Inspection on 03/11/08 for Natalie House

This inspection was carried out on 3rd November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Natalie House 05/12/07

Natalie House 17/01/07

Natalie House 17/11/05

Natalie House 23/06/05

Natalie House 18/03/05

Natalie House 25/05/04

Natalie House 27/01/04

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10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Natalie House 14 Eachway Lane Rednal Birmingham West Midlands B45 9LG     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: Kerry Coulter     Date: 0 3 1 1 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 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Natalie House 14 Eachway Lane Rednal Birmingham West Midlands B45 9LG 01214579592 01214579592 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Alphonsus Homes care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category 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: Learning disability (LD) 5 Physical disability (PD) 5 Date of last inspection Brief description of the care home Natalie House is registered to provide care for up to five adults with learning and physical disabilities. It is situated in a quiet residential area on the edge of the Lickey Hills in Rednal, Birmingham. It is close to public bus routes and the shopping centre at Rubery is nearby. The property is a purpose built bungalow, first opened in 1991 and is furnished and decorated to a good standard. Each single bedroom has en-suite facilities, including level entry shower and hand wash basin. Bedrooms are decorated in homely and appropriate styles. There is a comfortable lounge and a separate dining room. There is a well equipped kitchen, laundry and office. The garden is enclosed and Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 0 5 5 Brief description of the care home private, including lawn and patio areas and is suitable for wheelchair users. There is limited off-road parking at the front of the building. Smoking is not permitted within the Home. A copy of the most recent CSCI inspection report is available in the Home on request. The service users guide stated that the fees charged to people who live there are from one thousand to one thousand four hundred pounds per week. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out over one day, the home did not know we were going to visit. Before we visited the home we asked the manager to send us an assessment of how the home is doing, we call this an Annual Quality Assurance Assessment. This provides information about the home and how they think it meets the needs of the people living there. Surveys were sent to care professionals, however at the time of writing this report none had been returned. Care Homes for Adults (18-65 years) Page 6 of 32 We looked at the care being provided to three people at the home by observing them, speaking with them, discussing their care with staff and looking at care files. People who live at the home were unable to tell us their views of the service provided due to their communication needs. We looked around the home.We looked at some records for staff and health and safety. We spoke with the manager and staff on duty. What the care home does well: What has improved since the last inspection? What they could do better: Care planning arrangements need to improve to make sure staff have enough information on how to support people so that they get the care they need. People should be offered the opportunity to go on holiday every year if they want to so they can have a break from the home and benefit from different experiences. Care Homes for Adults (18-65 years) Page 8 of 32 Medication practice needs to improve to make sure that people get the medication they need, safely. Assessment is needed of the new bathing facilities to make sure they are safe and meet peoples needs. Improve staffing by recruiting extra staff or the use of agency staff to reduce the number of times when there are not enough staff on duty to effectively meet peoples needs. Arrange for staff to have training every year on manual handling so that they know how to assist people to move safely. Make arrangements for repairs to electrical installations to be carried out to make sure they are in good order and that people are kept safe. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People generally have all the information they need about the home so they can make an informed choice as to whether or not they want to live there. Evidence: People who live at the home have a copy of the service user guide. This has recently been updated to include pictures so that it is easier for people to understand. The range of fees have also now been included so that people know how much it costs to live at the home. The home currently has no vacancies and the last time someone new moved into the home was in 2003. Therefore, the standard relating to the assessment process was not fully looked at. However, discussions with the manager indicates that the admission procedure remains unchanged and that a full assessment would be carried out before any new person was admitted to the home. Care Homes for Adults (18-65 years) Page 11 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff do not have all the information they need to support individuals. This could mean that people are not supported to meet their needs in the way they choose to be. Evidence: The records of three of the people who live there were looked at. It is good that annual reviews are held for people and where appropriate their relatives are invited to attend the meeting. Each person had a care plan, this included information on how staff are to support the person with their daily living skills, at night, their activities, personal care, communication and health needs. Plans were generally brief