Inspection on 21/01/09 for Mill House

This inspection was carried out on 21st January 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Chesham House

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

Abbey Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 20/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Mill House Litcham Road Gayton Kings Lynn Norfolk PE32 1PQ     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: Lella Hudson     Date: 2 1 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. 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 31 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 31 Information about the care home Name of care home: Address: Mill House Litcham Road Gayton Kings Lynn Norfolk PE32 1PQ 01553636654 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) The Regard Partnership Ltd Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is 21 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home The Mill House is a Care Home which provides care and accommodation for up to 21 adults of both sexes who have mental health difficulties. There are four units of accommodation which are all linked together and share a garden. There are many changes of level within the building and there is no passenger lift to the first floor and so the Home is not suitable for residents who have physical disabilities. Inspection 21 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home reports are made available in the Home. Fees currently range between £375.00 to £1,200.00 per week. Fees are agreed on an individual basis dependent on need. Care Homes for Adults (18-65 years) Page 5 of 31 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: This report contains information gathered about the Home since the last Key Inspection in November 2007. The Home was bought in 2007 by the Regard Partnership through a share buyout and is now considered to be a new registration as it was registered in August 2008 under the name of Regard Partnership. The previous Manager of the Home has moved to manage another Home within the organisation. The current Manager has been in post for six months and is in the process of becoming registered with the Commission. The Manager sent us the completed Annual Quality Assurance Assessment (AQAA) which contains information about the quality of the service provided. We received completed surveys from one member of staff and five of the residents. The report also Care Homes for Adults (18-65 years) Page 6 of 31 includes information gathered during an unannounced visit to the Home which we carried out on the 21st January 2008. The Manager was not present during that visit but we spoke briefly to her after the visit. During the visit we looked around the accommodation, spoke to the deputy manager, staff and residents as well as looking at records. What the care home does well: What has improved since the last inspection? What they could do better: Despite the poor staffing levels and the poor state of the accommodation being raised at the last Inspection and through the organisations own internal quality audits very little has improved for the residents. Even with the additional night staff and housekeeping staff there is still a need to increase the staffing levels at other times, particularly at weekends. The accommodation is in a poor state of repair and decoration. In general, the accommodation is scruffy and needs deep cleaning in some areas. Many areas are in need of new carpets and furniture. The most serious areas of concern are the state of the bathrooms. For example, one of the baths has peeling enamel but we were told that the residents still use this bathroom. There are plans to address some of these issues but no action had been taken at the time of our visit. The organisation has introduced a new care planning format. There are still some areas of the care plans which do not contain enough information and there are some areas of identified risk that have not been adequately assessed. There are still some improvements needed to the medication system to ensure that all Care Homes for Adults (18-65 years) Page 8 of 31 residents receive medication at the correct times and in a consistent way. Although the staff receive training in mandatory subjects there is a need to ensure that they all receive relevant training about issues specific to the needs of individual 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 31 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 31 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. The Home has an effective admissions procedure. Evidence: There have been admissions to the Home since the last Inspection. We looked at the records relating to the admission process and saw that this contained detailed information about the residents needs and that information had been gathered from the resident and health/social care professionals involved in their life. Care Homes for Adults (18-65 years) Page 11 of 31 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 views of the residents are sought and they are encouraged to make their own decisions. Risks are not all identified and assessed adequately. The care plans are not detailed enough for ensure that staff are able to consistently meet the needs of the residents. Evidence: The Manager had stated in the AQAA that the organisation introduced new formats for the care plans and risk assessments in November 2008 and that staff are in the process of having training about the use of these. At the last Inspection there was a requirement for the care plans and risk assessments to be more detailed. We looked at two of the care plans and spoke to staff about the care needed by the residents. The care plans contain a lot of assessment information relating to the residents needs at the time of the their admission to the Home. There is evidence that the residents are involved in the care planning