Inspection on 27/10/08 for New Dawn

This inspection was carried out on 27th October 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

New Dawn 31/10/07

New Dawn 02/10/06

New Dawn 29/11/05

New Dawn 09/05/05

New Dawn 18/01/05

New Dawn 10/05/04

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: New Dawn Dog Lane Horsford Norwich Norfolk NR10 3DH 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: Judith Last Date: 2 9 1 0 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. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 43 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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 43 Information about the care home Name of care home: Address: New Dawn Dog Lane Horsford Norwich Norfolk NR10 3DH 01603 891533 01603 893537 bwadsworth@cmg-operations.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Care Management Group Ltd (trading as CMG Homes Ltd) Name of registered manager (if applicable) Mr Shaun Anthony Hunt Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 20 20 20 0 0 0 care home 20 learning disability physical disability sensory impairment Additional conditions: Twenty (20) people with a Learning Disability who may also have a Physical Disability and/or a Sensory Impairment may be accommodated. The total number should not exceed 20. Date of last inspection 3 1 1 0 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 43 A bit about the care home New Dawn is a care home providing personal care and accommodation for 20 young people with severe learning difficulties. The home is in the village of Horsford, not far from the city of Norwich. Local facilities, including shops, pubs and a post office are not far away. The home is all on one floor with purpose built extensions. Care Homes for Adults (18-65 years) Page 5 of 43 All bedrooms are being used as singles and people can keep things in their rooms that they like. Communal areas have lots of room and are comfortable. There are no steps for people who want to go into the garden. Care Homes for Adults (18-65 years) Page 6 of 43 There is parking at the front of the building. Care Homes for Adults (18-65 years) Page 7 of 43 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 8 of 43 How we did our inspection: This is what the inspector did when they were at the care home We visited the home unannounced and were there for about 7 hours including a second visit when we went back to speak more to staff. Before making our visit we reviewed all the information we have about the home and looked at detailed information that the manager was asked to send to us. Care Homes for Adults (18-65 years) Page 9 of 43 We also wrote to people before we visited to ask what they think about the service. We had letters from two people working at the home, two relatives and one person living there. It was difficult to communicate with most of the people living at the home although we did speak to some of them briefly. We spoke to two members of staff, the manager and a relative. Care Homes for Adults (18-65 years) Page 10 of 43 We used a method of inspection we call case tracking. This is used to see what records say about peoples needs. We then find out from observation and discussion what happens in the daily lives of those people and the outcomes they experience. Fees for the service range from 675 pounds to 1750 pounds per week according to peoples needs. What the care home does well Care Homes for Adults (18-65 years) Page 11 of 43 Peoples needs are assessed properly before they move in so they could be sure the home would be able to meet them. The manager knows that he has to keep peoples needs under review so that everyone can work together to meet them if they change. There is a lot of equipment for staff to use, to help with moving people round their home safely. People have their own belongings in their rooms. This means that each one looks different and shows the things people are interested in. Care Homes for Adults (18-65 years) Page 12 of 43 Staff acting as keyworkers support people with this and try to make sure they are treated as individuals. Staff try to find activities that people will enjoy. Some people need help to eat their meals and to drink. Staff sit with them and try to uphold their dignity while they are assisting. Care Homes for Adults (18-65 years) Page 13 of 43 People are supported with their health care. Staff use what they know about people’s body language, behaviour and sounds for people to try and make sure people are safe and well. What has got better from the last inspection The manager (who was new when we last visited) has worked hard with the staff team to improve a lot of things about the home. This includes the things that we said had to be done when we last visited. Care Homes for Adults (18-65 years) Page 14 of 43 Peoples care plans have been updated and improved so they show better what staff need to do to support people properly.. Keyworkers look at what is going on for people on a regular basis so that care plans can be reviewed promptly if peoples needs change Care plans are better at showing people have treatment recommended by other health professionals. The way medicines are managed have got better so people can be more sure they get what they need at the right time. Care Homes for Adults (18-65 years) Page 15 of 43 Staffing levels were better when we visited this time. This meant more staff were around to attend to peoples needs promptly and to support them with activities. The manager has arranged for keyworkers to spend more time with people on their own, to help communicate and work with them without lots of other people around. Care Homes for Adults (18-65 years) Page 16 of 43 Staff get more opportunities to meet with their bosses and to discuss their work. This helps to ensure staff understand their roles in supporting people effectively and are working consistently. More staff have had training in developing different ways to communicate with people who find this difficult. They try to find ways to help people make more choices in their daily lives. What the care home could do better Care Homes for Adults (18-65 years) Page 17 of 43 The manager needs to look at how he tells people about fees. At present it is in one set of information rather than where the law says it needs to be, so he has to make sure he gives everything to people who ask about the home. The manager should review individual risk assessments for people so that these are clearer and easier for staff to follow in keeping people safe. Some of the information about diabetes needs to be clearer. This is so staff do not forget what should happen and are reminded what they need to do if there is a problem. Care Homes for Adults (18-65 years) Page 18 of 43 Keyworker reviews that take place monthly need to accurately reflect the difficulties or health problems people experience. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Judith Last 33 Greycoat Street London SW1P 2QF 02079792000 Care Homes for Adults (18-65 years) Page 19 of 43 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 20 of 43 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 21 of 43 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 (or their representatives) would have information to make an informed choice about whether the home is able to meet their needs. Their needs will have been assessed before they decide to come so that the home could be sure of being able to meet them. Evidence: Since we last visited, the statement of purpose and guide for service users have been revised. The fees are included in the statement of purpose rather than the service users guide as they should be. Given the cognitive difficulties of people living at the home, their relatives or representatives would need to access the information. The manager recognises that the service could do better in developing different ways to present information so that people using the service would be more able to understand parts of it. He says in written information to us that he plans to work on this over the next 12 months so we have not made any recommendations. One relative told us that they had been given lots of information about what the home could offer and had made visits to see what it was like before the person moved Care Homes for Adults (18-65 years) Page 22 of 43 Evidence: in. We know from our previous visits that people have their needs assessed before moving in. There are formats for assessing and recording peoples needs. Everyone already at the home has their needs recorded on their files. Care Homes for Adults (18-65 years) Page 23 of 43 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 . People are more involved in making decisions about their daily lives as a result of efforts made to improve communication with them. Evidence: Since we last visited, the manager and staff team have been working hard to make sure that peoples individual plans are more organised and easier to follow. This makes it easier for new staff to get to understand peoples needs and how they are to be met. Both staff who wrote to us felt they had up to date information about peoples needs. We also asked a new staff member how they got to know what kind of support people need. They told us that this was explained to them, but also that the information is in the plan. They say that care plans have useful information and everything you need to know about people and how to support them. Individual plans are not currently accessible to people living at the home and most would find the information difficult to understand even if it was explained to them. However, some contain pictures and photographs that show some efforts are being made to involve people more. Care Homes for Adults (18-65 years) Page 24 of 43 Evidence: We saw that information is reviewed regularly. There are action plans setting out goals for people. A relative told us that they felt someone had come on a lot in the short time (x) has been here and was much more accepting of the presence of other people than they had been. The majority of people living in the home have difficulties with communication. The manager has tried to address this and improve the way people are communicated with. Some staff have had specialist training and the Speech and Language Therapist from the local learning disabilities team has been involved. Since we last visited, photos have been brought in to help people make decisions about activities and to show who will be on duty to support them. One person uses objects of reference (things that can be handed to them and associated with different activities, or drinks for example). A relative confirms that these are in use. The manager has committed himself, in information sent to us, to working further to increase the options for communicating with people who find this difficult and increase their opportunities to make decisions. Of the two relatives who wrote to us, one feels that the person is usually cared for in the way they have agreed or expect. Another felt that the person was always cared for as they expected. There are risk assessments for people and the activities they undertake. However, as at our last visit, these are added to piecemeal and reflect individual hazards rather than an activity. This makes them more difficult to follow and for staff to be aware of how they are to reduce all the risks associated with one particular activity. Since we last visited, a lock has been fitted to the cupboard where care plans and archived material is stored so that this protects peoples confidentiality. Care Homes for Adults (18-65 years) Page 25 of 43 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 . Staff and the manager are working hard to provide people with a fulfilling and stimulating lifestyle subject to their abilities. The manager acknowledges difficulties in this area although considerable improvements have been made since our last visit. Evidence: Both relatives who wrote to us feel that the service always supports people to live the life they choose. Most people do make use of the skills centre next door for more opportunities for stimulation. The manager is aware that it is difficult sometimes to make sure that people with more severe learning and physical disabilities are able to access the same opportunities for stimulation and activities as are open to others. The difficulties presented by some people mean that they need high levels of supervision or assistance when they are