in content and would benefit from further development. For example for one person it detailed that staff should use objects of reference to communicate with them but did not record the objects that should be used. Some people had plans on what staff should do if they started to display unwanted behaviours such as banging their head on the wall. However there was no information Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: about how to reduce the risk of this occurring or signs and triggers that staff need to look out for that indicate the person may be going to do this. Plans had been reviewed in the last six months but had not always been updated when needed. For example the home has recently had a new bath fitted that is quite different in design to the last one. Discussion with staff indicated that the way in which people need to be assisted into the bath had changed but care plans had not been updated to reflect this. During the course of the visit, it was possible to observe members of staff supporting people to make choices about what they wanted to do. Sometimes this was limited because of peoples communication support needs and learning disabilities. The annual quality assurance assessment records that the home are trying to improve communication methods and a referral has been made to the speech and language therapist. We looked at the risk assessments for three people, and as identified at the last inspection some improvements are needed. People had assessments that covered areas of risk such as bathing, manual handling, using the kitchen, pressure care and going horse riding. One person had two separate risk assessments for choking. One that was quite brief said that meat needed to be cut up whilst a second more detailed assessment said it needed to be blended. Information in risk assessments needs to be accurate so that staff know how to support people safely. As already identified the home has has a new bath fitted. Risk assessments for bathing and manual handling will need to be reviewed to ensure people are able to get in and out of the new bath safely. This is quite important given that the new bath is quite high and one person is having to use a small step to get into the bath. This needs to be fully assessed to make sure the person is not at risk of falling. Care Homes for Adults (18-65 years) Page 13 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place to ensure that the people living there experience a meaningful lifestyle. People are offered a varied and healthy diet so ensuring their health and well being. Evidence: The home have day care workers, whose main role is to provide activities for people. The home has its own mini bus with a tail lift that helps people get out to activities in the community.One staff said that they try and rotate who is going out so that everyone gets the chance to go out at least three times a week. People who live at the home participate in a range of activities based on their interests and abilities including aromatherapy, hydrotherapy, parks, horse riding, shopping trips, day tips and meals out. People are also encouraged to participate in house hold tasks and cooking with the full support of staff. It is good that a separate individual activity programme is Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: devised for each person based on their individual interests and abilities. Previous inspections have identified that people have not had opportunities to go on holiday if they want to because of staffing shortages. The manager said that this year one person had a holiday but that other people had not. The manager said that this was due to staff having their own commitments such as child care. People should be offered the opportunity to go on holiday every year if they want to so they can have a break from the home and benefit from different experiences. Records showed and staff said that people are supported to keep in contact with their family and friends where appropriate. This is through visits and telephone calls. Records show that everyone who is important to people is welcome to visit, this includes the dog of one persons family. Staff also support people to buy presents and cards for their relatives at special times such as Mothers day. There were no rigid rules or routines observed at Natalie House and it was evident that the staff encouraged people to choose how they spent their day, within the limitations of their disabilities and this ensures that their individuality is maintained. Menus sampled showed that people living there are offered a variety of food that includes fresh fruit and vegetables to ensure their diet is healthy. An alternative is offered for each meal and the menu meets peoples cultural requirements and preferences. People are offered a choice of main meal each day and a take away meal is purchased once a week. The people living there often go with staff to shop for their food and are sometimes involved in preparing meals. Care Homes for Adults (18-65 years) Page 15 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements do not always ensure that the health needs of individuals are met, which could impact on their well being. Evidence: The people living there were well dressed in individual styles that were appropriate to their age, gender, cultural background, the weather and activities they were doing. All people at the home need support from staff with their personal care but staff do encourage people to do as much for themselves as they are able, for example brushing their own hair. We saw that one person did not have his slippers on properly, staff noticed this and prompted him to put them on properly so he was not at risk of tripping up. Records showed that people go out with staff to buy their own toiletries, clothes and to go to the hairdresser. Records