process. For example, some of the care Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: plans are signed by the resident. Also, one of the residents has written their own pen portrait and list of their needs. The new care plan format does not provide much room for writing in the identified actions and so some of these are difficult to read as staff have tried to put too much information into a small box. There is evidence that the care plans are regularly reviewed but as the original care plan is not changed this means that the staff have to read through all of the reivews to see what the current plan of care is. The care plans and risk assessments are still in need of further improvements. For example, for one of the residents, smoking in their bedroom has been an issue. We were told this by staff and there were several references to this in the daily notes. However, there was no risk assessment for this and no care plan. One of the action points for a resident was to encourage them to be more independent but there was no detail about how this should be done or by whom. Also there is no care plan or detailed guidance for staff about the arrangements in place for one of the residents who does some of their own cooking and shopping. There is also no risk assessment in place for one of the residents who is allowed to smoke in their own flat. The responses in the residents surveys that we received stated that they always or sometimes make their own decisions and all stated that they are able to do what they want. Residents told us that they are asked their views at the House meetings and also that staff talk to them every day about what they want to do and what support they need. The House meetings have been changed so that they now take place fortnightly rather than weekly and residents said that they prefer this. We looked at the arrangements in place for looking after residents money. Residents benefits are paid in to the organisations bank account and seperate records are kept for each resident. We looked at the records and the cash held for one of the residents and these tallied. The acting manager said that only he and the Manager have access to the safe but that residents can be given their money from petty cash if they need money when staff do not have access to the safe. There are no financial care plans in place. We saw the organisations own Quality Audit Tool that had been carried out in June 2008 and saw that several of the issues identified in this report had been identified as being outstanding at that time. This includes the need for more detail in the care plans, the need for financial care plans and for all risks to be assessed. Care Homes for Adults (18-65 years) Page 13 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The availability of staff support and transport can restrict the opportunities for residents to take part in meaningful activities. Residents are involved in the preparation of meals and their dietary needs are met. Evidence: The responses within the residents surveys that we received all stated that they are able to do what they want to do. However, residents told us during our visit that although they do have a choice about what they would like to do this is sometimes restricted due to the lack of transport or staff to support them. For example, after 6pm there is usually only one member of staff on duty and so there is no staff available to provide support to residents away from the Home. At weekends there is usually only two staff on duty. The completed staff survey that we received stated that there are not enough staff on duty. Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: The Home is situated in a rural village and we were told that there is a bus to the town of Kings Lynn once an hour during the day during the week. The Home has transport and residents can also use taxis if they need to. Very few of the residents attend formal day services of any kind. Some residents do voluntary work and others attend educational courses. Residents told us that they sometimes go on holiday in small groups and that on Sundays there is a small group of them that go out for part of the day with a member of staff. There is a pool table in the conservatory and the deputy manager said that there are plans to change this room into the games room in which they will have darts, pool table, computer games and a music centre. There is a television and dvd player in the lounge and most of the residents have their own televisions and computers if they wish to have them. During our visit a volunteer was in the Home providing a reminiscence group. One of the residents has their own dog and is responsible for looking after him. The care plans contain information relating to the arrangements in place for assisting residents to maintain contact with friends and family, if appropriate. One of the residents said that their relative visits on a regular basis and that they are also able to have friends to stay if they wish to as there is a guest room in the Home. Some of the residents are given their own money to self cater. The arrangements for shopping have recently changed so that this is now done on a more individual basis with keyworkers rather than everyone going to the shop together. Some residents have their own cooker and fridge in their room to enable them to self cater. One of the care plans that we looked at did not have any information or risk assessments in about the resident self catering. Residents told us that they enjoy their meals and that there is always a choice. Menus are planned with the involvement of residents. Residents usually get their own breakfast and lunch whilst the staff cook the main meal of the day. Residents are able to get breakfast whatever time they get up. They also have access to drinks and snacks throughout the day. One of the residents told us that staff gave her assistance and advice with