Inspection on 05/12/08 for Mullion

This inspection was carried out on 5th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mullion 06/12/06

Mullion 20/12/05

Mullion 06/07/05

Mullion 25/01/05

Mullion 20/09/04

Mullion 15/03/04

Similar services:

Hillview Farm

Dalewood Respite Care

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Fairways

Treloar College

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Mullion 230 Portsmouth Road Horndean Hampshire PO8 9SY     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: Christine Walsh     Date: 0 5 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 35 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 35 Information about the care home Name of care home: Address: Mullion 230 Portsmouth Road Horndean Hampshire PO8 9SY 02392596820 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Stephen Richard Brockway Type of registration: Number of places registered: Community Integrated Care care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 3. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Mullion is a registered care home, providing personal support and accommodation for three young adults with learning disabilities. Mullion is a bungalow set back from the main road just outside Horndean. Mullion bungalow is owned by Knightstone housing association. Stephen Brockway is Mullions registered manager, Community Integrated Care are the service providers. Mullion comprises of three single bedrooms, a communal lounge, dining room and kitchen, a laundry and an enclosed garden. Information in respect of current fees was not available at the time of this visit. Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 3 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 peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. This site visit formed part of the key inspection process and was carried over one day by Mrs C Walsh, regulatory inspector. The manager completed an Annual Quality Assurance Assessment (AQAA) document, which was returned to the Commission for Social Care Inspection prior to the visit to the home. The information obtained to inform this report was based on viewing the records of the Care Homes for Adults (18-65 years) Page 6 of 35 people who use and work at the service, speaking with the residents, and staff and observing care and support practices. A tour of the home took place and documents relating to health and safety matters were viewed. The people who live at The Mullion are known as Residents and referred to as such throughout the body of the report. What the care home does well: What has improved since the last inspection? No requirements or recommendations were made following the last visit to the home. They tell us in their Annual Quality Assurance Assessment (AQAA) that they have made a number of improvements in the service and these were seen at the time of the visit. Evidence tells us that the home has successfully integrated a new resident to the home and everyone involved in the process are pleased with the way the home supported the resident to move in. The home tells us they have improved the decoration of the home in a number of areas, including redecorating and refurbishing a bedroom to a residents liking and physical needs. They have purchased a large wide-screen television for the lounge and upgraded a number of fire safety measures such as new fire doors, new fire control panel and new emergency lighting. This tells us the home is aware of residents individual needs and wishes and the Care Homes for Adults (18-65 years) Page 8 of 35 importance of ensuring the home is maintained to a satisfactory standard, this includes the recent upgrade of the fire safety systems. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 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 10 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides the people who use the service with a Service User Guide which tells them about the home and the services it provides. The people who live in the service have limited comprehension of the written word therefore would benefit from a Service User Guide in an accessible format The home ensures the people who express a wish to move into the home have their needs assessed prior to moving in to ensure their needs can be met. Evidence: The AQAA (Annual Quality Assurance Assessment) told us that they believe the team has learnt how to present the positive attributes of The Mullion, ease the transition and understand the anxieties of prospective residents and their family. This was tested by viewing the homes Service User Guide, assessment documents for a resident and discussion with the registered and deputy managers. The residents living at The Mullion have limited verbal communication and use other Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: forms of communication such as gestures and behaviours to express what they need, want and to express different emotions. The service user guide in its current format does not take these alternative forms of communication into account. The home may wish to consider how the service user guide can be adapted if and when they have another vacancy. The manager spoke at length of how the home ensures prospective residents and their families are made familiar with the home, the way it is managed, staffed and the facilities it provides. This includes working closely with the prospective resident and family, encouraging visits to the home and staff working with the prospective resident in their familiar surroundings. The manager told us that this had been very successful and all parties are pleased with how the resident has settled into the home. The assessments seen include information from the placing authority, health care professionals and other services the prospective resident access. The service undertakes it own assessment of needs which includes ensuring prospective resident will be compatible with current residents. The