sampled included an individual health action plan. This is a personal plan about what support a person needs to be healthy and what health care services they need to access. Records generally showed that where appropriate people are referred to health professionals to get the help they need to meet their health needs. The home Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: had recently changed the format of the plans and not all information had been transferred from previous records. The new plans did not show for everyone when they last went to the dentist. The manager contacted the dentist during our visit and was able to show that everybody had been to the dentist this year. Health plans were written for any health concerns that individuals may have and these included some good information about the nature of the health concern and the support required from staff in order to manage and monitor the particular condition. For example one person who is identified as being at risk of pressure sores had previously had a red area to their skin. A care plan had been put in place for this and advice sought from the GP so that it got better. As detailed in the care plan the person spent some time on their bed during our visit. We spoke with staff about this persons needs and they were all aware of the pressure care needed. At the last inspection it was identified that some improvement was needed to the frequency of weight monitoring for individuals to ensure their health and well being. Records were available to show that peoples weight is now being monitored. One person refuses to be weighed and so a risk assessment for this has been completed. Records were available to show that monitoring is undertaken of peoples bowel movements as they are at risk of constipation. Medication is stored in a locked cabinet. All staff responsible for the administration of medication had undertaken training about the safe management of this. One person at the home sometimes has medication that staff need to administer when they have a seizure. Records show that several staff have been trained to do this by the community nurse. Staff have recently had refresher training for this, staff who did not do the refresher training are not on the homes list of staff who are allowed to administer the medication. The home has its own systems in place for checking that medication is being given safely, a weekly audit is done that covers medication stock, administration records (MARs), expiry dates of medication and cleanliness of the cabinet. The audits did not identify any issues regarding the MARs but some issues were seen to need improvement at this inspection. Observation of the MARs showed that some medication that had been discontinued was still recorded (although there was no evidence that this had been given by staff). Also, one person had recently been prescribed medication that the MAR said they were to have twice a day but staff had only given this once. The manager said this medication had been prescribed on an as required basis only. The home did not retain a copy of the prescription for this medication but a letter was available from their Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: consultant to show it had been prescribed as required. Records also showed that staff had contacted the GP to check when it should be given. The manager contacted the GP again during our visit to confirm that it was as required medication. The manager said that there had been issues with the medication administration records from the pharmacist. The manager was able to evidence that she had arranged a meeting with them in a couple of days time so that in future the supplied MARs would reflect what the person should actually be having. Discussion with the manager indicated that she was unaware that she was able to make handwritten amendments to the charts to reflect that medication had been discontinued or to reflect changes made by the GP. The manager contacted us the following day to inform us that the necessary handwritten amendments had been made to the MAR. Some people are prescribed PRN (as required) medication. There were individual protocols in place (except for the medication only recently prescribed) stating when and why this should be given to ensure it is given only when needed and not misused. At the front of each persons MAR there was a photograph of them so that unfamiliar staff would know who to give medication to. Care Homes for Adults (18-65 years) Page 18 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints procedure in place and systems are in place so that the people living there are protected from abuse. Evidence: Since the last inspection we had not received any complaints about the service provided at Natalie House and no complaints had been made to the Home directly. The home has a complaints procedure, this was on display in the hallway of the home. The people living at Natalie House have communication support needs, and a formal complaints procedure has little relevance for them. They are reliant on the vigilance of relatives or staff members who know them well to interpret changes in demeanor, behaviour or body language, to alert them to the fact that something is amiss. The annual quality assurance assessment records that communication passports are being developed for people. These will help staff to identify when people are unhappy about something. At the last inspection the manager said she was intending to review the format of the complaints procedure to try and make it more accessible to people. This has now been done and a pictorial complaint procedure has been produced. Staff cover safeguarding procedures on induction to the home and all but one staff Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: have completed training in the protection of vulnerable