room and sensory area are in one large room, divided into separate areas that are easily identified by residents who have sensory difficulties. The garden area is paved with raised Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 0 6 6 Brief description of the care home flowerbeds. All areas of the home are accessible by wheelchair users. The home is situated near an industrial site, some of which is being redeveloped for residential use. It is quite a distance away from Edmonton Angel, Tottenham and Wood Green shopping areas. The home has its own transport with a tail lift for residents with mobility problems. The aim of the home is to provide a friendly, warm, relaxing and homely environment striving to preserve and maintain the dignity, individuality and privacy of the residents and remain sensitive to each service users changing needs. The residents have access to a range of specialist services geared towards meeting their individual needs. The fees for the service are 1145 per week and there are no additional charges. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The inspection took place on the 27 March 2009 and was unannounced. The inspection lasted for seven hours and was the key annual inspection. The inspection looked at how the home was performing in terms of the key National Minimum Standards for Younger Adults and the associated regulations. The inspector was able to observe the support given to the current five residents. The inspector was also able to spend time talking to the manager and senior carer as well as three of the care staff who were working. During the inspection the inspector met one relative and also spoke to one other relative after the inspection. In addition the inspector received six surveys completed by staff and one completed by a resident with support from relatives. The inspector did a tour of the premises and also looked at a range of records including Care Homes for Adults (18-65 years) Page 6 of 32 resident records, staff files and health and safety documentation. The home had provided the inspector with a completed self-assessment questionnaire (AQAA) prior to the inspection. What the care home does well: What has improved since the last inspection? What they could do better: There are a number of areas for improvement identified at this inspection. Firstly the residents need to be supported to maintain their primary healthcare checks and to ensure their specialist appointments happen in a timely manner. This is to ensure their health needs are met. They also need to be supported to have person centred plans that reflect their personal goals, as well as regular review meetings and to ensure their relatives are involved in this process if they wish to do so. This is to ensure that the residents current and future needs are met. Staff need to be aware of each residents cultural and religious needs. Residents should also be supported to have a holiday if they wish this to take place. Medication received in the home needs to be recorded accurately to ensure accuracy at all times. In terms of staff, they all need to be offered ongoing training and regular supervision. There needs to be a clear record of what training each person has already received so future training can be properly planned. Staff records need to be maintained so that the manager can address any recruitment issues that arise such as whether staff have current permission to work in the UK. Some staff need to receive essential health and safety training to help keep the residents safe. A quality assurance exercise needs to take place to ensure the views of everyone is taken into account when looking at improvements for the home. Also the outcomes of complaints and the time taken to resolve complaints needs to be accurately recorded Care Homes for Adults (18-65 years) Page 8 of 32 to ensure issues are addressed in an appropriate timescale. All these issues reflect the managers approach and indicate that he needs to be more organised and pro-active to ensure the best standard of service for the residents. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be assured that they will be thoroughly assessed and have opportunities to visit the home as part of deciding if the service is right for them. Staff have a wide range of skills and experience to enable them to meet the residents complex needs. Evidence: Based on the assessment outcome, we inform the prospective service user if our service can meet their aspiration and needs and if it does we invite them to visit the home and spend some time and meet the service users who live in the home and after that if they choose we can start the transition period which can be short or long depending on how quickly the prospective service user is settling in. (Extract from the AQAA prepared by the home) The long standing staff really know my relative well and have a very good relationship with him. (Comment from a relative) At the time of the inspection one person was visiting Meridian Walk as part of a Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: process to decide if they wish to move to the home. Care staff also explained that they have been visiting this person at their existing home to get to know them better. They have also received detailed information about the needs of this person from care professionals as part of this assessment and moving process. In addition the residents who have lived at Meridian Walk for a number of years also have assessments prepared by the staff from the home and care professionals. We discussed the current needs of the people who live in the home with the manager and care staff. They have very specific individual needs linked to their learning disability and complex physical needs. The staff spoken to had a very good understanding of the individual needs of the residents. In addition it was observed that the staff were supporting the residents with great skill and sensitivity. The staff spoken to said they had received training on meeting the needs of the people living in the home, which has included epilepsy and supporting people with swallowing difficulties. We also looked at the statement of purpose and service user guide. Both these documents provide information about Meridian Walk and the service user guide is pictorial to make it more accessible for people with a learning disability. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are supported to have a care plan and risk assessments. This will facilitate the residents to receive the support they want and to make choices in their daily lives. Further work is needed to ensure these identify individual outcomes that the residents may wish to achieve. Evidence: All the service users have a comprehensive care plan, detailing their needs and how they like to be supported to meet these needs. (Extract from the AQAA prepared by the home) We only get invited to review meetings by the social worker not to reviews arranged by the home themselves. (Quote from a relative) We inspected the care plans for four people currently living in the home. We also spoke to the care staff about the plans. These documents provided clear guidance on each persons support needs and reflected their individual likes and dislikes. The care Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: plans also included details of each persons important relationships and their religious and cultural needs. The home is introducing person centred plans. One person whose case notes were inspected had a person centred plan that made good use of photos and another person had a partly completed person centred plan. The other two residents did not yet have a person centred plan. The person centred plans have not yet helped the residents to identify any key goals or areas they would like to progress in their lives. This meant that it was not possible to see if residents were being supported to achieve their hopes and aspirations. Two of the four residents whose care plans were inspected had not had a review meeting with a representative from social services in the last year and no meeting had yet been arranged. The senior support worker was not aware of the home contacting the social workers to highlight the need for a review. Relatives commented that they are not invited to internal six monthly reviews to review the care plan. Each resident had a named key worker. The staff were asked about their role as a key worker and this showed that the support they provided was very comprehensive including helping with personal shopping, attending healthcare appointments and ensuring all the residents personal care needs were met. The manager explained that one of the residents had recently been allocated a new key worker. The parent had not been told the name of this person and thought their relative did not have a key worker. The four residents whose case notes were inspected all included individual risk assessments covering all areas of potential risk and these identified what action the home would take in response to the identified risks whilst at the same time promoting each persons independence. These had been reviewed and were up to date. We observed the people living in the home and their interaction with the staff. It was positive to note that they were being facilitated to make choices including when they wished to get up or move around the home, when they were ready to eat and in some cases what they wanted to eat or drink. The staff were observed to be very aware of non-verbal communication. They were also able to describe how they facilitate choices by for example offering a choice and observing the residents response. The carers explained that none of the residents has an advocate, although it was observed that they all have relatives who are able to help with decision making on behalf of the residents. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported to develop their independence and to eat a healthy and nutritious diet. Residents are currently being supported to access a range of community based activities. Flexible routines in the home promote choice for the residents. Evidence: They do some lovely food with fresh vegetables and my relative is not loosing any weight. (Quote from a relative) Service users lifestyle and the individuals rights to live their lives as ordinarily as possible is the main and most important objective of our service. (Extract from the AQAA prepared by the home) On the day of the inspection it was seen that residents who were not having, to leave Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: the house early to go to the day centre were given the choice to remain in bed for longer. Residents were supported to get up in a slow and leisurely manner. It was however noted that two residents who were going to the day centre needed to eat their breakfast rather quickly in order to be ready for the transport that was collecting them. One resident who was not feeling very well was able to stay at home with staff available for support. We saw that residents were being supported where possible to do things for themselves. For example people were feeding themselves using adapted plates and cutlery. Where residents wanted to walk around they were encouraged to do so. We spoke to the staff and looked at the residents activity records to get an understanding about the activities that are taking place. Concerns had been raised earlier in the year about the lack of activities taking place on the days people were not attending the day centre. One relative stated that the activities had now improved. It was positive to note that residents were enjoying a number of different outings including swimming, trips to the park, going to the theatre, bowling, shopping and meals out. It was also seen that staff were working at the home at specific hours to provide the support to enable these activities to take place. A few activities were also taking place in the evening. Within the home there is a visiting aromatherapist, as well as the use of the sensory room, foot massage and other ball games. Residents were seen enjoying listening to music in their bedrooms. The senior support worker explained that they are currently planning a holiday and sorting out passports in order to enable people to go abroad. No holiday has yet been arranged and no holiday took place last year. The AQAA identified that the residents have different ethnic and cultural backgrounds. One person is Muslim and one carer said she did not eat pork and another carer said she ate every food. The care plan did not clarify this matter. It is important that the religious and cultural wishes of the residents are discussed with their relatives to ensure these are respected. Two residents go to church with staff. The manager explained that the people living in the home have close contact with their relatives, who either come to visit them or they are supported to go home. From discussions with staff it was clear that these relationships are valued, for example one resident had been supported to buy their mother a gift for mothers day. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: We saw the record of food eaten in the home and this was a healthy and nutritious diet. There was fresh food available in the home. The care plans provide the details of how each person needs to be supported with their eating. Several of the residents have swallowing difficulties and can loose weight very easily. The care staff explained that the residents have their weight monitored at their day centre. On the day of the inspection two of the residents went out for lunch. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are supported in a manner that protects their privacy and dignity. Some residents are not being supported to access the healthcare input they need in a timely manner. Evidence: All the support and personal care is given in the service users personal and private space, with the level of staff support required to ensure they maintain their dignity and independence. (Extract from the AQAA prepared by the home) My relative is always clean and appropriately dressed. (Quote from a relative) We observed during the inspection that the people living in the home were given support with their personal care based on their individual needs. The residents were all well dressed and groomed and what they were wearing was very suitable for their age. The people living in the home have en-suite bathrooms and this helps to maintain their privacy. The healthcare records were inspected for four people living in the home. Three of the Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: four residents had seen their GP in the last three months. The manager explained that all of the residents had received dental input, although this was not recorded in their case notes. None of the residents had received an optical check for three years. All the residents had received chiropody input and two had received input from the dietician and speech and language therapist a couple of years ago. One resident who has complex epilepsy has no record of seeing a psychiatrist or neurologist for eighteen months although an appointment has been arranged. A relative said they had needed to sort out what had happened to an outpatient referral for their relative, as it was not being addressed by the home. We checked the medication in the home. The home uses a blister pack system. The medication received in the home had not been recorded on the medication administration record, which meant it would not be possible to follow an audit trail. The medication administered was correctly recorded. Where medication was given as required there was written guidance on when this should be administered. Following the inspection the manager said that all the permanent staff had received medication training from the pharmacist, but there was no record of when this took place. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home have access to an appropriate complaints procedure but outcomes of complaints need to be monitored. Procedures and training on safeguarding vulnerable adults are in place to protect the residents. Evidence: All our staff have attended the protection of vulnerable adult training and sat a test to make sure that they are aware of the issues of abuse and how to recognise it. (Extract from the AQAA prepared by the home) I will listen to the complaint and reassure the resident, relative, advocate or friend and then pass the concerns to my manager following the companys complaints policy. (Extract from a staff survey) We looked at the complaints record and saw that there had been two complaints in the last year. An appropriate format is available to record complaints but it was not clear how long it took to resolve the complaints or what action had been taken to address issues raised in the complaints. The inspector saw that the home had a protection of vulnerable adults procedure prepared by the company. The staff training records were inspected and showed that all the permanent staff had received training on safeguarding vulnerable adults. Since the last inspection there have not been any safeguarding issues in the service. The Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: staff who we spoke to during the inspection demonstrated a good knowledge of safeguarding procedures. We looked at the personal monies and records for four of the residents. The company or a relative manages their monies on their behalf. The residents whose monies were managed by the company had a clear record of their finances, which showed they were receiving their benefits. All the residents had cash available in the home and there was a record of all expenditure with receipts available. Staff ensure the monies are accurate as part of the handover process. One resident had accumulated a large balance. The relative said they had made many detailed suggestions about how this money could be spent to benefit the resident but this had not been implemented by the home. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are benefiting from an environment that is clean, tidy and homely. The furniture reflects their personal preferences. Maintenance issues are identified and addressed. Evidence: The home provides a homely, safe, comfortable and clean environment. The service users share a large open area divided into lounge, dining and kitchen areas where service users can identify where they are and move around. (Extract from the AQAA prepared by the home) We did a tour of the building and the home was clean and tidy. The home has been designed to meet the needs of the residents. At the time of the inspection a representative from the housing association responsible for the building was visiting the service. This was to look at improvement works in the garden. They also said they would be returning to do a list of works that need to take place in the home. This was positive as parts of the building look in need of refurbishment. A number of improvements had taken place since the last inspection including the provision of new carpets, four bathrooms have been refurbished and improved CCTV cameras are available to help with external security. It was however noted that in a Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: few areas the carpets appeared stained and need to be professionally cleaned. The residents bedrooms are very personal with different beds according to their individual needs. We also saw that in the lounge there were a range of seats again reflecting each persons preferences. At the time of the inspection the lift was not working properly and the cooker was broken. Both had been reported so that repairs can be arranged. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are supported by a committed and stable team of staff. Despite irregular supervision and training the staff work hard to deliver good care. Evidence: We provide a high level of staffing to give the service users the best possible support when they most need it. (Extract from the AQAA prepared by the home) When I am unsure or need support I always seek it from the rest of the staff team and speak to my manager. Where training is needed this is often available. (Quote from a staff survey) We are a bit short staffed but members of the team help out. (Quote from a member of staff) We checked the rota for the home and this showed that there is a team of nine permanent staff and some bank staff working in the service. The staffing structure consists of the manager, senior support worker and a team of support workers. During the day there are usually three staff working and additional staff are arranged to help with activities. At night there is one waking and one sleeping in member of staff. The staff turnover has been low but recruiting new staff has taken a long time and the Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: home uses bank staff and agency staff. The manager explained that applications have been received for a permanent vacant post. Most of the staff spoken to during the inspection had worked in the service for several years The AQAA prepared by the home stated that five staff have completed an NVQ in care and two are working towards the qualification. We looked at the recruitment records for the two new bank staff and two permanent members of staff. Evidence of a CRB disclosure was communicated from the HR department at the