assessment informs the reader what support is required with areas, such as personal care, communication, relationships and social activities. The deputy manager told us. The system we use for assessment and transition means everyone is made aware of the needs of the resident and how they need to be supported. This has worked really well. A care manager told us: There is a good assessment process prior to service users moving in. Care Homes for Adults (18-65 years) Page 12 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. The home ensures personal plans are in place that reflects peoples individual needs and tells the staff how the people who use the service wish to be supported. By using a person centred approach the home ensures the people who use the service are supported to make informed decisions about how they wish to live their lives. The home ensures the identified individual risks to the people who use the service are minimised and staff are aware of what they need to do to protect their health, welfare and safety. The home must however ensure all areas of risk are documented. Evidence: The AQAA told us that the home does well to provide choice at every reasonable achievable opportunity to their residents irrespective of limited verbal communication ability. The AQAA goes onto tell us how this has been accomplished through, training, experiences and the philosophy of care. The AQAA also told us that it recognises it Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: could do better to continue to promote independence. This was tested by observing day to day practices, viewing the personal plans of two residents, which included care plans and risk assessments, speaking with a resident and two members of staff and viewing comment cards. The personal plans told us that the service provides a person centred approach to the care and support needs of individual residents. It tells us who the important people are in their lives, gives an insight to their personality, their likes and dislikes and how they need to be supported in areas of their daily lives. Care plans are written in a way that promotes residents dignity, privacy, choice and independence. The manager told us that staff must read and sign to indicate they have read the care plans, this was evident at the time of the visit. The registered manager told us that as far as feasibly possible they will involve residents in the planning and reviewing of their support plans. Each resident is well supported by family members who are fully involved in their day to day lives and who will be involved in the review of their personal plans. Staff said they found the personal plans to be informative and tell them what they need to know when supporting residents with their daily lives. A member of staff said in a comment card: We always communicate changing needs of service users by use of communication book, evaluation sheets, meetings and general discussion. A care manager told us that the service does well to provide a person centred service with good and accurate recording. Throughout the course of the visit it was observed that staff support residents to make decisions about what they wish to do. This was done using various communication aids dependent on how residents communicate and understand. It was witnessed that residents are provided with choices and asked what they would like to do. Personal plans tell the reader what areas residents are confident in making choices and decisions and areas where they may need support or prompting. The home has various communication tools to assist with the decision making process such as a picture menu and weekly picture calendar which has been designed to provide flexibility in specific activities. Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: A member of staff who was spoken with at the time of the visit verbally demonstrated they understand the values of respect, choice, privacy, dignity and promoting independence. The member of staff told us. The people who live here are happy, we take into account what they would like to do, their age and their abilities and do our best to make it happen. A comment card received from a member of staff told us: The service does well to support service users and train staff to understand all aspects of rights and inclusion. Each resident is assessed on aspects of their care and support that could prove to be a risk to their health, welfare and safety. These include areas of personal care and environmental risks such as bathing, accessing the community and moving and handling. The risk assessments tell the reader what the risk is and what action is needed to minimise it. It was noted through conversation with the registered manager that not all risks spoken about had been documented within the risk assessments, such as bathing and eating and drinking. The registered manager must consider documenting these specific areas of concern within the risk assessments to ensure the residents health and safety within these areas of activity. The home has detailed behavioural support plans that tell the reader how to recognise behaviours, potential triggers and how to minimise triggers which could escalate the behaviours. A member of staff spoken with at the time of the visit confirmed that as part of their induction they were made aware of residents personal plans, risk assessments and behavioural support plans. The member of staff went on to tell us, that as part of the role of a keyworker they are responsible for ensuring any changes are escalated to the rest of the team to ensure continuity of care. Care Homes for Adults (18-65 years) Page 15 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 home ensures the people who use the service are supported to maintain an active lifestyle that suits their needs and individual interests. The home ensures the people who use the service maintain contact with family and friends and socially engage with their peers and the local community. The home ensures the people who use the service have their rights respected, are provided with opportunities to make decisions about their every day lives. The home ensures the people who use the service are provided with support choose healthy meals. Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: The AQAA told us that the home does well to encourage family involvement, create a friendly, relaxed, comfortable and homely atmosphere, nutritious meals and activities. This was tested by viewing personal plans, daily activities, menu plans, observing practice, and speaking with a resident, staff and the manager. Each residents personal plan has an activity record that identifies the activities they enjoy and a record of activities they have been involved in each day. The plans include attending day services, swimming, horse riding, in house activities such as watching TV and listening to music. Residents are encouraged to attend these and access the community. On the day of the visit a resident was being supported to go shopping and out for a meal which is a favourite pastime of theirs. Each resident has a designated day a week where they are supported by staff to access an activity of their choice. The home has numerous pictures and collages of residents involved in various activities through out the home and in each residents bedroom. These include adventure activities, holidays, parties, theatre trips and family get togethers. Comments received from staff and relatives told us: Staff: We make time for everyone but sometimes it would be nice to do more. The service does well to encourage individuals to live a more independent life. The service is quite good in making sure all residents have got one activity or the other every week. Relative: Apart from being very caring they give my xxx a good social life doing the things xxx likes to do. The AQAA told us that the home has plans for the next twelve months to organise holidays for the residents with support from staff to do this. Residents are supported to maintain contact with family and friends, this was evidenced in records held in their personal plan. The information tells the reader about relationships that are important to residents and the contact they have with those people. Daily notes record if contact has been made with family and friends, which Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: includes visiting the family home or family and friends visiting the home. A relative commented: The home is a friendly and happy environment, I am always made welcome when I visit. Through observation the staff and the manager showed us they treat residents with respect and uphold their dignity, privacy and individual choices. Information in personal files inform the reader, the name by which resident wishes to be to known by, and what behaviours and non-verbal clues are telling staff about how they are feeling. A member of staff was aware of their roles and responsibilities in respect of providing an individual approach and valuing residents for who they are. This shows us that they have an awareness of the importance of treating and respecting residents individual rights and beliefs. Residents have access to their own bedrooms when they wish and have access to all communal areas of the home. For residents who require supervision for their safety, staff provide support to access areas such as the kitchen, garden and the community. Mealtimes are led by what the staff know of the residents individual likes and dislikes and their preferences. A member of staff said that they encourage residents to eat healthy meals. The menu appeared balanced and provided healthy options. A resident who was eating their lunch at the time of the visit told us that they enjoyed their food. Care Homes for Adults (18-65 years) Page 18 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. The home does well to ensure the people who use the service receive the appropriate support with their personal care, health care and medication in the way in which they require and prefer. Evidence: The AQAA told us that the home does well to provide support necessary to meet personal care needs whilst considering the residents dignity and privacy and trying to increase their independence. The AQAA went onto tell us that they do well to support residents when meeting with health and ensuring staff are appropriately trained to administer medication. This was tested by viewing personal plans and medication records, speaking with staff and the manager. The personal plans provide detail on how residents wish to spend their day including what time they like to get up, go to bed and when to have a bath. The plans provide detail on how to support residents with their personal grooming. Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: A member of staff said they were aware of residents individual support needs as the staff are encouraged to read the plans, be involved as a keyworker to support residents with their everyday needs and be involved in reviewing their personal plans. Plans demonstrate that there are clear structures in place, which have been developed to support residents to undertake everyday activities with limited stress and anxiety. The registered manager stated that the home has good links with primary care and specialist health care teams. Residents personal plans provide evidence that their health care needs are regularly monitored and reviewed. The plans also provide information on specific health care needs, what action is required and how staff must support residents with these health care needs. The home has systems in place for the administration of medication. The home uses a monitored dosage system (MDS) supplied by a recognised high street pharmacy. Medications are received, stored, recorded and disposed of using systems as recommended in the Royal Pharmaceutical Guidelines. It was noted that the medication cupboard was