Inspection on 11/11/08 for Patrick House

This inspection was carried out on 11th November 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Patrick House 11/06/08

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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: Patrick House 2 Patrick Road West Bridgford Nottingham NG2 7JY     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: Linda Hirst     Date: 1 1 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 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Patrick House 2 Patrick Road West Bridgford Nottingham NG2 7JY 01159215523 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Carl Dixon Type of registration: Number of places registered: Mr John William Nunn care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 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 category: Learning Disability Code LD Date of last inspection Brief description of the care home Patrick House is an adapted property on a residential street in West Bridgford. It is a ten minute walk from the centre of West Bridgford and people who live at the service have access to a range of shops, cafes, restaurants, places of worship and local transport facilities. The service is registered to care for up to 6 people who have a learning disability. The accommodation is homely and comfortable and spreads over three floors. There is no vertical lift at the home and it is not suitable for people who have mobility difficulties. There is a very small car park at the front of the home but plenty of on street parking is available. Each person who lives at the home is given a Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 6 Brief description of the care home copy of the service user guide and a brochure. The manager tells us that they will provide a copy of the latest report for anyone who wishes to see this. The fees for the service range between £812 and £1193.02 these fees do not include the cost of some activities, travel costs, clothing, toiletries or spending money for holidays. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The Quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. In planning our visit we reviewed all of the information we have received about the home since we last visited and we considered this in planning the visit and deciding Care Homes for Adults (18-65 years) Page 6 of 35 what areas to look at. We did this inspection with an expert by experience who spoke to people who are using this service. An expert by experience is a person who either has a shared experience of using services or understands how people in this service communicate. They visited the service with us to help us get a picture of what it is like to live in or use the service. This is important because the views and experiences of people who use services are central to helping us make a judgement about the quality of care. The main method of inspection we use is called case tracking which involves us choosing people who live at the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. English is the first language of all of the people who are living at the home at the moment. The staff team come from a wide variety of backgrounds and experiences. We spoke to two members of staff and three of the four people who live at the service to form an opinion about the quality of the service being provided to them. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who live at the service. There are some requirements that we made on our last visit that have not been fully complied with and we are having a meeting with the manager and the provider to make it clear that we expect them to comply with these or we may take further action. What the care home does well: What has improved since the last inspection? What they could do better: We also found that the staff could work harder to involve people in their care plans so they can give their views about what they would like staff to help them with and how they would like them to do this. Care Homes for Adults (18-65 years) Page 8 of 35 The people who work in the home do not know about a new Law, the Mental Capacity Act which has been brought in. This Law means that people can make decisions for themselves unless (by a certain set of rules) they are assessed as not being able to make the decision. As the staff dont know about this Law they may be stopping people from making some decisions when it is their right to make them. We also feel that there is no reason for not having house meetings where the people who live at the home can be consulted about the things that affect their day to day lives at the service. The Expert felt the service could be much better at providing things for people to do, both in the service and the community. He also felt the staff could help people go to college and support them to go to the places they want more. We found that some staff need to talk to people more about their sexual health and contraception to prevent pregnancy (if that is their choice), infection and to keep them healthy. We found that the staff could be better at writing down when people have taken their tablets and they could work out ways of making sure people get their tablets even if they are going out so they stay well and healthy. We felt some staff could understand what kinds of behaviour could be abusive so that people are protected and the arrangements for getting peoples money out of the bank could be safer to protect people living at the home. This could be backed up by clearer guidance for staff in their policy. We found that people have not been given information about how to make complaints in a way they understand. The manager is still not writing down how many hours he works at the home and he is not making sure he fills this in every week, so we dont know how often the staff have access to the manager. He still needs to improve many areas, particularly in terms of supervising staff to make sure they are doing their jobs properly. The provider is still not visiting the home often enough and he is not writing down what he has found and whether the home is being run in the best way. We found that the people who live at the home are not being asked what they think of the service in service user meetings or in questionnaires. Nor are the services being checked and audited to make sure they are providing good quality care and are good value for money. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 35 Care Homes for Adults (18-65 years) Page 10 of 35 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who want to live at the service have their needs properly assessed so they can be assured that these can be met at the home. Evidence: We looked at the care plan of the last person who came to live at the home to check they were properly assessed before they came to live at the service. We found that the person had been fully assessed by Adult Social Care and Health staff and that the service have a copy of this assessment. In addition we found they have got other assessments from specialists which give more information about the persons needs. The manager has used the information in these documents to write the care plan. The Expert spoke to the person and they said, I am sometimes happy in the home, just happy living in Nottingham. I like living here and do not want to move. The staff we spoke to have been recently appointed, they said, I dont really know much about the introduction stage. There are no new service users expected in at the Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: moment but when there is, (the manager) will go through this with us. Care Homes for Adults (18-65 years) Page 13 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the care plans have improved, the people who live at the service are not sufficiently involved in decision making and planning their care. Evidence: We looked at the care plans of three of the four people living at the service. We found these have improved since our last visit and they record the preferences of people as well as their needs and any risks they may face. However, they are not in a user friendly format and they are not in plain English which would make it difficult for people to be actively involved in planning. We did see, however that some people have signed their plans and they are being reviewed regularly. We saw evidence in the plans to show that peoples religious, cultural and sexual needs are being assessed and considered. One person told the Expert, I dont know if I have a care plan, another said they Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: have a care plan but the person could not remember if they have seen or been involved in setting up their care plan. The involvement of people in their own care is an area which could be strengthened. Staff told us, I assume the social worker writes the care plans, they cover anything you need to know. I sat here on my first shift and read them all. Obviously some bits about their personality are not there but you learn along the way. Some preferences are in there but things that are listed are those that would make a difference. Although peoples preferences are recorded in the care plans we found that their ability to make decisions is not being assessed in line with the Mental Capacity Act 2005. Staff told us, you cant write everything down. I think you have to get to know them because they change their mind at the drop of a hat, they really do. A staff member we spoke with did not know about the Mental Capacity Act and has not had any training in this area. This aspect of the care provision needs urgent attention to make sure that the Law is complied with and people can make their own decisions if they have the capacity to do so. We could not find any evidence that house meetings are being held at the service. The Expert commented from his interviews with people living at the home, They did not think there was a house meeting between staff and service users. They have no evidence such as minutes of there being any house meetings. The Expert observed that the people who lived at the service, did not seem to feel able to speak openly. Care Homes for Adults (18-65 years) Page 15 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the service are able to make choices about their life style, and they are supported to develop their life skills well. The social, educational, and recreational activities do not meet individuals expectations. Evidence: One of the care plans we looked at shows that the person is very independent and goes out travelling independently. The person has a job and goes out into the community to play football, to shop and to visit parents. A person who spoke with the Expert said they would like to go out more both with and without support. The person has tried going to college but said, I get anxious when I am there, and dont want to go again. They also said, I get a bit bored sometimes, there isnt anything to do. Another person said, I would like to go to college to study Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: English and yoga. I dont go out very often, the person said they would like to go clubs but doesnt go to any at the moment. Two of the people who spoke with the Expert said they go to the shops independently. They both said they would like to be able to go into Nottingham on their own, but would need the staff to take them a few times first so they get to know the route. They said they would like to be able to go to other places on their own, but neither could say where they would like to go. When these comments were raised with the manager he told the Expert that there are confidence issues with some of the people who live at the service and this prevents them from going out at times. He stated the aim of the home is to move all of the people living there into independent living within the next two to three years. The staff we spoke with told us, (one person) has a job and plays football, (another) is interested in college so we are trying to get (them) on a life skills course. It is hard to get (a named resident) to go out to even buy new shoes. They are pretty self sufficient, if they wanted to go out into West Bridgford they could. I have just been out to the shops with (a named person) to do the shopping, (the person) prefers company and loves going to the library. The Expert noted that the staff at the service do not appear to offer activities to the people living there. We found that the staff have made improvements to the care plans around relationships and issues of sexuality, sexual