outside the home. Care Homes for Adults (18-65 years) Page 26 of 43 Evidence: Staff say it is difficult sometimes to engage people in activities in house. However, we saw them working at this. During our visit we saw staff trying to engage some people in a music session with musical instruments, and others with painting decorations for Halloween. This was difficult in some cases with some people preferring to watch rather than engage in activities. A staff member told us that they do try hand over hand support to encourage people to participate but that some people will remove their hand showing they do not wish for this approach to engaging them. During our visit one person was taken swimming by two staff members. Records for the same person show they enjoy the tranquillity of visits to the cathedral and that staff take them out for this. There is an accessible vehicle for people to use and staff say the new one is better as it has a higher ceiling making it easier for them to make sure that those in wheelchairs are positioned properly and safely. The manager has implemented a system of keyworker one to one time. Keyworkers keep records of the time they spend with people on their own, trying to engage them in things like tidying their room (even if they are only able to spectate rather than do this), looking at books and photo albums for example. People do have holidays, subject to their wishes, staffing needs and difficulties overnight. A staff member told us that anyone who is not able to go on holiday (or does not want to do so), is offered regular days out. The two relatives who wrote to us feel that the home always supports people to stay in touch with them and that they are kept informed of important matters affecting the person. One relative told us that if there were any issues that the manager would be on the phone to try and resolve them. The manager has acted to increase choices available to people on the menu. A staff member told us that they had some pictures but would show people what was on offer to encourage choices. In the past there have been concerns about peoples nutrition and the manager showed that there has been input from the dietitian in helping to develop menus and in making suggestions for those who find it difficult to eat. Because a lot of people need assistance with eating, meals are generally served over a period of time. Some people eat in the dining area off the lounge and we saw others in the conservatory. Staff were sitting alongside people who needed assistance, contributing to their dignity. There are records to show peoples weight is monitored so that any problems developing can be followed up promptly. Care Homes for Adults (18-65 years) Page 27 of 43 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 health and personal care that people receive is based on their individual needs. The management of medication has improved considerably to help promote peoples health and welfare. Evidence: Peoples personal care needs are set out. Most of the people living in the home need full support and assistance from staff to manage their personal care and hygiene. Daily records show that this is given. Staff say that they will try to encourage people to make choices, for example about what to wear, and will offer alternatives. Since our last visit, a lot of work has been done to develop alternative means of communication to try and make it easier for people to make choices. Health action plans have been introduced since we last visited. These set out peoples needs for support with their health and particular problems. They also show that a range of health care professionals is involved and consulted. For example there is evidence of the involvement of speech and language therapist, physiotherapist, specialist epilepsy nurse. This contributes to people receiving the support they need to Care Homes for Adults (18-65 years) Page 28 of 43 Evidence: keep them well. Records recognise difficulties with health conditions and the need for increased staff support to manage them. One persons opportunities for activities have declined following a fracture but the support plan reflects guidance from the physiotherapist that they can now stand with staff support - to encourage bone growth at the fracture site. A consultants appointment is due. This shows that staff follow up issues to try and enable people to recover their health. There is no structured recognised assessment for peoples vulnerability to pressure sores. However, there are risk assessments on file. Staff told us about how they reduce the risk by ensuring people have the equipment they need in place (pressure relieving cushions and mattresses), that their clothes are not rucked under their bodies and that they are moved and handled properly. They say they have access to enough aids (hoists and appropriate slings) to do this properly and one person told us that people would be turned to help minimise the risk of pressure sores developing. Records show peoples mental health is considered and we saw information about a persons mood and emotions and how they would express these. We also saw evidence of referral to a behavioural specialist to help address concerns. This shows that concerns are followed up to promote peoples wellbeing. One person requires their blood sugar to be monitored twice weekly because of diabetes. The levels are recorded on the medication administration record and there is a risk assessment about the use of Hypostop should the persons blood sugar drop too far. There is nothing specific in support plans or guidance about using the Hypostop showing the acceptable range for readings and when staff should be seeking additional advice. However, one staff member told us that staff had training some time ago and was able to tell us what the range should be, saying that the seniors should all know. They added that more training in diabetes has been requested and the manager is pursuing this. Peoples epileptic seizures are recorded. However, we had concerns about the consistency of information. Keyworkers complete review sheets monthly, and one had already been completed for someone for October. This did not record the persons problems with seizures identified in daily notes for 12th October