clean and tidy. Each resident has a list of medications prescribed, which includes regular and as required medication. As required medications are supported by care plans that detail when the medication needs to be administered, such as when a resident is feeling overly anxious. All staff are responsible for the administration of medications. The deputy manager confirmed that they have all received training which was delivered by an outside agency and which covered such areas as storage, procedures for administration and side effects. The AQAA tells us it has improved in the areas of administering medication by reducing the use of antipsychotic medication (medications used to minimise anxiety and psychotic episodes) and limiting the number of epileptic seizures experienced by residents. It was established at the time of the visit that although seizures had reduced admission to hospital had taken place. A prolonged seizure placed a resident at risk and they required emergency first aid. The registered manager informed us the admission had been a stressful experience for all concerned. The home does not undertake invasive medication procedures such as administering rectal Diazepam. Following a lengthy discussion with the registered manager he was asked to consider risks to residents not receiving medication promptly and anxiety caused to them when they are admitted to hospital, to that of requesting to use an Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: alternative quick acting muscle relaxant and training staff to administer. Care Homes for Adults (18-65 years) Page 21 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. The home ensures it listens to and acts upon the concerns raised by the people who use the service. The home ensures the people who use the service are safeguarded from potential risk of harm. Evidence: The AQAA told us concerns and complaints are treated seriously and professionally and all staff attend abuse awareness training. The AQAA goes onto to tell us that the home will continue to be vigilant whilst maintaining a high standard of protection both in the home and out in the community. This was tested by viewing the homes current complaints policy, the complaints log book and resident behaviour support plans, speaking with staff and the manager. The complaints procedure details how residents or a representative can make a complaint and what action must be taken to resolve it. The AQAA tells us that the home has not received any complaints in the last year. The complaints log is in place to record any complaints that may be received. The registered manager said the home encourages open dialogue with relatives and other representatives and will spend time with relatives sharing relevant information. Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: The residents living at The Mullion have limited ability to express their concerns verbally. Two members of staff spoken with said they are aware through residents behaviours if they are happy or not and through spending time residents and their relatives they have been able to establish what various behaviours are telling them. On behalf of a resident their relative told us in a comment card: If xxxx was unhappy or wanted to make a complaint I would do this on xxx behalf. The three comment cards received from staff told us that they all know what to do if a resident or someone on their behalf raises a concern or a complaint. This was later ocnfirmed when two staff were asked what they would do if someone raised a concern or said they had a complaint to make. The home is to consider adapting the current complaints procedure in an accessible format to enable the current residents or prospective residents to have a better understanding of their rights to complain. The staff are provided with safeguarding of vulnerable adults training, which provides them with the knowledge to identify various types of abuse and how to report these. A member of staff spoken with at the time of visit confirmed that they had received training and was aware of their roles and responsibilities in maintaining residents health and wellbeing and reporting incidents of concern. Some residents present with behaviours that challenge. There are detailed intervention plans in place and the home monitors the wellbeing of residents on a regular basis. The home has support of specialist health care teams who are skilled in managing challenging behaviours. We were told the residents have limited understanding of the value and use of money and therefore their finances and personal monies are managed by the home. The deputy manager went through the process of how the home protects residents from the risk of financial abuse, demonstrating the systems used. We were informed that every handover checks are carried out on residents monies. Despite a very small discrepancy it was observed that the home has adopted safe procedures when handling residents monies. Care Homes for Adults (18-65 years) Page 23 of 35 Care Homes for Adults (18-65 years) Page 24 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. The home ensures the people who use the service live in a welcoming, comfortable and clean environment that meets their physical and social needs. The people who use the service live in a clean home where staff have received training to protect them from the risk of infection. Evidence: The AQAA told us that they have created a warm, clean home with a friendly relaxed atmosphere which is a nice place to live for the residents and a nice place to work for those who support them. The AQAA tells us that it has and will continue to make improvements to the home in the next twelve months, including the purchase and installation of a physically adapted bath. This was tested by touring the home, seeking the permission of a resident to view their bedroom, speaking with staff and viewing staff training records. The Mullion is a domestic style bungalow with bedrooms