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Inspection on 16/02/09 for Petersfield Care Home

Also see our care home review for Petersfield Care Home for more information

This inspection was carried out on 16th February 2009.

CSCI found this care home to be providing an Adequate 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has worked towards meeting all of the previous requirements and the some of the recommendations. This suggests that the proprietor and acting manager are keen to ensure that people who live in the home experience quality outcomes which comply with national minimum standards and regulations. The staff make efforts to involve people in decision-making and participation. They know the preferred ways in which people communicate and encourage them to make choices throughout the day. People are cared for in a respectful manner by staff working in the home so that people`s self-esteem and dignity are upheld at all times. The staff make sure that people lead full and active lives based on their individual needs and capabilities. People are enabled to attend various activities including day centres, shopping centres, and we were told by one person that they had enjoyed going to Blackpool discos. Also it was positive to see that people are encouraged and supported with daily living activities around the house, for example, washing up, making beds, making drinks and sandwiches. The physical design and layout of the home enables people to live in a safe, well-maintained and comfortable environment, which encourages independence. The home maintains consistency in their staff group who are all family members which benefits the people who use the service in receiving care from people who are familiar with, and have knowledge of, their personal preferences.

What has improved since the last inspection?

Care plans and risk assessments are now in place and provide sufficient information in relation to people managing their own finances so that they are protected from harm. The acting manager is now proactively pursuing their application to become the registered manager of Petersfield which reflects their commitment to this role.

What the care home could do better:

Although improvements have been made with in relation to care planning and risk assessment, the next area for improvement is to involve individuals in their own care planning so that they are able to have a say in how their needs are met. Health action plans need to be developed with health professionals so that people`s health needs can be outlined, monitored and met in a timely way. To record the portions of fruit and vegetables people eat on a daily basis to ensure that the recommended `five a day` are being offered and thereby promoting healthy diets. Staff need to sign the homes infection control procedures to confirm that they have read these so the people are protected by staff practices in this area. No training has been provided to any staff in relation to the specific needs of peoplewith learning difficulties. This was identified at the previous inspection but no action has yet been taken to address it. The homes documentation in relation to recruitment records needs to be more robust to ensure all the required recruitment checks have been made and these can be evidenced within staff member`s records. This will ensure that vulnerable people are protected. Some further work is needed to make sure that the quality monitoring system is comprehensive. For example, the questionnaires that have been completed by people living in the home and people who visit the home require analysing so that improvements and outcomes can be measured ensuring the home is run in the best interests of the people who live there. There is a list of requirements and recommendations at the end of the report should the reader wish to look at these.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Petersfield Care Home 60 St Peters Road Handsworth Birmingham West Midlands B20 3RP     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: Sally Seel     Date: 1 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Petersfield Care Home 60 St Peters Road Handsworth Birmingham West Midlands B20 3RP 01215151654 01215151654 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ms Vinette Campbell care home 5 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 5 5 adults, under 65, with learning difficulties (5 LD) Date of last inspection Brief description of the care home Petersfield Care Home is situated in Handsworth close to Perry Barr shopping centre. The home offers care to five adults with a learning disability. There are currently five people living in the home. The home is well situated for access to local shops, pubs, places of worship and transport links to Birmingham city centre. Members of the owners family staff the home. There is no off road parking. There is one bedroom with an en-suite facility on the ground floor. Other bedrooms are provided on the first floor of the property and comprise of two single and one shared room. The home has a large open plan lounge and dining room and a very spacious kitchen/dining area, which is also used for socialising. The home has an enclosed well laid out rear garden. The furniture and fittings are of a high standard. A copy of the last inspection report, statement of purpose and service user guide are avaliable so that people can read them if they choose. Interested parties will need to contact the home direct to enquire about the fees Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home charged. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: One inspector undertook this fieldwork visit to the home on the 16 February 2009, over a seven hour period. The acting manager and proprietor assisted us throughout. The home did not know that we were visiting on that day. There were four people living at the home on the day of the visit and the inspector arrived before people living in the home had left for the day. Information was gathered from speaking to and observing people who lived at the home. Two people were case tracked and this involved discovering their experiences of living at the home. This was achieved by meeting people or observing them, looking at medication and care records and reviewing areas of the home relevant to these people, in order to focus upon outcomes. Case tracking helps us to understand the Care Homes for Adults (18-65 years) Page 6 of 32 experiences of people who use the service. Staff files, training records and health and safety records were also reviewed. Prior to the inspection the acting manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us some information about the home, staff and people who live there, improvements and plans for further improvements, was taken into consideration. Regulation 37 reports which staff at the home send to CSCI about accidents and incidents that affect peoples safety and wellbeing were reviewed in the planning of this visit. Also two people who lived in the home together with two members of staff completed surveys. Information from both these sources was used when forming judgements on the quality of service provided at the home. The people who live at this home have a variety of needs. We took this into consideration when case tracking two individuals care provided at the home. For example, the people chosen have differing communication and care needs. The atmosphere within the home is inviting and warm and we would like to thank everyone for their assistance and co-operation. What the care home does well: What has improved since the last inspection? What they could do better: Although improvements have been made with in relation to care planning and risk assessment, the next area for improvement is to involve individuals in their own care planning so that they are able to have a say in how their needs are met. Health action plans need to be developed with health professionals so that peoples health needs can be outlined, monitored and met in a timely way. To record the portions of fruit and vegetables people eat on a daily basis to ensure that the recommended five a day are being offered and thereby promoting healthy diets. Staff need to sign the homes infection control procedures to confirm that they have read these so the people are protected by staff practices in this area. No training has been provided to any staff in relation to the specific needs of people Care Homes for Adults (18-65 years) Page 8 of 32 with learning difficulties. This was identified at the previous inspection but no action has yet been taken to address it. The homes documentation in relation to recruitment records needs to be more robust to ensure all the required recruitment checks have been made and these can be evidenced within staff members records. This will ensure that vulnerable people are protected. Some further work is needed to make sure that the quality monitoring system is comprehensive. For example, the questionnaires that have been completed by people living in the home and people who visit the home require analysing so that improvements and outcomes can be measured ensuring the home is run in the best interests of the people who live there. There is a list of requirements and recommendations at the end of the report should the reader wish to look at these. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have sufficient information about the home to enable them to make an informed decision about whether they would like to live there. Pre-admission assessments are undertaken by people visiting the home to ensure that people know their needs can be met prior to making a decision about whether the home is right for them. Evidence: The home statement of purpose and service user guide have been updated since the last inspection. This means information about the home is now up to date. These information guides tell people what services are on offer to them and how their individual needs can be met if they choose to live in the home. Positively, we found the views of other people who live in the home and their family members detailed in the service user guide. These provide people considering living at Petersfield insights into what individuals living there feel about the care and support they receive. A sample of these told us:- Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: I feel the home is clean and nicely furnished, I feel happy at the home. Very professional approach homely atmosphere. I visited today and he looks very well, smart and well fed, looks and seems more cheerful. The acting manager told us that they are now looking to produce the statement of purpose and service user guides using pictures as aids so that all individuals are able to understand contents. Also the acting manager told us in her completed, Annual Quality Assurance Assessment, (AQAA), all service users are assessed on the unit so all parties are aware of what the service, building and company are about. People are given the opportunity of looking around the home, meeting members of staff and assessing the environment on an individual needs basis. This results in people having the information they need about the home, and that the home is able to meet their specific needs before they choose to live there. As at the previous inspection there have been no new admissions to the home and so the outcomes for any new person coming to live in the home could not be fully assessed. However, we were told by the acting manager that they always carefully consider the other people living at the home when they receive referrals for individuals who may be suitable to live at Petersfield. This practice shows regard is given to ensure that any new person coming to live at Petersfield would be able to fit in with the people already living there. People told us:Home is very nice. I like it here. Mom is nice. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to lead independent and fulfilled lives with good opportunities of engaging people in the activities that they enjoy doing. Evidence: There has made some good progress to ensure all care plans cover all aspects of peoples personal, social and health care needs. We sampled care records and found peoples social, emotional and psychological needs are documented for staff to follow through in a sensitive way. These are clear and simple agreements that are completed with the involvement of the individual and a member of staff. These stated, to encourage X to assist in laundry and making the environment safe for herself and another example was, X is very independent going to toilet staff to monitor if there is any problems. From these set care plans are completed which are individual plans that enable people living at Petersfield to reach their aims and maintain their independence in personal hygiene, relationships, socialising, recreation, mobility, eating and healthcare. We found that plans provided staff with easy to follow Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: instructions, such as, X is very independent in dressing and she chooses what she wants to wear staff to encourage X to dress herself. The acting manager told us that they had worked hard and employed a consultant to gain advice in developing new care plans as this was an area that required improving from the last inspection visit. The acting managers next area that could be improved is ensuring that people living in the home are able to understand and take part in all their care planning. For example, creating lifestyle plans where individuals are able to include photographs and pictures which are meaningful to them. We looked at risk assessments which contained details of how people could be helped to be as independent as possible and the measures which needed to be put in place to make sure that they would be as safe as possible. It was positive to see examples of risk being promoted and not restricting peoples quality of life and experiences. On one care record a risk assessment confirmed, going out - could wander off, encourage X to go out, X must have a member of staff with her to go out, if she goes missing follow policy and procedures, and on another record, washes up, could cause infection, could burn herself with water. Staff to make sure that water is not too hot and make sure X has washed up. The AQAA confirms the acting managers proactive approach to ensuring, Activities and stimulation both in and out of the home to encourage self sufficiency. From observations on the day of our visit people are included in planning the care that meets their needs and making decisions about how needs are met. For example, people were getting ready to go to a day centre and ensuring they had their lunch boxes to take in readiness for the transport that takes them there. Other people were begining to rise from their beds and came to get their breakfasts in a relaxed and unhurried manner, choosing whether to get their breakfasts straight away or sitting in the loiunge for awhile first. gathered around the kitchen table when they were ready to have their breakfasts. Two of the four people living at the home completed questionnaires. All state they always make decisions about what they do during the day and people told us:I like going to work and washing up. I am able to do anything I like. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home are helped to develop their skills and relationships in the home and community so that they are able to lead an interesting lifestyle that meets their needs and expectations. They are provided with a healthy diet which suits their needs and preferences. Evidence: We saw staff talking with people who live in the home throughout the inspection politely and in a friendly manner. The home was seen to promote peoples daily routines in a flexible manner. For example, people were moving around the home freely, choosing where to sit, what they wished to do and who to interact with. As at previous inspections daily life at Petersfield reflects a homely atmosphere where people who live there have become part of a large family group. Individuals who live at the home refer to the proprietor who they live with as mom. It was acknowledged Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: that some people may have concerns about this term of reference. However, one person who lives at the home demonstrated to the inspector that they knew that their biological mom had died but it had become normal practice to refer to the proprietor as mom and therefore less concerning as the day progressed. This same individual eagerly said, Going with mom and X to one stop shop. Like going here in moms car. Efforts are made to ensure daily routines are flexible and spontaneous activities are also encouraged. People were seen to be at ease in their own surroundings and were able to wander in and out of the different rooms. Individuals were observed watching television or going into the kitchen area to chat to the proprietor and acting manager sharing a drink and biscuit or helping to tidy their bedrooms. It was uplifting to observe that people were never ignored by the acting manager or the proprietor when they entered rooms. Individuals were acknowledged, How are you today? together with introductions as the inspector met people throughout the day. Observations made during the visit indicate that people living in the home do enjoy a variety of activities and some of these are undertaken within the community. For example, on the day of our visit two people were going to a day centre which they referred to as work. However, the acting manager told us that if individuals did not want to go to the day centre or join in any activity then their decisions would be respected. Individuals would not be forced to participate in anything they did not want to. Care records examined showed that people experienced a wide range of activities, such as, knitting, sewing, colouring, going to a tea dance. One person was telling the inspector about going on holiday to Blackpool which they enjoyed. People are also actively involved in the homes daily activities which provide individuals important life skills. In one care record it acknowledged the risk to individuals when doing daily life activities. However, plans were in place to manage risks responsibly such as, making a sandwich, could cut themselves. Make sure X gets the things together, encourage to use the knives right, if cuts themselves take to hospital to get treatment. On the day of our visit breakfast and lunchtime meals were observed. People were seen to have their meals at the times of individual choices and were provided with individual meal preferences. Therefore menus are not always used as meals are provided in a flexible way with what people want on any given day. We were told that staff do not record individuals daily portions of fruit and vegetables. We recommend that staff do this so that people are encouraged to maintain the recommended five a day for a health diet. People were relaxed and seemed to enjoy gathering around the kitchen table to eat their meals and engage in conversation with others. Staff also have meals and drinks with people where conversation is encouraged. Peoples own specific food options and or cultural needs were observed at all times. The acting Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: manager and proprietor would purchase foods that meet peoples cultural needs but even then people are given the choice to ensure that people are not discriminated against. People spoken with on the day of our visit confirmed that visitors are made very welcome by the home and visiting was not restricted in any way. People told us:I like to go out and sometimes we eat out. I like tidying up and helping mom. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive the health and personal care they need in a way they prefer so that they stay healthy. Individuals health needs are protected by the homes policies and practices regarding medication. Evidence: On the day of our visit we observed that that people needed minimal support with personal care. People were seen to be dressed appropriately for the weather and choices of clothing appeared to reflect personal tastes, ages and gender. One person who lives in the home showed the inspector their bedroom and their choices of clothing items together with which items were their favourites. Everyone who lives in the home has access to the health care they need. Peoples care plans show that people are seen by their doctors when they are ill and by other health care professionals when needed. Positively, in one care record we noted that the individual did not want to have certain medical tests and or scans. The rights of this person was respected and it was noted that they were having yearly health checks and blood tests to check for any abnormalities. The AQAA also echoes, Close liaisons with Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: professional staff eg psycologists, GP promote self care and determination. We discussed with the acting manager the development of health action plans which would help them to record, monitor and action all health needs. This is something the acting manager will look into as they continue to develop and improve care records. We spoke with the acting manager about how individuals weights are monitored. This seems to be an area that is lacking. Therefore it is important that individuals weights are recorded and monitored to ensure that any significant losses and or gains are recognised in a timely manner so that any underlying medical conditions are picked up. We found no end of life care plans so that individuals can be reassured that their practical, physical, emotional and spiritual needs will be managed in a way that people prefer at this time in their lives. These care plans will be particularly important as one person who lived at the home died recently and we only found one care record that confirmed a persons funeral wishes which was produced using pictures. None of the other care records had individuals funeral wishes in them and the acting manager confirmed that this has not been done. At present none of the people who live in the home administer their own medication. The pharmacist that supplies medication to the home does a check of medicines to see that they are managed safely on behalf of the people who live there. The medication administration records (MARS) were well maintained and the system for ordering medication was good. Staff have received training in safe medicine handling and this means that people who live in the home are protected from unsafe medication practices by staff who have the necessary understanding. One person told us, If I am ill, mom would take me to doctors. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure is accessible to people should they need to make a complaint. There are systems in place to ensure people are safeguarded and protected. Evidence: There have been no complaints received by CSCI during the last twelve months. The home has a procedure in place for looking at any complaints that it receives. The acting manager told us that people living at the home are supported to raise concerns. The home has a complaints procedure that is included in the service user guide but consideration should be made to produce this using pictures as aids so that all people living in the home are able to understand its contents. Generally people spoken with knew how to make a complaint and or raise a concern if they needed to. The acting manager is looking at ways of enhancing the process of feedback they receive from people who use the service. For example, to use questionanires and continue with residents meetings. This shows that the acting manager and proprietor are promoting peoples rights to have their views and or concerns listened to. There are safeguarding policies and procedures in place to offer protection to people living at Petersfield and staff have recently attended adult abuse training, with Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: certificates in place. This provides confidence to people that they will be protected from abuse whilst living at Petersfield. As at previous inspection all individuals living at the home manage their own finances with some assistance. It was positive to see that risk assessments are now in place which provide staff with instructions to follow ensuring individuals are safeguarded whilst managing their own finances. One risk assessment stated, Money could be mislead or lost or someone might mug X, they have a cash point card, staff to encourage X not to tell anybody the number to the machine. Encourage X to keep it safe, if card gets stolen report it, stop card if money gets lost, inform manager and manager informs police. If X borrows money she pays it back, to monitor X so no one takes advantage record and report, inform the manager. Completed Surveys asked people if they knew who to go to if they are not happy and how they should complain and all confirmed yes. People told us:We go to talk to mom. I have no complaints. There are safeguarding policies and procedures in place to offer protection to people living at Petersfield and staff have recently attended adult abuse training, with certificates in place. As at previous inspection all individuals living at the home manage their own finances with some assistance. It was positive to see that risk assessments are now in place which provide staff with instructions to follow ensuring individuals are safeguarded whilst managing their own finances. One risk assessment stated, Money could be mislead or lost or someone might mug X, they have a cash point card, staff to encourage X not to tell anybody the number to the machine. Encourage X to keep it safe, if card gets stolen report it, stop card if money gets lost, inform manager and manager informs police. If X borrows money she pays it back, to monitor X so no one takes advantage record and report, inform the manager. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are happy with their environment which is clean and generally comfortable with lots of homely touches. Evidence: Petersfield is a large Victorian house which provides spacious accommodation for five people and the proprietor who lives there aswell. We looked at one persons bedroom with their permission, the lounge and kitchen areas of the house. We found that the rooms spaces were large and there are many homely touches. The dining area is situated in the large kitchen area with dining table and chairs big enough to seat six people. Off the dining area towards the back of the house is an adjoining small toilet and laundry area which people living in the home are able to access if they wish to assist with laundering tasks. The lounge area is also a large space which has a table and chairs towards the conservatory area of the home and the other half of this room has a comfy leather settee and chairs so that people are able to relax and watch television as they please. Within this room there are also homely touches with pictures and photographs of the proprietors own family. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: One of the people who live at the home eagerly showed the inspector their bedroom which they share with another person. This was clean and bright with personalised objects of this individuals own choice displayed on the walls, tables and bed. Due to the person sharing their bedroom there is a privacy curtain in place so that peoples rights can be maintained within their personal spaces. The individual told the inspector that they liked their room very much and enjoyed sharing it. Also on the first floor there are two single bedrooms, bathroom, toilet and proprietors accommodation. All furniture, fixtures and decoration were of a good standard so that people live in a well maintained environment that meets their needs and enhances their lives. The garden area of the home has a seating area so that people living in the home can sit out in warm weather as they choose. All areas of the home were seen to be clean and hygienic with no offensive odours present. We were told that the environmental health department undertake their assessments via computer due to no issues of concern being raised. The acting manager showed us the homes infection control guidance. However, as at the last inspection this is still not signed by staff as having read this so that people living in the home can be assured that the infection control practices undertaken by staff protect them. People in general liked the decor of the home and one person said It is lovely and very clean. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally staff are well trained and have the skills and knowledge to meet peoples individual needs. The homes recruitment procedure needs to have all documentation in place to ensure vulnerable people are protected. Evidence: People who live at Petersfield are supported and mainly cared for by three staff, the acting manager, registered proprietor and another family member. On the day of our visit the registered proprietor and acting manager were on duty. This enables one to one activities to take place together with collective ones so that peole are provided with different opportunities which suit them on any given day. We obsevered that inidviduals who lived in the home only required minimal care and supervision. However, staff showed that they were knowledgeable about the likes and dislikes of people living in the home. We found that the interaction between people who lived at the home and the staff on duty reflected that they have formed friendly and respectful relationships with them. As at the previous inspection all of the questionnaires completed by people who live in the home and returned to the CSCI state staff always treat them well. Staff rotas were sampled and showed that there is usually one person on duty Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: between the hours of 8am to 9pm, Monday to Friday and 9am to 9pm at weekends. The registered proprietor can be called upon through the night if people need assistance as confirmed earlier in this report as they also live at Petersfield. This staffing ratio appears to meet the needs of people who live at Petersfield and supports individuals in following their particular interests. The acting manager confirms this in their completed survey, We always provide service user with care to suit their needs and promote independence. There have been no new staff employed at Petersfield since their last inspection but the acting manager showed and told us the application forms of four potential new members of staff. These new staff members would be employed in various roles, such as, bank cover, domestic and an individual that is currently assisting the acting manager in a consultancy role and would also be completing some training. However, when examining some of the application forms we found recruitment information was missing from application forms. For example, we found no documentary evidence of work history with any gaps iin employment confirmed. We spoke with the acting manager about this and they will now revise the style of application forms to ensure all recruitment information is gained so that people living in the home are protected by robust recruitment practices. We examined the personnel files of staff already employed at the home including the acting manager and found that Criminal Bureau checks (CRB) were dated January 2004. As at previous inspection it is recommended that CRB disclosures are renewed every three years to offer continued protection to people living at Petersfield. The AQAA shows two staff have acheived NVQ Level 2 and ensures that the staff team are equipped to undertake their role in a skilled manner. It was positive to see that since the homes last inspection staff have received mandatory training in, health and safety, infection control, food hygiene and manual