although they are recorded on the seizure chart. This means that, in any follow up that might take place, problems could be overlooked and lead to an underestimation of the seizures someone experiences. Last time we visited, we had a number of concerns about the way medication was managed, recorded and administered, and about the training that staff had to give this. We looked at medication administration records in current use, and for the previous month for three people we case tracked. Care Homes for Adults (18-65 years) Page 29 of 43 Evidence: We saw the staff member responsible for giving medication when we visit checking and preparing medicines in line with company procedures and good practice. Records of administration were complete and a separate record is kept where medicines are administered at the skills centre. A controlled drug register is in use where appropriate. The medicine we had concerns about last time was being double checked and recorded. This means measures in place for monitoring the use of such medication have improved since we last visited and people are more protected from error. The medication administration record for one person is inconsistent with daily notes for the recording of administration of rectal diazepam following epileptic seizures. The daily notes record this as administered at 8.42am and the medication administration record shows it as administered at 9.42am. This means that there is ambiguity in showing how promptly staff responded to the seizures to promote the persons recovery. Staff we spoke to, staffing records and a list displayed confirm that staff have training about the administration of rectal diazepam to promote peoples safety in the event that they have bad seizures from which they do not recover promptly. One staff member we spoke to and who was administering medication, confirmed that they had training by the University of East Anglia in medication administration and awareness. This supports what the manager says in the information he sent to us, about senior staff having had more in depth training about managing medicines since we last visited. The medication policy makes clear that people have the right to refuse their medicines and guides staff about what to do. We asked a staff member about this, having seen that one person had refused their medication. We were given an explanation that took into account peoples rights, the timing of other doses of the same medicine, the condition for which it was prescribed and any follow up that might be necessary. This shows that staff are aware of peoples rights but would also follow up concerns with other professionals in their best interests. The manager intends that more staff should receive training in the Mental Capacity Act to help support this. Care Homes for Adults (18-65 years) Page 30 of 43 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 . People (or more likely their representatives) can be confident that their concerns will be taken seriously and addressed. Staff are aware of the vulnerability of people in their care and have a range of procedures and guidance to help contribute to upholding the rights of vulnerable people. Evidence: The complaints procedure is posted on the wall in the reception area so that visitors can see it and know how to complain. There is a version with pictures and symbols but in practice, peoples cognitive abilities mean they would need assistance from staff, their relatives or representatives to make a complaint. The information includes pictures of the manager and regional director, to whom complaints can be made. The manager says they could do better in increasing communication and as we have commented elsewhere, the staff team have been trying to do this. Support plans do set out the body language or signs of distress that people might show that could give rise to the staff and manager exploring issues about their welfare. The two staff who wrote to us say they know what to do if someone raises a concern about the service. Both relatives who wrote say that they know how to complain. One person says that their complaints have not always been handled appropriately in the Care Homes for Adults (18-65 years) Page 31 of 43 Evidence: past but goes on to say this was under a previous manager. They comment specifically that under the present management, things are dealt with promptly. They go on to say that the new manager is brilliant. This indicates that relatives are confident any concerns they do raise will be received and dealt with constructively and properly. The organisation has a history of delivering training in recognising and responding to abuse for staff. We know from information that the manager has sent us in the past, that all concerns are taken seriously and that he knows how to refer any concerns about vulnerable adults in his care. The regional director who oversees the home and maintains a regular presence in a nearby office, also has a good history of participating with other agencies in raising alerts and cooperating with investigations. There is written policy guidance for staff about peoples rights and about what might be seen as abuse. This also covers bullying of service users. Staff sign up to say that they have read and understood policies as part of the in house induction process. They are also expected to complete information as part of induction to show their understanding. Care Homes for Adults (18-65 years) Page 32 of 43 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People live in a comfortable, clean and well maintained environment with the equipment they need to access facilities. Evidence: The home is well maintained. The manager acknowledges that damage does occur to the lower parts of walls as a result of people using wheelchairs. In one place, cladding has been applied, parts of which can be easily replaced should they become damaged. Redecoration is ongoing as necessary and the dining room has recently been redecorated. The manager says that there are proposals to divide the home to provide for smaller, more homely group living. Records show that fire safety systems are maintained and tested regularly to contribute to peoples safety in the event a fire breaks out. Peoples individual rooms