and bathing facilities on the same level. Communal areas meet the numbers and needs of the residents currently living in the home. The communal areas have been decorated and furnished in keeping Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: with the needs of the residents. Mounted photographs of residents add to the personal and warm feeling of the home. The kitchen is domestic in size and fully equipped preparation and cooking of meals. The home has a reasonable size garden with a patio area. The deputy manager said there are plans to add extra sensory stimulus in the New Year to encourage residents to take more of an interest in their surroundings. The home has access to maintenance support from the landlords maintenance department. The registered manager told us that there are plans in the New Year to purchase and install a bath that will meet the physical needs of the residents. He went onto tell us that he has involved the help and advice of an occupational therapist who will provide support in assessing residents and ensuring the correct equipment is purchased. Residents bedrooms were comfortable, clean and furnished with quality furniture and furnishings. The registered manager pointed out that furniture had been purchased with the physical needs and potential risks to the residents in mind. Smooth rounded edges and flush handles were seen in one bedroom. The bedrooms are personalised to reflect residents personality and individuality. The home was clean and follows recognised practices in maintaining a clean hygienic environment and staff have received training in infection control. Staff are provided with protective disposable gloves to use when required, such as assisting with personal hygiene. It was established however that a toilet and situated in the homes utility room did not have hot running water or soap to wash hands. We were informed that it was an oversight as soap is usually in the bathroom. Staff are currently using an alternative sink situated in another bathroom to wash their hands. The registered manager was made aware of the risk of transporting germs from one room to another through contact with doors and door handles and must chase the maintenance department to fix the hot water tap. Relatives were complimentary of the homes cleanliness. A relative said: The home is always fresh and spotlessly clean Care Homes for Adults (18-65 years) Page 26 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 home ensures the people who use the service are supported by competent, skilled and appropriately recruited staff in such numbers that meet their individual needs. Evidence: The AQAA informed us that the home has recently employed a deputy manager and has systems in place to ensure the home is appropriately covered by staff. Staffing levels are dependent on residents needs and daily activities. The service has a nominated person responsible for recruitment and all staff undertake specific training in order to meet the needs of people with autism and staff are supported to undertake National Vocational Qualification (NVQ) following a structured induction and probationary period. This was tested by viewing staffing levels and observing practice on the day, viewing staff recruitment and training records, speaking with staff and the manager. The home was busy at the time of the inspection visit as residents were undertaking various activities with staff support. This included supporting residents to engage in activities in the home and support another to access the community for the day. The staff appeared organised and confident. Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: When a resident was asked if the staff were helpful the resident replied that they were. Staff were observed going about daily tasks and supporting the residents with their personal needs when required. We were informed by the manager that staff are encouraged to undertake a national vocational qualification (NVQ). He also said he will support them to undertake NVQ levels 2, 3 and 4. All staff working in the home have achieved or will be working towards an NVQ. Recruitment files were viewed and found to hold all appropriate documents required when employing staff to work with vulnerable people. Evidence of an application form, two references, criminal record bureau (CRB) disclosure and protection of vulnerable adult (POVA) check were in place for each member of staff. A member of staff confirmed that she had completed an application, attended an interview and provided identification and names of referees. Staff undergo an induction into the home where they are supported by named staff to become familiar with the needs of the residents, the ethos of the home and the way in which the home operates. The staff receive training required by law (mandatory training), such as moving and handling, first aid, fire safety and food hygiene. In addition staff receive training specific to the needs of the residents such as communication, managing challenging behaviour, medication and epilepsy. The deputy manager has undertaken specific training to be a trainer in moving and handling and fire safety. A member of staff told us. If we have a specific interest in something we only have to ask our manager and he will support us where he can to attend training or assist us to research the information. The manager told us. I am keen for staff to progress in their career and will support them where I can. However one member of staff told us. A member of staff said: Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: I feel I needed more support in understanding more specific needs of individuals with very diverse communication preferences such as autism. Relatives told us in comment cards that they always feel the staff have the right skills and experience to support their relatives individual needs. There was evidence that staff receive regular support and supervision from the manager. The deputy manager informed us she has received training in support and supervision and with the guidance of the manager was feeling more confident to support staff in this area of administration and staff management. When asked what was good about the service a member of staff said: Theres unity and team work here, we all do everything for everyone and there is good support. The training is very good and you are encouraged to do a National Vocational Qualification up to level four . Im gaining more experience and learning something new everyday. Another said: It is relaxed here, jobs get done and we dont get stressed about things. 