handling. At the homes last inspection it was also recommended that staff receive training in relation to learning disabilities, such as, a Learning Disability Qualification accredited training. This remains outstanding, we therefore recommend that this qualification is now considered. This will ensure that staff have enhanced knowledge of the people who live at this home. All of the questionnaires completed by people living in the home state staff always treat them well and people told us:I like mom and Diane and we do things together and on our own. Mom is always here and happy. Care Homes for Adults (18-65 years) Page 25 of 32 Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can feel confident that the management practices within the home are improving to ensure the best outcomes for people who live there. Quality assurance is improving and the acting manager is continuing to strive in this area. Evidence: As at the homes last inspection, the registered manager has relinquished the majority of her role to her daughter, Diane Brown, who is now in the role of acting manager. Also at the previous inspection a requirement was made for the acting manager to apply to the Commission for Social Care and Inspection (CSCI) for registration as the homes manager. We were told that this has been done and the acting manager has communicated with the CSCI registration team via email and is awaiting further correspondence. The acting manager holds, NVQs Level 2 and 3 together with the Registered Managers Award, (RMA). At the previous inspection a recommendation was made that the acting manager undertakes learning disability training to compliment the knowledge they have. This remains outstanding but the acting manager told us Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: that they are giving soome thought to this. We were shown that the acting manager is now in the process of developing the homes formal quality assurance processes as this was a recommendation made at the last inspection. This is going to be achieved by gaining peoples views on the quality of the service that individuals receive at Petersfield. We confirmed with the acting manager that at the homes next inspection we would expect this to to be fully operational with results that can be examined to ensure that aims and objectives are being measured to achieve good outcomes for the people who live at the home. Health and safety records show that a five year electrical wiring certificate was issued October 2006, small electrical items were tested for safety and that gas appliances were serviced. Also a number of checks are made by staff to make sure that peoples health and safety is maintained. We found records that showed that the fire alarm system was last tested on 9th February 2009. A fire drill was also carried out in February so that people living in the home are assured that they are protected by the homes fire practices. The acting manager has demonstrated that they are working hard to achieve good outcomes for the people living in the home by the imporvements that have been confirmed throughout this report. In the AQAA, the acting manager confirms their management style is, supportive encouraging and enabling rather than dictatorial open and inclusiveness atmosphere with family, domestic environment. The acting managers next goals to work towards are, person centred care planning, recruitment practices are robust and quality assurance is developed further. This will ensure that people who live at Petersfield are included in all aspects of their lives and that their aspirations are achieved by good management practices. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 To make sure that the address for CSCI is updated on both the service user guide and terms and conditons so if inidviduals want to make a complaint or request further information they are able to. To consider producing the statement of purpose and service user guide in pictorial formats so that individuals considering living at Petersfield would be able to understand information provided. Care plans need to be person centred to ensure participation of individuals and or their representatives so that preferences can be made. To record individual daily portions of fruit and vegetables so that healthy diets can be maintained as five a day is the recommended amounts. Peoples weights should be monitored and recorded so that any underlying medical conditions are detected early so that peoles health and wellbeing is being promoted. Health action plans should now be considered with health professionals where needed so that individuals health is Page 30 of 32 2 4 3 6 4 17 5 19 6 19 Care Homes for Adults (18-65 years) monitored effectively and any action required is provided within a timely manner. 7 21 End of life care plans and last wishes so that individuals and or their representatives can have the opportunity of choosing how their care is delivered at this time in their lives. All staff need to read and sign the infection control guidance so that assurance is given that the management of systems relating to infection control protect the people who live in the home. Training in relation to learning disabilities such as Learning Disability Qualification accredited training is provided to ensure staffs knowledge is enhanced to meet peoples needs. All application forms for new staff need to detail full work histories with explanations provided in relation to any gaps in employment so that people living at Petersfield are protected from harm. That CRB disclosures are renewed every three years to offer continued protection to people living in the home. That the acting manager undertakes learning disability training to compliment the knowledge she has of the service user group she manages. The person managing the home to proceed with their application for registration to CSCI. Quality assurance systems should now be fully implemented with the analysis of the views of the people, (which the acting manager has collected), who live at the home and recorded in report format in order that the home can measure if it is achieving its aims and objectives and to evidence it is complying with its statement of purpose. 8 30 9 33 10 34 11 12 34 37 13 14 37 39 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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. 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