adults. Policies and procedures to include whistle blowing are readily available to staff. We spoke with one member of staff about what they would do if they suspected abuse and they were able to give satisfactory answers that would protect people. At the last inspection it was identified that one person had a large bruise to their face, the cause of which was unknown. The manager had not discussed with social services if this needed to be investigated under safeguarding procedures. Practice now seems to have improved and evidence was available to show that where someone had a bruise above the eye but the cause was unknown, (but thought to be from self injurious behaviour) social services were informed. The manager said and records showed that staff had not had training in the Mental Capacity Act. The Mental Capacity Act came into force in April 2007. This legislation requires an assessment of peoples capacity to be done if there is any doubt that the person does not have the capacity to make a decision about their health and welfare. If they are assessed as not having the capacity an Independent Mental Capacity Advocate (IMCA can be appointed to help them with this. Staff need to know about this legislation so they are aware of the implications of this for the people living there. A secure facility for the safekeeping of small amounts of individuals money was provided at the Home. A sample check of two peoples financial records was undertaken. Receipts and items were available to verify expenditure. Care Homes for Adults (18-65 years) Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a clean and comfortable living environment in which they are generally safe and secure. Assessment is needed of the new bathing facilities to make sure they safely meet peoples needs. Evidence: Natalie House provides a homely and well-maintained living environment for people living there. It was warm, clean, free from unpleasant odours, well decorated and furnished throughout in a homely style. Since the homes last inspection communal areas and some bedrooms have been redecorated, decorators were at the home during our visit finishing off the work. New settees have been provided in the lounge and arrangements are being replaced to replace two remaining armchairs chairs that have become quite worn. Staff told us that a new boiler had been installed since our last visit and said that this had improved supplied of hot water in the home. Last year a new carpet was fitted in the hallway and had soon been damaged by what had appeared to be cleaning products. The manager told that arrangements would be made for the damaged section of carpet to be replaced. However this has not been Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: done due to other sections of the carpet having since lifted away from the floor beneath. Staff and the manager told us that the original carpet fitting company have visited and decided that the carpet had not been fitted correctly. The manager said that the carpet fitting company would hopefully be fitting a new carpet soon. Peoples bedrooms were in good decorative order in an appropriate style to reflect the gender, age, culture and interests of the individual. Bedrooms contained personal possessions, ornaments, televisions and DVD players so that they felt comfortable. All bedrooms were for single occupancy and had an en suite toilet and hand basin facility. Previous inspections have identified that the bathing facilities in the home were not of an ideal design to meet the needs of the people living there. At the last inspection the manager had quotes for a new specialist bath and ceiling hoist track systems to be installed, she said it was hoped this would be done in the next twelve months. At this visit we found that a new bath had been installed but that this was not one specifically designed for people with mobility difficulties. Discussion with the manager appears to indicate that the new bath was chosen due to the much cheaper cost rather than the needs of the people at the home. The manager and staff spoken with felt that the new bath was however an improvement on the old one. The position of the bath has moved so that there is now more room in the bathroom to manouvre the hoist and assist people to get undressed and dressed. The bath has been raised so that the feet of the hoist can fit underneath and it is easier to hoist people into the bath, this also reduces the strain on staffs backs when bathing. However as the bath has been raised this could mean that for people who do not need to use a hoist to get in that it could be more difficult for them to use. Discussions with staff indicate that one person now has to use a small non slip step to get into the bath. As recorded earlier in this report there was no risk assessments available for this. We also noticed that there were no grab rails positioned near to the bath, assessment is needed to see if these need to be available for people. It is advised that the home seeks input from an occupational therapist to make sure that the new bath is the right design to safely meet peoples needs. Hand wash and hand towels were available in the kitchen, laundry, bathroom and toilets so to reduce any risk of cross infection. Care Homes for Adults (18-65 years) Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements are variable and do not always ensure that the people living there are supported by enough that staff are well trained, effective and supported which could impact on how they meet individuals needs. Evidence: Direct observations of staff interactions with people who live at the home provide evidence that they have a good relationship with people in their care and a good general understanding of their needs. The home has a stable group of staff and this means that people are usually supported by