are personalised so that they all look different. Equipment is provided to help people access facilities. This includes hoists and beds of different types where appropriate. Bathrooms are equipped with facilities to support people who need assistance to get Care Homes for Adults (18-65 years) Page 33 of 43 Evidence: into and out of them, and there is also a level access shower with shower table for people with significant physical disabilities. Temperatures to hot water outlets for baths and showers are controlled by thermostats and there are thermometers in each location for staff to double check that temperatures do not present risk to people. Staff say that they have access to plenty of appropriate aids to enable people to access facilities in their home. There are 23 care staff employed at the home (including one agency/pool member of staff). The manager sent us information that showed 8 of these people have had training in infection control. There is a dedicated laundry sited away from areas where food is prepared or consumed so risks of infection are minimised. Ancillary staff deal with most of the laundry. We saw that staff have access to protective clothing to help minimise the risk of infection. There are dedicated catering staff who prepare most meals and who are not expected to participate in care tasks. This helps to minimise the risk of cross contamination of food. The manager says the catering staff are training in food hygiene as are most of the care staff. We saw confirmation in training records that one person employed for about four and a half months had training in food hygiene. There were no unpleasant smells associated with difficulties managing continence when we walked round the building. Care Homes for Adults (18-65 years) Page 34 of 43 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 . People are supported by a competent staff team with the manager keeping a careful eye on whether staffing levels are sufficient to meet peoples changing and complex needs. Evidence: The manager gave us information about staffing. This shows that there are 23 care staff in the home. The list by the front door, for information for visitors, shows that 6 staff have achieved National Vocational Qualifications to level 2 or above. Seven other people are listed as working towards qualifications at present. A staff member we spoke to says they have recently completed their course and were waiting for their certificate. This means that people have access to training to help increase their skills in meeting peoples needs and levels of qualified staff are improving. The two staff who wrote to us, and two we spoke to, say that they have access to good training to keep them up to date. One staff member commented that mandatory training is good and equips them with regular updates (for example in first aid and moving and handling). However, they would welcome more training in more specialist areas to help them meet peoples needs more effectively. The manager already has plans to address some of this and says that some staff are to do training in person centred planning, training in dementia and learning disabilities. Care Homes for Adults (18-65 years) Page 35 of 43 Evidence: As he has identified areas for improvement himself, we have not made a recommendation. Four staff have already had specialist training in communication to help improve this for people living at the home. Induction records show that people have access to the training they need when they first start work. Both people who wrote to us say this covered what they needed to do the job very well. We asked one person about it who said induction was very good. They also told us that training comes up very quickly. Two staff wrote to us saying that there are generally enough staff members around, except that occasional (and unavoidable) sickness could present problems. When we visited this time, there were more staff on shift than during our last visit, despite the need to provide additional cover to one person who was in hospital. Levels were sufficient to allow one person who needs two staff with them, to go swimming. The manager recognises the need to keep staff numbers under review as a result of the changing needs of people living at the home - including complex health care needs and the requirement for high levels of supervision both inside and out of the home to promote their safety and wellbeing. There is a core of staff who have worked at the home for some time and have got to know people well. One relative who wrote has been concerned about the turnover of staff and how this impacts upon their experience and skills. This would impact on their ability to provide consistent care to people with complex needs and communication difficulties. The manager says that three full time staff had left the home in the 12 months preceding his completion of the information he sent to us. Internal quality audits and the information the manager sent, suggest that turnover has decreased recently so this will contribute to the consistency of care for people living at the home. We looked at files for two members of staff recently recruited. These show that all the statutory checks are made before people start work and that references and full employment histories are obtained. This means that recruitment procedures contribute to protecting people from those who may not be suitable to work with vulnerable adults. Staff who wrote or spoke to us, told us that they have supervision regularly. This means that they get the chance to meet with a senior member of staff and talk about their work or to discuss goals. One person had not had their assessment at the end of the probation period, which records show normally takes place and is recorded. Care Homes for Adults (18-65 years) Page 36 of 43 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is being effectively managed, taking into account the views of people connected with the service and the safety and welfare of people living and working in the home. He has identified further improvements he needs to make to develop the quality of the service further. Evidence: Mr Hunt, the manager, has completed his Registered Managers Award and his registration with the Commission as a fit