Inspection on 04/11/08 for Pia - Princes Street, 46

This inspection was carried out on 4th November 2008.

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

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

Other inspections for this house

Pia - Princes Street, 46 26/11/07

Pia - Princes Street, 46 27/11/06

Pia - Princes Street, 46 13/12/05

Pia - Princes Street, 46 08/07/05

Pia - Princes Street, 46 12/01/05

Pia - Princes Street, 46 06/08/04

Pia - Princes Street, 46 23/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Pia - Princes Street, 46 46 Princes Street Nuneaton Warwickshire CV11 5NW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kevin Ward     Date: 0 4 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Pia - Princes Street, 46 46 Princes Street Nuneaton Warwickshire CV11 5NW 02476353581 02476640146 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Susan Sugars Type of registration: Number of places registered: People in Action care home 7 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 7. 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 46 Princes Street is a registered care home for seven adults with learning disabilities. People in Action provides 24 hour care and support for the people living in the home. The home is located in the centre of the town of Nuneaton, North Warwickshire, and as such is close to all local services and facilities the town has to offer. It is a two-storey building with gardens to the front and rear of the property. There are 8 single bedrooms, one having a shower en-suite facility. One of the bedrooms is used as the sleeping/office for staff. Two of the bedrooms are located on the ground floor. The ground floor bathroom/toilet has a walk-in shower facility and bath, which has an Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 7 Brief description of the care home electrically operated bath seat. There is another shower facility and separate toilet and bathroom/toilet located on the first floor. The shared facilities in the home consist of a large lounge, kitchen with dining area and well maintained garden to the rear of the property. The garden provides separate areas of privacy, has a greenhouse and a vegetable patch. 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means that people who use the service experience good outcomes. This was a key unannounced inspection, which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for people. The inspection focused on assessing the main key Standards. As part of the inspection process the inspector reviewed information about the home that is held on file by us, such as notifications of accidents, allegations and incidents. Five people at the home and a health professional completed surveys giving their views on the home. Care Homes for Adults (18-65 years) Page 6 of 32 The inspection included seeing everyone living at the home. Due to the communication needs of some people living at the home it was not possible to get a clear impression of their views of the service. The inspection also included case tracking the needs of two people that live at the home. This involves looking at their care plans and records and checking how their needs are met in practice. Discussions took place with four staff on duty, as well as the manager. A number of records, such as care plans, complaints records, and fire safety records were also sampled for information as part of this inspection. An annual quality assurance assessment was completed and returned by the provider in time for this inspection, providing the managers views of the homes performance during the last year. An expert by experience attended the site visit to give his views on the home, In particular social activities and mealtimes. An expert by experience is the term used to describe people whos knowledge of Social Care services comes directly from using Social Care services What the care home does well: What has improved since the last inspection? What they could do better: The manager has agreed to consider providing some people with a summary of their care plan in an easy read format to remind them about the support they are to be provided with by staff. There is scope for increasing some peoples involvement in cooking their own meals Care Homes for Adults (18-65 years) Page 8 of 32 and for encouraging them to choose at mealtimes, to increase their independence. The radiators have covers on them, making it difficult to adjust the temperature controls. The manager has assured us that this is being remedied. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitable procedures are available for supporting people to move to the home in a sensitive manner. Satisfactory information is made available to people to help them to make an informed decision to move into the home. Evidence: The Statement of Purpose and service user guide has recently been reviewed. The service user guide now includes the range of fees charged at the home. The current fees range between Five hundred and thirty and nine hundred and forty eight pounds per week. The service user guide has been illustrated with photographs to make it easier for people to read and understand. Two peoples files were checked and both contained contracts explaining their rights and responsibilities at the home. No new people have moved to the home since the last inspection. The files of two people previously (most recently) admitted to the home show that peoples needs had Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: been properly assessed, as part of the admission process. Both files provide evidence to show that their placements were reviewed with the involvement of social workers and relatives, at the time, to ensure they were settling into the home satisfactorily. 