staff who know them well. Only four of the staff at the home have a National Vocational Qualification (NVQ) in care, however most of the staff team are currently undertaking this award. At the last inspection we made a recommendation that arrangements were made for more staff to have a NVQ. Discussion with the manager indicates that the home now uses an external assessor rather than the manager having to do the assessing. This will hopefully mean that staff will achieve this qualification quickly. At the last inspection it was identified that improvements were needed to staffing levels. Discussions with the manager indicate that one person at the home is needing Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: more staff input due to a change in their needs and increased self harming behaviour. Since our last inspection staffing has improved and there are now three staff on duty most days, however discussion with the manager indicates that the home is not funded for this and extra money has been requested from social services. Due to some staff vacancies some staff are doing extra hours to try and maintain staffing levels. Sometimes there are not enough staff to cover the rota and so on occasions there are two staff on duty so further improvement in levels is needed. At the last inspection we found that staff recruitment had been poor, this has now improved. We looked at the recruitment records for two new staff and found that they were robust. For one new staff the home was still awaiting the return of their full Criminal Records Bureau check but had confirmation that the person was not on the list of people who are not allowed to work with vulnerable adults. The staff rota recored that this staff was to be supervised and discussion with them indicates they have not worked alone with people. Discussions with staff and staff training records show that staff get most of the training they need, this includes an induction to the home for new staff. Staff have undertaken training that includes first aid, food hygiene, medication, adult protection, fire, epilepsy and manual handling. Recently staff have done training in equal opportunities and dementia. Training records show that most staff have not had any manual handling refresher training since February 2007, this should be done annual to make sure people know how to move people safely. Records did not show that staff had done any training on managing peoples bevaviour despite records showing that some people who live at the home have behaviours that include self harm. The manager said that staff had some training from the community nurse on this but that it had not been recorded. At the last inspection it was identified that staff meetings and supervision needed to happen more frequently. At this inspection we found that staff had not had a meeting since May, the manager said this was because staff had not turned up for other planned meetings and that a new meeting was arranged for November. We looked at the supervision records for five staff for 2008. Two staff had two supervisions, two had only one each and one staff had none. Staff need to have regular supervision so that they receive the support they need to carry out the job. Staff meetings should happen at least every two months so that staff know about the changing needs of the people who live there and are kept up-to-date with best practice. Care Homes for Adults (18-65 years) Page 24 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements do not always ensure that the home is run in the best interests of the people living there to ensure their safety and well being. Evidence: The home has a registered manager in place who has worked there for some time. She was professional throughout the visit and observed to have a very caring attitude towards people at the home. One staff told us that the manager was very approachable. The manager has not yet achieved the Registered Managers Award (RMA) and at the last inspection said she hoped to finish this soon. At this inspection we found that the manager had ran out of time and had to re-register to do the award. t is important that the manager is pro active in finishing this as this inspection has found that some areas for people need to improve and progress towards this is often slow. Knowledge gained during completion of the RMA will hopefully help the manager to be more effective and improve outcomes for people. The manager completed the annual assessment (AQAA) for the home prior to the Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: inspection taking place. The content did not always reflect what was actually happening in home, for example it said supervisions were regular when this was not the case. Quality assurance systems are in place but need to improve. The Service Manager visits the home and writes a report of their visit as required under Regulation 26 to ensure the home is being well managed. Reports provided showed these visits are generally done monthly, however some reports for earlier in the year were not available. Some reports had highlighted things that needed to get better several times but it was not clear from the report what action was being taken to make sure outstanding issues were improved. At the last inspection we saw that some of the reports said that satisfaction surveys needed to be sent to peoples relatives, discussion with the manager indicates this has still not been done. Due to people at the home having limited communication methods it is important that the home seeks the views of other people involved in their care such as relatives of care professionals. The home has a system for completing internal audits and these showed that areas for improvement were being identified however the manager needs to make sure staff are effectively managed to achieve the identified