and proper person to run the home. He participates in regular mandatory training and in other training identified by the company or manager as appropriate to developing his skills. This has included recent training in the Mental Capacity Act to keep his knowledge up to date. Staff told us that they felt able to talk to the manager and that his door is always open. One commented that he always spoke to people on shift and asked how they were getting on. We asked about staff meetings and whether people were able to speak up and discuss issues, as well as raising items for the agenda. Staff felt that they were able to do this. Care Homes for Adults (18-65 years) Page 37 of 43 Evidence: A relative said that the manager would always follow up issues with them or seek additional information if he felt it was needed. One wrote to us specifically about how good the manager was and how they felt the care home was now doing a good job so they did not return from a visit being anxious about the persons care. Another says that the persons keyworker is always there to help as is Shaun, the manager. These things indicate that the manager makes himself accessible to staff, takes a role in monitoring and developing the service and ensuring he can deal with things promptly as they arise. The organisation has systems in place for monitoring the quality of services it provides and taking responsibility for improving things. The manager says that a survey of stakeholders has recently taken place and does so each year. However, head office collates the results and these are not yet back with him with suggestions for improvement. The manager receives monthly reports about the quality of the service. These are completed by another manager in the group or (on a quarterly basis) by the regional director. There are also quality audits by the organisations quality monitoring team. The manager was able to show us their audits indicating significant improvement and a reduction in the numbers of requirements they made of him to address identified shortfalls in the service. Mr Hunt has also completed fully and clearly, the information he was asked to send to us before we went. He cited a variety of evidence for what was going well, which we were able to check against during our visit. He also clearly set out his intentions for making further improvements to the service and so we will be able to monitor this at future reviews of service provision. We have not made many recommendations about good practice as he has already indicated the areas he believes should and could be improved. The manager carries out monthly audits of safety issues and identifies where remedial action is needed. This provides for monitoring that other staff with delegated responsibilities for checks and monitoring have completed them. These responsibilities are recorded and displayed so that everyone can see who deals with what, including any relatives who may have concerns. We sampled some maintenance and safety records and these corresponded to information the manager had sent us. Because of the large number of aids to mobility, such as special bathing equipment, mobile and ceiling track hoists, the manager has put together a reference file listing all serial numbers and with photos for reference. This enables monitoring of the appropriate tests and servicing and helps make sure no equipment is missed. Servicing of these was up to date showing that it remains safe for people to use. Training records show that staff do have training in health and safety, some have completed infection control, further training is proposed in epilepsy. There are regular Care Homes for Adults (18-65 years) Page 38 of 43 Evidence: updates of training for moving and handling and first aid. Staff we spoke to were aware of the individual safety issues relating to the people they support, including those who are particularly vulnerable because of health conditions. These things contribute to maintaining peoples safety and welfare. We consider that the checks, training and monitoring arrangements, as well as regular reviews of risk assessments, mean that the manager tries to ensure any avoidable risks are minimised and people are not subjected to unnecessary risks. We have made recommendation elsewhere about reviewing risk assessments to relate to a whole activity taking into account individual risks posed by that activity. This would help condense the process. Care Homes for Adults (18-65 years) Page 39 of 43 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 40 of 43 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 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 1 Although a full range of information is available to people enquiring about the home, the manager should make sure that the statement of purpose as well as the service users guide is given to prospective service users or their representatives. An additional page should be incorporated into the service users guide so people have all the information they need. The manager should review the way risks are assessed for the activities each person does. This is so it is clearer how to minimise the risks associated with any individual activity that people might undertake and how their safety is to be promoted. Staff should take care that their reviews of peoples progress and problems occuring each month, accurately reflects what they have experienced. This is to help ensure problems are not underestimated when information is presented to other health professionals. The desired range for blood sugar levels should be specified so that it is clear for staff when they should be looking for Page 41 of 43 2 9 3 19 4 19 Care Homes for Adults (18-65 years) additional advice, rather than relying on memory and past training. This is so people are not at risk of having their health needs overlooked or any possible delay in treatment. 5 20 Staff should ensure that the timing of emergency medication needed to control epilepsy is accurately and consistently recorded to show they always respond promptly in such situations, to promote someones wellbeing. Care Homes for Adults (18-65 years) Page 42 of 43 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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