healthy eating when she asked for this. Care Homes for Adults (18-65 years) Page 15 of 31 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. Residents needs can not always consistently be met. The medication system is now safer than it was but there are still areas in need of further improvement. Evidence: Very few of the residents need physical support with personal care but many do need prompts in this area. The care plans are not detailed enough for staff to have clear guidance about the support each resident needs. The poor state of most of the bathrooms also means that there can be difficulties in meeting residents personal care needs. The care plans do contain some information about residents mental health needs and how these should be met. Again these would benefit from being more detailed. The care records show that residents are supported to attend regular health appointments such as dentists, opticians as well as with mental health professionals. One of the care plans is detailed about the support that a resident needs at certain times and this confirmed the information told us by the resident concerned and the Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: staff about the support needed. The resident said that the staff are always kind and supportive and that they are good at distracting me. However, the resident did also say that during the evenings it can be difficult for staff to find time to speak to residents individually as there is only one member of staff on duty. They also said that at night time as there is only a sleep in member of staff on duty this means that there is no-one to talk to during the night. They said that they know that they can wake the sleep in staff if its an emergency but sometimes would just like to have a chat with someone if they are anxious about something. The Manager and one of the care staff are registered mental health nurses. The deputy manager and one of the care staff have achieved Level 3 in mental health care. Discussions with the staff and a look at the training matrix show that very little other training is provided with regard to working with people with mental health problems. The residents surveys that we received all state that the staff treat the residents well and that they listen and act on what the residents say. We observed the staff supporting the residents in a positive way. However we were told by staff and residents that at times there are not enough staff on duty. The staff are also responsible for the cooking and cleaning of the Home and this means that they can become task orientated rather than providing individual support to residents. The deputy manager said that there are plans to recruit a cook and cleaner so that the care staffs time can be spent directly with residents. The deputy manager has taken on additional responsibilities with regard to medication. There have been many improvements in this area. The medication storage has improved as it has been moved to a much larger room and there are dedicated medication trolleys for proper storage. There is a medication fridge with daily temperature checks being taken. The medication is not currently booked in when it arrives and it is not kept in secure storage until it is booked in and put in the medication trolleys although it is kept in a locked room. The deputy manager said that all the staff received training to administer medication from this new system in the last week. There are risk assessments in place for the use of Clozapin and there is a signed list from the GP about which homely remedies residents are able to have. We looked at the Medication Administration Records and there were no gaps. However, we did see that on one occasion a member of staff had signed as having administered the medication but this had then been refused by the resident. This issue had been identified as poor practice at the last Inspection also. We looked at the records relating to one of the residents who is responsible for their own medication. There is a risk assessment but this needs to reviewed and updated. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: We also noted that there is no guidanance for the use of PRN (as required) medication. Care Homes for Adults (18-65 years) Page 18 of 31 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. Complaints are taken seriously and action taken to address them. Procedures and staff training are in place to provide protection to the residents from abuse. Evidence: The residents surveys all indicate that the residents know who to speak to if they are unhappy about something. The staff survey states that they are aware of what to do if someone wishes to raise a concern/complaint. The Commission has not received any complaints about the Home since the last Inspection. According to the AQAA the Home has had three complaints since that time. We spoke to the Manager after the visit to the Home and she said that they are now recording all concerns as well as complaints so that there is a clear record of action taken to address any issues. The staff who we spoke to said that they have received training about Safeguarding vulnerable adults and that they are confident that any concerns that they may raise will be dealt with appropriately. The training matrix shows that the majority of staff have had this training within the last two months. Residents told us that the staff listen to them. Residents have opportunities to raise any concerns in the house meetings as well as on a more individual basis. Care Homes for Adults (18-65 years) Page 19 of 31 Care Homes for Adults (18-65 years) Page 20 of 31 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home is in a poor state of repair. It does not provide clean, homely, comfortable accommodation for the residents. Evidence: We were shown around the Home during our visit. We looked at all of the communal areas and two of the residents