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. A competent manager manages the home with a skilled staff team who ensure the home is safe and run in the best interest of the people who live there. Evidence: The AQAA tells us the manager has worked in the home for over six years and has achieved the registered managers award and national vocational qualification (NVQ) level 4. The manager tells us in the AQAA that he has completely reorganised filing systems and the home is constantly fine tuning its efficiency and standards. The AQAA also tells us in the area where it is asked what the service could do better, I think we have fined tuned our fine tuning!. This was tested by speaking with the manager, the deputy, viewing regulation 26 reports, staff training records, touring and viewing fire service records and where possible speaking with residents, staff and viewing comment cards received from relatives. Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: The manager demonstrated through the course of the day that he has a good understanding of the needs of people living at the home and of his roles and responsibilities in ensuring their needs are appropriately met. The manager was observed interacting positively with residents and staff, giving clear guidance and direction in a relaxed manner. The manager has the registered managers award (RMA), NVQ 4 and regularly updates his skills and knowledge by attending mandatory and related service needs. Staff were complimentary of the support they receive and the way in which the manager manages the home. A member of staff said. I really enjoy working here, Steve is a brilliant manager, and has helped me a lot with my NVQ. Steve is very good at picking up on peoples strengths. There is evidence that the manager holds regular meeting with his staff. Minutes of meetings told us that they are thorough and informative. There was evidence that staff are encouraged to express their views and introduce new ideas for the benefit of the residents. Examples of these ideas were visible around the home such as various communication tools and decoration. The manager told us he and his staff have established very good relationships with residents relatives and is confident that they feel he and his staff are approachable and will do what they can to support their next of kin. This was evident in compliments received in comment cards and those seen from relatives whose loved one had passed away. A relative said. I have a good working relationship with all the team at The Mullion. I get all the information I need. The relative went onto say. I dont think there is much room for improvement, I am quite satisfied with everything about The Mullion. A care manager said. Care Homes for Adults (18-65 years) Page 31 of 35 Evidence: Overall a good service that has worked well with a service user with limited communication and complex needs. In addition to meetings with staff and keeping a record of compliments received from relatives the home can demonstrate that it monitors the quality of the service through unannounced monthly visits to the home by a representative working for the service (CIC), known as Regulation 26 visits. These visits are carried out unannounced at least once a month. A report is completed following the visit. The regulation 26 reports viewed at the time of the visit told us what is covered during the course of the visit such as the day- to -day care practices and administration and the outcome of the findings. Where necessary actions are drawn up and reviewed during the next visit. There are safe systems in place for fire safety. Staff receive regular training and regular checks are made on fire safety equipment. There is evidence that the homes fire safety systems have been updated to comply with the Fire Safety Services Regulations. The deputy manager has been trained to provide training for staff in fire safety, evidence in staff meetings tells us that the deputy manager regularly updates staff on fire safety, which includes testing alarms, using fire safety equipment and carrying out evacuations. Training records also tell us that staff receive fire safety training. It was noted that not all staff that work nights are receiving regular fire safety training. The deputy manager assured us that this would be rectified. The registered manager is responsible to ensure all staff are receiving regularly mandatory training such as fire safety. Substances which may be hazardous to health were securely locked away and there are notices discreetly displayed around the home reminding people of good hygiene practices. There was evidence that all small electrical appliances are checked annually and services such as gas and electric supplies are serviced as required. Care Homes for Adults (18-65 years) Page 32 of 35 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 33 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 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 42 24 The registered manager must ensure all staff including night staff recieve training as required by law. This is to nesure the people3 who use the service are safeguarded from the risk of fire. 31/01/2009 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 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. 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