improvements. For example one audit identified that peoples records of their personal belongings needed to be updated but other entries identified that there were problems in getting this done as key workers had not done this, despite being asked to. The manager told us that the home had an annual quality audit completed this year, however the manager said she had not yet received the report for this. it is important that the manager receives the report in a timely fashion so that it can be used to formulate a development plan for the home. Fire records showed that staff test the fire equipment regularly to make sure it is working. An engineer regularly services the fire equipment to make sure it is well maintained so it works well. Records show that staff have had fire training and drills so they know what to do in the event of a fire occurring. During the visit staff burnt some food in the kitchen, this made the fire alarms sound. The home has fire doors set on magnetic door closing systems and all but one of these shut as they were supposed to. One bedroom door had not fully closed and observation of the carpet shows that the door may be dragging on the carpet and so will not close when the alarms sound. The manager said this would be reported to the maintenance man for urgent repair. An electrician completed the five yearly testing of the electrical wiring in September 2008 and stated that it was unsatisfactory. There were no areas that were identified as needing urgent work but ten things were listed as needing improvement. The manager said that the work to make the improvements had not yet been booked as the provider Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: was still deciding which company to use to do the work. A speedy decision needs to be made regarding this so that the necessary improvements are made without delay. Records showed that staff tested the water temperatures regularly to make sure they are not too hot, which could put people at risk of being scalded. At the last inspection we identified that the fridge temperatures were often too warm, this was the same at this inspection. Food needs to be stored at a safe temperature or else people who live at the home could be put at risk of food poisoning. Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 A full risk assessment needs to be completed on how people get in and out of the new bath. This will establish if people are safe or if changes need to be made to reduce the risks of people falling. 05/01/2009 2 20 13 The home must ensure that 07/12/2008 people receive medication as prescribed and that the medication administration record matches the GP prescription. The home must ensure that people receive medication as prescribed and that the medication administration record matches the GP prescription. 3 42 13 Evidence must be sent to the Commission to show that the required safety work have been carried out to electrical installations. 09/01/2009 Care Homes for Adults (18-65 years) Page 29 of 32 This will show that the electrical installations in the home are safe. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 Care plans need to be developed further so that staff have all the information they need to meet peoples needs. Plans should also be reviewed and updated when peoples needs change. Complete an audit of risk assessments to ensure information within them is up to date and accurate, this will help staff know what they need to do to help keep people safe. People should be offered the opportunity to go on holiday every year if they want to so they can have a break from the home and benefit from different experiences. Record keeping needs to improve regarding when people have attended health appointments so that staff know when people have been to an appointment and when they need to go again. This will help people to stay healthy. The home should retain copies of medication prescriptions so that staff can check that people are having medication as prescribed by the GP. Staff need to have training in the mental capacity act so that they are aware of its implications for the people living at the home. It is advised that the home seeks input from an occupational therapist to make sure that the new bath is the right design to safely meet peoples needs. An assessment should be undertaken to establish if people need to have a grab rail fitted adjacent to the new bath to assist them in getting in and out safely. Improve staffing arrangements by recruiting additional staff or the use of agency staff to reduce the number of times when there are not enough staff on duty to effectively meet peoples needs. Ensure that staff training records are updated to show all the training that staff have done to include managing Page 30 of 32 2 9 3 14 4 19 5 20 6 23 7 27 8 29 9 33 10 35 Care Homes for Adults (18-65 years) behaviour training. 11 35 Arrange for staff to receive manual handling refresher training on an annual basis to make sure they have the skills and knowledge to move people safely. Staff meetings and supervisions should happen at least every other month so that staff receive the support they need to carry out the job and know about the changing needs of the people who live there and are kept up-to-date with best practice. The manager should complete the registered managers award so that she has the right knowledge and qualifications to ensure the home is well run. Quality assurance systems need to be improved so that the home is run in the best interests of the people who live there. Systems for checking that the fire doors are working correctly need to be improved so that any faults are quickly identified and arrangements can be made for repairs to take place. 12 36 13 37 14 39 15 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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