showed us their bedrooms. At the last Inspection a requirement was made for the Home to be kept in a good state of repair, to be kept clean and reasonably decorated. This requirement has not been met. The deputy manager said that the organisation has carried out a review of the accommodation and has plans in place for redecoration and refurbishment of some areas. A recent fire assessment has been carried out and as a consequence some doors have been replaced. There are plans for the kitchen to be refitted and for the conservatory to be redecorated once the leak in the ceiling has been completely dealt with. Overall the condition of the accommodation is poor and in need of immediate work to bring it to an acceptable standard. Many areas of the Home, residents rooms and the communal areas are dusty and dirty. The residents are encouraged to look after their Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: own bedrooms, with support from staff if needed. There is a smoking shelter in the garden as the Home is a non smoking home. However, there is a strong smell of cigarettes and stale smoke throughout the whole Home. Many of the carpets through the Home are stained and in need of replacement. Residents told us that there are problems with the heating and the hot water. The deputy manager confirmed this and said that the plumber was due to visit that day to review the boilers. The bathrooms are in a particularly poor state of repair. One of the bathrooms on the ground floor has damp all over the ceiling and needs a new door. The upstairs bathroom is in a very poor condition. There is a smell of damp, the bath is stained and the enamel is peeling off. The enamel is very sharp where it is peeling but the deputy manager said that residents are using this bath. He also said that this bathroom is going to be refurbished and that this room and the shower room next door will be made into one larger bathroom. He said that nobody uses the shower room at the moment. There is a small flat attached to the main house and two residents live in the flat. This gives them additional independence but with the support of staff if they need it. One of the residents is now not able to use the bathroom in the flat due to increasing mobility needs. One of the residents who self caters has a cooker and fridge in their room. There are no risk assessments in their care plan with regard to this. The resident told us that they had requested that some more shelves were put up in their room as currently lots of things are on the floor. We saw that this request was in the house meeting mintues in November 2008. This has not yet happened. The resident also told us that they have requested a chair and a table as they have to sit on the bed to eat their meals but that this also has not happened yet. Care Homes for Adults (18-65 years) Page 22 of 31 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 staffing levels are not adequate to meet the residents needs in a consistent way. Effective recruitment procedures are followed and staff receive induction training. Increased training about issues specific to the residents needs will increase the staffs skills. Evidence: The staff survey that we received states that appropriate recruitment checks were carried out prior to them starting work and that they received good induction and ongoing training. It states that there is not enough staff. The residents surveys all state that the staff treat them well and that they listen and act on what the residents tell them. A recommendation was made at the last Inspection for the weekend staffing levels to be reviewed. The report also questioned whether one sleep in member of staff is adequate to meet the needs of the residents. The staffing levels have increased slightly on some days but there is still only one staff on duty after 6pm and only two staff on duty at weekends. However, we were told that a review of staffing has been carried out and that there are plans in place to make improvements. Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: The night staffing arrangements are going to change so that there will be one waking night staff and one member of staff sleeping in. The shift pattern is also going to change so that staff will work during the day from 8am to 8pm and the night shift will be 8pm to 8am. This should mean that there will be at least two staff on duty well into the evening which will be an improvement. There are no plans at present to increase the staffing levels at weekends. The Manager is currently recruiting for housekeeping staff who will be responsible for the cooking and cleaning. This will free the care staff to spend time with residents. They may still be involved in these household tasks but it will be with regard to encouraging independence for the residents. The Manager and deputy manager work Monday to Friday. The Managers hours are supernumeray to the staffing rota but the deputy manager works three days a week with residents and has two administrative days. The Home does not currently have any support with administrative tasks. The organisation employs its own bank staff to cover when needed and we were told that agency staff are not used at the Home. We observed staff supporting residents in a positive way. There was friendly communication between staff and residents. Residents told us that the staff are kind and that they help them when they need it. We looked at a selection of staff files and could see that appropriate checks are carried out prior to staff starting work. Staff complete an induction that we are told complies with the Common Induction Standards. We spoke to staff about their training and were given a copy of the training matrix. From this evidence we can see that staff receive updates of mandatory training and are encouraged to do NVQs but that there is little additional training which is specific to the needs of the residents. The