health and contraception. We saw one plan which identifies the persons friends, and the plan indicates that the friend is welcome to come to the service to visit and to have a meal. One of the people who spoke with the Expert told him, when my parents come they are made welcome, the person said they can have a private visit in the television room or the persons bedroom. The person commented, I dont have any outside friends only people who live here. The staff we spoke with told us, (a named person) has spoken about having a partner but (they) are wary about it. I dont think (the person) is serious about it. The staff member said that she feels that if people needed advice on sexual health on contraception they would go to the staff. This assumes a level of understanding and knowledge which seems to conflict with information held on peoples care plans. Staff told us that families come and visit, we would prefer to know when people are coming, two families visit. (A named person) has a friend who comes round for dinner so we make extra. Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: Two of the three people the Expert spoke with said they have full use of the home. They have keys to their own rooms and can go to their rooms whenever they like. The staff told us, people will join in the cooking, they wash the pots, clean the kitchen and do their own washing, they are also responsible for keeping their own room clean. Care Homes for Adults (18-65 years) Page 18 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate 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, but the recording of medication is not consistent and does not ensure that people receive their tablets as prescribed by their Doctor. Evidence: We found from the care plans that in the majority of circumstances the people living at the service are independent in terms of personal care tasks. One person has specialist hair and skin care products and the care plan documents the reasons that these are to be used, the staff understand that these are needed to keep the persons skin and hair healthy. We observed that the people who live at the service dress in clothes they like and which are appropriate for their age. Staff we spoke with confirmed that people do not really need any help with personal care, she said, (one person) has help to have (their) hair washed, (the person) will sometimes accept help from male staff, but prefers females. We found evidence in the care plans that health care needs are assessed well, we saw Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: a particularly good care plan around a person who has Diabetes and this gives staff clear guidance about how to support the person with this need. We found evidence of checks on optical health, on blood pressure and weight. The information available and plans around mental health needs and history were also very comprehensive and they give staff plenty of information to help them understand the needs of people living at the service. Staff we spoke with demonstrated a good understanding of the different health needs of people living at the service and they told us people have regular health care checks undertaken to make sure they remain well and healthy. We looked at the arrangements for medication and found the storage to be safe and secure. The person who has Diabetes does their own blood monitoring tests and the record of readings shows these are fairly consistent. The records of receipt and returns are acceptable. We looked at the Medication Administration Records and found ten gaps without any explanation for this. When we looked at the blister packs we found the medication has been given but staff have not signed the record to show that this is the case. One entry indicates that people missed their medication as they were out of the service, but there was no record to indicate whether the Doctor had been contacted to check whether these should have been given when the person returned. These matters must be addressed. We spoke with staff and they told us, I have had training on the Monitored Dosage System from Boots, this was a distance learning course. Some can apply their own creams but other than that we help people with their medication. We dont touch the medication but pop it out into pots and when they have taken it we sign the record. The people the Expert spoke with did not make any comments on personal or healthcare support, though one person came to the office during our visit to ask for some medication. Care Homes for Adults (18-65 years) Page 20 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for managing complaints are not robust enough to ensure that people have their concerns responded to appropriately. The arrangements for safeguarding are not robust enough to ensure people are fully protected. Evidence: We saw a copy of the complaints procedure on display near the front door, but given that some people who use this service may struggle to read text, a signs and symbols version would be good practice, this is an outstanding recommendation. We looked at the record of complaints and found that none have been recorded since our last visit to the home. One person who spoke with the Expert said they know how to complain, but could not explain the procedure, the person said their only concern was a squeaky floor board in their bedroom. Another person said staff have not explained the complaints procedure, this was done in a previous placement. Staff we spoke with told us, I have never really dealt with a complaint, some people may have a moan, but there are no serious complaints. What I would do with a complaint would depend on how serious it was, if it was serious it would be dealt with by the manager. Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: We looked at the safeguarding policy for the service, this is not in line with local safeguarding procedures and the document is under review. There is a copy of the local safeguarding procedures on site and training on safeguarding is recorded as being planned for the second week in December. We have not been notified of any safeguarding allegations and the manager told us none have been made since our last visit to the service. People who live at the service told the Expert that they have their own bank accounts and go to collect their money with staff support. The manager told us that the amounts which are withdrawn and cross referenced with the entries on their bank statements. When we looked at peoples finances, however, we were concerned that a persons Personal Identification Number (PIN) and their card are kept together and these are able to be accessed by all staff. This is not safe or best practice and advice should be sought from the persons care manager on how to safeguard the persons financial interests. Staff we spoke with told us, I have not had any training on abuse as yet. I have been through the policy. If an allegation is made I would write it down and take it to the manager. If it wasnt sorted out I would take it above him. I have never seen anyone behave in a way which was abusive but I would step in and then report it. I wouldnt consider talking sharply to someone as abuse, raising your voice with (a named person) would not upset (them). It is not what you say but how you say it that matters. I wouldnt shout at them or verbally abuse them, no more than talking to someone across a room. The arrangements for safeguarding people at the service need to be thoroughly reviewed to make sure that people are clear about the kinds of behaviour which are or could become abusive and the actions to be taken if allegations are made. Care Homes for Adults (18-65 years) Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, well maintained and homely and provides comfortable accommodation for the people who live there. Evidence: We did a partial tour of the building, including all communal areas and we also looked at two bedrooms with the persons permission. We found that all of the concerns we had on our last visit have been attended to. The home is on a small scale and is very homely and comfortable. There is a bathroom and a shower and two bedrooms are en suite. There is only one lounge and a kitchen/diner, but people also use their own bedrooms if they want space or privacy. The people who spoke to the Expert said they can go to their bedrooms when they like to watch television. One commented, I am very happy living here, but said that repairs take, a long time. Staff we spoke with told us, the house is always clean, we take it in turns, all of the repairs that needed doing have been done. No one has any infections that could be passed on at the moment and people do their own washing anyway. Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: Care Homes for Adults (18-65 years) Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by trained staff in sufficient number to meet their needs. The staff have been safely recruited. Evidence: We looked at the staff rota we found that sometimes there is one person on shift, others the service is staffed by two staff. At weekends the home is only staffed by one person. The manager now records the days he is at the service but not the hours as required. His days have also not been completed consistently. The people who spoke with the Expert commented that they are happy with the number of staff on duty. They said the staff take them out if they want to go anywhere. They said they know where the night staff sleep and would wake them if they needed to. They told the Expert that the manager is also on call at night and would come in if the staff phoned him. The staff we spoke with told us, We try to have a minimum of two staff on shift at all times. There are no times when there is only one person on shift, we choose not to do this. Sometimes (the manager) is extra to the shift. Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: The service has achieved the target of 50 of care staff trained to National Vocational Qualification Level 2 already and they are looking to increase the number who have done this training. There is no evidence that people are undertaking the common induction standards, but the manager said that they have been let down by a training provider and have now found an alternative. He told us that the aim is for all staff to do the Induction training. We found evidence on staff files show that staff have had training in Non Abusive Physical and Psychological Intervention techniques (NAPPI), medication safety, health and Safety, epilepsy and continence. The manager told us that training is pending on Infection Control, NAPPI, First Aid and safeguarding. Staff we spoke with told us, I have done medication training, I have not done the common induction, I spent the day with (the manager) discussing service users, medication, how the house runs, everything you need to know. I was extra to the rota for about three days, then I was on the shift. I have been on shift alone but not often. We looked at staff files and found these have improved and those we looked at have all of the information and documentation required by Law to make sure people are suitable to work with vulnerable people. Care Homes for Adults (18-65 years) Page 26 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the service has shown some improvement, but this is still not sufficient to ensure the home is being run well and in the best interests of the people who live there. Evidence: The staff rota shows that the manager is working at the service between one and four times a week. His hours however are still not being recorded as required. The management arrangements for the service are being reviewed but the manager will remain at the service until this is complete. We found that the owner has been visiting the service but not as regularly as he should and the reports on his visits are being written by the manager which he then signs. This is not best practice, and the reports have not been completed every month, nor have they been sent to us every month in accordance with the requirement we set during our last visit. Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: The people who spoke with the Expert commented, the manager comes in a few times a week, another said, the manager comes into the home when he feels like it, the owner doesnt visit very often. One person said they could not remember the owner speaking with them, another said they are not sure who owns the home. From this we may assume that the owner is not speaking to the people living at the service to ask their opinion of the quality of the care being provided. We are not satisfied that the owner has complied with the requirement for him to visit and report on the conduct of the home every month and we have arranged a meeting to discuss our expectations with him. Staff told us, I think the service is run really well. I think the care these guys have is excellent. There have been some improvements in the management of the service, but as can be seen from this report there are still issues which need more effective management, (YA6, 7, 12, 15, 20, 22, 23, 32, 39.) These issues must be resolved. We could not find any evidence that Quality Assurance has been undertaken, and this is an outstanding requirement. The staff told us they do not know if any quality assurance has been started and the manager admitted it has not. This lack of auditing remains a cause for concern, especially as there is no effective monitoring by the provider and no service user meetings. This must improve. We found that all of the Health and Safety checks and tests have been undertaken at the required intervals to make sure people living at the service are safe. Care Homes for Adults (18-65 years) Page 28 of 35 Are there any outstanding requirements from the last inspection? Yes R 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 1 37 17(2), Sch 4(7) There must be a record of 11/07/2008 the hours the manager works at the home including in what capacity he is working to ensure that the needs of people living at the service are met. This is an urgent action Care Homes for Adults (18-65 years) Page 29 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 1. Peoples capacity to make 31/12/2008 decisions must be assessed and recorded in line with the Mental Capacity Act 2005 and the Code of Practice. 2. All staff must have information or training on how to undertake and record their assessments of capacity. To ensure peoples right to make their own decisions is upheld. 2 12 16 People must be consulted about their social, educational and recreational interests and these must be facilitated and provided for both in the service and the community. To ensure they live happy and fulfilling lives. 12/01/2009 3 20 13 Arrangements must be 19/12/2008 made to ensure people receive their tablets as prescribed by their Doctor. If Care Homes for Adults (18-65 years) Page 30 of 35 they are not in when the dose should be given, staff should seek advice from the Doctor about whether to give the dose on the persons return. To ensure the health and wellbeing of people living at the service. 4 20 13 The staff must sign the Medication Administration Record after people have taken their medication. If the medication is not given for any reason an appropriate code must be entered to indicate why. To provide a clear record of the medication people have taken and to ensure that people receive their tablets as prescribed by their Doctor. 5 23 13 The safeguarding policy must be rewritten to ensure it is in line with No Secrets and the local safeguarding policy and that it offers protection to people living at the service. 6 23 13 All staff must receive training on safeguarding to ensure they are absolutely clear about what kinds of behaviour are abusive and the action to be taken if allegations are made. 30/01/2009 31/12/2008 19/12/2008 Care Homes for Adults (18-65 years) Page 31 of 35 So that they can provide care appropriately and protect the people in their care. 7 23 13 Alternative arrangements 19/12/2008 must be put in place which must ensure that peoples bank cards are not kept with their PIN number. To ensure that peoples financial interests are safeguarded. 8 37 26 There must be a report by the provider done once a month about how the home is being managed and conducted. A copy of these reports must be sent to us every month to meet legal requirement. 31/12/2008 To show that the service is being managed effectively and is improving and to prove the fitness of the provider. This requirement is partially met. Timescale of 11/7/08 not fully complied with. We will repeat this requirement for a final time. It must be complied with to avoid further action being taken. 9 39 24 Quality Assurance audits of the home must be carried out 30/01/2009 Care Homes for Adults (18-65 years) Page 32 of 35 To inform the development of a business plan aimed at improving the quality of the service for the people who live there. This requirement is not met. Timescale of 15/8/08 not complied with. We will repeat this requirement for a final time. It must be complied with to avoid further action being taken. 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 There should be better opportunities for people to be involved in developing and reviewing their care plans to ensure their views are taken into account in the delivery of care. Formal meetings with people who live at the service should be held and their content recorded so that there is clear evidence of the issues raised by them and what action is being taken to address these. This recommendation is outstanding and has not been complied with. 2 7 3 12 If people need to be accompanied to activities to build their confidence or their knowledge of how to get to different places the staff should facilitate this to ensure their lifestyle preferences are met. The staff should be proactive at speaking with people who live at the service about their sexuality and sexual health and should not assume that people will approach them for advice to ensure their health and wellbeing. Every person living at the service should be made aware of their right to raise concerns and how they should do this. This information should be in a format that they could 4 15 5 22 Care Homes for Adults (18-65 years) Page 33 of 35 understand so they know what to do if they have any concerns about the service they receive. This recommendation has not been complied with. It is outstanding 6 22 Peoples concerns as well as their complaints should be recorded and considered as part of their feedback on how well the service is meeting their needs. All staff should undertake the common induction training to make sure they understand their role, their responsibilities and follow best practice. 7 32 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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