head office. The other recruitment checks were in place including two references and ID were available for one of the bank staff but the other bank worker who appeared on the rota had no recruitment records available in the home. The two bank staff had completed an induction checklist. It was noted that the record of one member of staffs permission to remain working in the UK had expired although this was addressed after the inspection. We inspected the training records. This proved to be difficult as there were no comprehensive records in the home and the information sent from head office was not accurate and up to date. This made it hard to confirm which staff had received training and when this needed to be refreshed. I was able to see the corporate training programme and this included a good range of training. The staff said that no training was booked for staff from this service in the next few months. We looked at the supervision records. This is carried out by the manager and senior support worker. It could be seen that a number of staff had not had regular supervision with gaps of more than two months between sessions. The format used for supervision is appropriate and includes a record of any action agreed, however the record of supervision showed very little evidence of a more detailed discussion. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A permanent manager is in place who is very caring and has appropriate experience. The managers failure to address all the operational issues in the home means that the residents are not getting the quality of service that should be available. Health and safety measures are in place to safeguard the people living in the home. Evidence: The manager is always working to improve the outcomes for service users and is highly competent to run the home. (Extract from the AQAA prepared by the home) The manager is very kind but too laid back. (Quote from a relative) I end up doing things for my relative because I feel I need to, but the home should be doing them really. (Quote from a relative) Whenever you want help he is always there. (Quote from a member of staff about the manager) Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: The manager explained that he has almost completed his NVQ level 4 in care. He has worked with Heritage Care for nine years and has plenty of experience. Following the complaint earlier in the year we told the manager that there would be an inspection of the service in the near future. Despite being aware of this it was disappointing to find so many areas outstanding. It was also evident that relatives had a sense of frustration over things they would like to have addressed. The manager is well supported by other departments in Heritage Care such as finance and HR and yet his style appears largely reactive rather than proactive. This is now potentially having an impact on the outcomes for the residents and needs to be addressed. The manager had no knowledge of a quality assurance exercise, taking place in the last year to seek the views of relatives and care professionals about the service being provided. The Heritage Care policies and procedures indicate that these systems such as the use of questionnaires are available. The AQAA stated that the maintenance checks in the home have been completed. Fire safety measures are in place including the servicing of the fire alarm and extinguishers, the weekly testing of the fire alarm and the completion of the fire safety risk assessment. The record of fire drills shows a gap of six months between drills in the second half of last year and these should be more regular. The manager said that five staff updated their fire safety training earlier this year using online learning. The staff training records show that several of the permanent and regular staff need to complete essential health and safety training including four who need training in food hygiene and four who need training in moving and handling. None of the staff have received training in infection control. Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 12 The registered person must ensure the residents are all supported to attend healthcare appointments. This is to ensure they receive the healthcare input they need. 29/05/2009 2 20 13 The registered person must ensure there is a record of medication received in the home. This is to ensure there is an accurate record of the medication available. 30/04/2009 3 22 22 The registered person must ensure the record of complaints includes when the complaint is resolved and the outcome. This is to ensure complaints are addressed in a timely manner and the issues are fully addressed. 30/04/2009 Care Homes for Adults (18-65 years) Page 29 of 32 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 4 35 18 The manager must ensure that there is an updated record of staff training available in the home. This is to ensure that staff training needs are identified and staff enabled to attend the training they need. 30/04/2009 5 36 18 The registered person must ensure that staff receive regular supervision of an appropriate standard. This is to ensure that all staff have the opportunity to discuss their performance in the service. 29/05/2009 6 39 24 The registered person must ensure that a quality assurance system is implemented in the home. This is to ensure the views of residents, their relatives, friends and other care professionals are received and used to improve the standard of service. 29/05/2009 7 42 13 The registered person must ensure all the staff have completed the necessary health and safety training. This is to avoid unecessary risks for the residents. 29/05/2009 Care Homes for Adults (18-65 years) Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 The registered person should ensure the person centred plans are completed with each resident and these include their individual goals and aspirations. The registered person should ensure review meetings take place with care professionals at least once a year. They should also invite relatives to internal care review meetings and ensure relatives know the name of the key worker. The registered person should ensure that all the staff understnad each residents religious and cultural needs. The registered person should ensure residents are enabled to have a holiday if they wish to do so. The registered person should ensure all healthcare appointments are correctly recorded for future use. The registered person should follow up suggestions from relatives in terms of purchases to be made for residents using their personal monies to improve their quality of live. The registered person should ensure that there is a clear understanding of staffs current permission to work in the UK where needed. The registered person should ensure the manager reviews his working practices and management style to ensure the service is managed effectively at all times for the benefit of the residents. 2 6 3 4 5 6 11 14 19 23 7 34 8 38 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (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 32 of 32 - 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!