organisation has introduced training based on the computer for a lot of mandatory subjects. Only the Manager and the deputy manager have attended training about the Mental Capacity Act. Staff said that they receive regular supervision from the Manager and that they are always able to speak to the Manager about any issues that they may have. Care Homes for Adults (18-65 years) Page 24 of 31 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 Manager provides good leadership and management to the staff team. Areas in need of improvement that are identified during reviews of the quality of the service provided are not addressed in a timely way by the organisation. Health and safety is compromised in some areas. Evidence: The Home was bought by the Regard Partnership in 2007 through a share buyout and so only reregistered in August 2008 when there was a change in the name of the company. The previous Manager of the Home has moved to another Home within the company and the current Manager, Dianne Eaton, has been at the Home for approximately six months. She has previous experience of managing a Care Home and has relevant skills and qualifications. She is currently going through the process to become registered with the Commission. The deputy manager was only appointed to the post a month prior to our visit. He has worked at the Home for several years and so knows the residents and staff well. He Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: has attended some management training and said that more is planned. Staff and residents told us that the Manager is approachable and that she has good communication skills. They said that improvements have been made since she started working at the Home. The Manager was not present during our visit to the Home but we spoke to her briefly afterwards. The views of the residents are sought in a variety of ways. They are encouraged to discuss issues during the fortnightly house meetings as well as to meet with their keyworkers on a more informal basis. Minutes are kept of the house and staff meetings with records kept of action taken to address issues. There are systems in place for reviewing the quality of the service provided but there appears to be little action taken to address some of the major issues. For example, the organisation undertook a quality audit in June 2008 which identified many of the issues identified in this report such as the care plans needing more detail, risk assessments needed for financial arrangements and redecoration and refurbishment needed. The Regulation 26 reports for 2008 identified that the staffing is not adequate and that the Home needs to be cleaner. The deputy manager has recently taken on the responsibility for Health and Safety issues and is due to attend training with regard to this. We looked at a selection of records relating to health and safety and can see that regular checks are carried out on equipment. A fire risk assessment was carried out in February 2008 and a recent fire safety audit has identified that some of the fire doors needed replacing. A health and safety risk assessment of the whole building was carried out in November 2008. Weekly visual checks are carried out. The health and safety of the residents could be compromised by the lack of risk assessments for issues relating to individual residents. The poor state of the accommodation also compromises the health and safety of some of the residents, for example, using the bath which has enamel peeling off it, the fact that one of the residents is unable to use the bathroom in their flat, and the poor state of some of the carpets. Care Homes for Adults (18-65 years) Page 26 of 31 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 27 of 31 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 1 33 18 It is required that the staffing levels are adequate to meet the needs of the residents To ensure that the residents needs are met in a consistent way 28/02/2009 2 35 18 It is required that the staff receive training about the specific needs of the residents To ensure that the residents needs can be met by the staff team 30/04/2009 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 6 15 It is required that the care plans are more detailed To ensure that there is clear guidance for staff about how to meet the residents needs in a consistent way 28/02/2009 2 7 13 It is required that the residents have a financial risk assessment 28/02/2009 Care Homes for Adults (18-65 years) Page 28 of 31 To ensure that there are clear arrangements in place for looking after residents money 3 9 13 It is required that risks are identified and adequately assessed To ensure that risks are safely managed 4 20 13 It is required that the Homes own medication procedure is followed To ensure that medication is managed in a safe way 5 20 13 It is required that written guidance is available for the use of PRN medication To ensure that all residents receive their medication at appropriate times and in a consistent manner 6 24 23 It is required that an action plan is submitted to the Commission which details the refurbishment and redecoration that is planned for the Home To ensure that there is a plan to address the shortfalls in the accommodation and to be able to monitor this 7 24 23 It is required that the accommodation is kept in a good state of repair and decoration. 30/06/2009 28/02/2009 31/01/2009 31/01/2009 28/02/2009 Care Homes for Adults (18-65 years) Page 29 of 31 To ensure that the residents have safe, comfortable, accommodation 8 27 23 It is required that the bath which is stained and peeling is replaced To ensure that the residents have access to safe, comfortable bathrooms which meet their needs 28/02/2009 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 Care Homes for Adults (18-65 years) Page 30 of 31 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. 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