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. Peoples needs are planned for and reviewed and they are consulted over everyday plans so that their choices and preferences can be supported. Evidence: Two peoples care plans were checked and others were sampled for specific information, such as eating guidelines. Overall both care care plans contain good levels of information to help staff to meet peoples needs properly. This includes some information about peoples preferred routines and the way they like their care to be provided. Some essential information about an individuals communication needs was seen on their file and the manager explained that a speech therapist was now involved to help in the development of a communication passport (personal detailed information about their communication needs). The current care plans are currently available for staff usage but the people at the home do not have their own copy. The manager agreed to consider ways in which Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: people may be provided with an accessible summary of their care plan for their safe keeping, where appropriate. Care plans and risk assessments are being reviewed and records of social work review notes show that people attend their reviews with support from relatives, where they are available. One person has guidelines in place to help staff to help the person concerned to manage their mental health needs. Staff keep a very good monitoring record of early warning signs of mental health relapse and the manager was seen to review this record during the site visit. Good work has taken place to involve a person in the management of their own mental health and they have been provided with a copy of strategies to help them in this regard, which is kept in the bedroom of the person concerned. Peoples likes and dislikes are recorded in their care plans. This a good way of supporting people with high communication support needs to express their choices. The people at the home confirmed that they attend house meeting to discuss everyday issues, such as menus and activities and make plans together. The support of a speech therapist has been sought to help a person with high communication needs to express their choices, using laminated cards which are left in their line of view in the hallway to act as a prompt (e.g. one was seen to contain a message saying they wanted breakfast. The person concerned took the message to staff to follow their request for breakfast. The notice board in the kitchen contained a makaton communication card (labeled sign of the week). A member of staff explained that a different symbol is chosen each week, as a means of teaching a person with changing communication needs to use the signs to communicate their needs. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to access the community and take part in a suitable range of activities that meet their needs. There is scope for increasing peoples choice and involvement in cooking at mealtimes so that they can exercise more control over their lives. Evidence: The people at the home have a mixture of structured day services and support from staff at the home on some days. Comments by people at the home and entries in their daily diaries indicate they are supported to take part in a satisfactory range of social activities that are in keeping with their wishes. One person said that she particularly enjoys going shopping. On the day of the site visit she was supported to go shopping with two other people to buy some bedding and curtains. Another person shared their weekly activity plan which included gym, badminton, football, horse-riding, pub lunch, Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: swimming and cinema. The person concerned keeps a record of whether they enjoyed the activity to help staff to check if it is still enjoyed or needs to be changed. Other activities included occasional outings, such as boat trips, theatre and parks. The people at the home have also been supported to go on holiday to Centre Parks this year. The expert by experience comments Sue told me that peoples activities are quite varied, depending on what they want to do that day. Some people like to go shopping, to the cinema, bowling, swimming, keep fit and the gym. Some of them go on walks with another organisation. One of them goes horse riding and other go to day centres. Some residents have access to a computer at the local museum. All residents have their own bus passes and use public transport regularly. They all have transport at the home which is wheelchair accessible. This is good. Two people at the home explained that they are supported to visit relatives and can receive visits from family or friends where they wish to do so. Two people said they like to go to a disco each week where they can meet up with friends outside the home. People were seen to answer the front door some of the time although on other occasions staff took the lead on this. The manager agreed to tell staff to encourage people to do this more often, to reinforce that it is their home and they are in charge. Similarly people are provided with keys to their bedrooms but do not currently hold keys to the front door. The manager said that she thought that three or four people would be able to hold keys safely and agreed to carry out a risk assessment and provide people with keys where appropriate. Three people are supported to go to church each Sunday, in keeping with their wishes, recorded in care plans. A 4 week menu was on the kitchen wall but this had not been reviewed recently. Peoples food preferences had been discussed but the menus had yet to be updated. Two people with good verbal communication skills said that they were offered choice over what they ate. However on the day of the site visit, three people returned from town and were made sandwiches by staff but were not asked what they wanted. The manager said that she had noticed this too and said that it was most out of character and not common practice at the home. The manager said that she would raise this matter with staff and would reinforce this area of practice, to make sure that people are provided with opportunities to express their food preferences. An expert by experience, present at the inspection, makes the point well Sue (manager) asked the people at the home is they minded us sitting in the kitchen whilst they had their lunch. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: It was good that Sue asked their permission. They all had sandwiches and yogurt for lunch, they were not asked what they wanted to eat, what fillings they wanted on their sandwiches or which flavour yogurt they wanted. People should be given a choice of what they want to eat at mealtimes. Staff did not communicate much with residents having lunch Comments by staff indicate that they try to strike a fair balance between healthy eating and respecting person choice. Some low fat foods, such as yogurts and spreads were seen in the fridge. Plenty of fresh fruit and vegetables were seen in the kitchen. After eating a bag of crisps, a person at the home was encouraged by the manager to eat a piece of fruit, in preference to an alternative snack with higher fat content. Two people were seen to make drinks during the site visit and to take part in making their own breakfast. When asked, one person said they would like to do more cooking. The manager said that she would make arrangements to support the person in this objective and to encourage others to develop cooking skills where appropriate. Guidelines are in place for a person with swallowing difficulties, which have been written with the involvement of a speech therapist. A member of staff was seen to provide unhurried one to one support to the person concerned to eat during the morning. 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. The people living at the home are provided with the support they need to meet their needs and stay in good health. Suitable arrangements are in place for the safekeeping and administration of medication so that it is stored, accounted for and administered safely. Evidence: The people at the home were seen to rise in at their own pace and receive unhurried support to prepare and eat their breakfast. Comments by two people at the home confirmed that they are able to sit up late into the evening if they wish to do so and enjoy age appropriate bedtimes. People confirmed that they are supported to shop and choose their own clothes and take advantage of the community hairdressers to have their hair cut. Everyone was well groomed and dressed in age appropriate, good quality clothing, indicating they are supported to maintain a good self image. Entries in peoples records show that hey are being supported to gain access to health professionals and to attend appointments with staff support. One persons records Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: show that support has been provided to access consultant appointments and for a bone condition and a referral has been made to an occupational therapist. The manager explained that where people have health needs of particular concerns they are supported to attend their health monitoring appointments by the manager or the assistant manager, so as provide consistency of care and to ensure that staff are then properly briefed. Evidence of this was seen in peoples health notes. An epilepsy information sheet was seen to be in place on a persons file along with a clear written protocols for responding to any seizures. The protocols had been signed by a consultant psychiatrist. Staff on duty demonstrated a satisfactory understanding of the protocols and confirmed that they are provided with epilepsy training. Good work has been done to identify a seizure monitoring device for nighttimes. The device sits under the persons mattress and an alarm is triggered in the sleep in room if the person has a seizure, so that staff can respond. This is far preferable to other monitoring devices that involve listening in, which can be an invasion of the persons privacy. Entries in peoples records show that they are supported to attend routine checks and appointments, such as dentists, opticians and chiropody to help maintain good health. The manager explained that due to peoples high support needs no one currently manages their own medication. A sample of medication current sheets were checked and indicate that staff are recording medication correctly. A member of staff was able to demonstrate a good understanding of safe medication procedures. Two staff on duty confirmed they had been provided with medication training and had been observed and assessed by the manager before being allowed to give medication out. They have also completed medication booklets which assess their knowledge of safe medication procedures. The manager said that she also intended to devise another checklist to underpin the areas of medication practices covered by her safe practice observations. Medication protocols are in place explaining the circumstances under which people should be given as needed medication. Since the last inspection the manager has started to audit the medication regularly each month using an audit form, to check that the medication is being managed safely. A staff member explained that after medication has been given a second member of staff checks the records so that in order that any medication errors may be promptly picked up and addressed. A medication stock record is being kept each month to effectively account for medication in the home. Creams are being dated as they are opened so that it is clear when they should be discarded, in keeping with good practice. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: The medication returns record was seen. This shows that medication is being routinely returned to the chemist and signed for by the pharmacist. Care Homes for Adults (18-65 years) Page 20 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. Suitable procedures are in place for investigating complaints and staff are trained to recognise and report suspicions of abuse so that people are protected from harm. Evidence: Their have been no complaints to us about the home since the last inspection. In the annual quality assurance assessment, the manager reports that there have also been no complaints made at the home since the last inspection. An easy read complaints procedure is in place for people at the home, containing pictures to make the information easier to read. There is also a separate sheet containing the photographs of committe board members and managers to whom concerns may be raised by staff or the people at the home. The manager said that she would arrange for the people at the home to have their own copy for safekeeping in their rooms. The service user guide has recently been sent to relatives. This includes a copy of the complaints procedure, so that relatives know how to complain on peoples behalf if necessary. Two staff confirmed they had received Safeguarding (against abuse) training and the training records show that this provided to all staff. Two staff demonstrated a Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: satisfactory understanding of the different types of abuse they may encounter and to whom they should report any such concerns. Staff confirmed that this is covered in whistleblowing training, provided by the organization. There has been one incident of assault by one person at the home upon another, several months ago. This was appropriately reported to Social Services for consideration under the safeguarding procedures. Appropriate health professionals were called upon following this incident to provide the necessary treatment and support required. The manager confirmed there have been no further incidents. Care Homes for Adults (18-65 years) Page 22 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 are provided with clean, comfortable, homely accomodation that is equipped to meet their needs. Evidence: 46 Princess St provides accommodation for seven people. The main lounge is comfortable and equipped with domestic style furniture, to make it homely. The lounge furniture is comfortable and two dining tables are in place in the kitchen to enable everyone to dine with a reasonable amount of space. The house has been decorated throughout, including the communal areas and bedrooms and looks nice and clean. People at the home said they had been involved in choosing the colours using colour cards. This was also verified in entries in house meeting notes. Peoples bedrooms show ample evidence to demonstrate that they have been supported to make these areas to their liking, e.g. with photographs, posters reflecting their interests and music playing equipment. A ceiling hoist is in place for a wheelchair user to support safe moving and handling Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: practices and a specialist bed has been provided to meet their needs. A downstairs shower is available ,with a shower chair for people with mobility problems. Bedrooms have radiators fitted with covers to stop people scalding themselves. There is currently no way of changing the temperature in the bedrooms without two staff lifting the covers off. The manager said that there are still plans to seek a better solution to this problem and said she would escalate the priority for this work to be addressed by the maintenance section. In the meantime, the manager said that she would proceed with fitting thermometers in bedrooms and keep a monitoring record to demonstrate that bedrooms are being retained at a comfortable temperature when people are at home. The home was clean and free from unpleasant odours. A cleaning schedule was seen on the kitchen notice board which staff follow to structure their cleaning routine. Protective aprons and gloves are available for staff to use when carrying out care tasks. Red disolvable laundry bags are available for staff to use to carry continence laundry in a hygienic manner. An industrial washing machine is in place in the home with programmes suitable for washing continence laundry items. Comments by staff and the manager confirmed that staff are provided with infection control training to support good hygiene practices. Care Homes for Adults (18-65 years) Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitable arrangements are in place for recruiting and training staff so that the people at the home receive appropriate care and support from suitable staff. Evidence: The core team of staff working at the home has remained the same, providing consistency of care for people. Staff explained that there are typically three or four staff on duty when everyone is at home in the mornings, evenings and at weekends. This was verified in recent staff rotas. One person also receives extra support to undertake a suitable range of day service activities. A worker sleeps in at nighttimes to support people in the event that they wake at night. A member of staff confirmed that in the past, extra waking staff have been on duty at night, where necessary (e.g. to support a person suffering a mental health relapse). Copies of two staff members recruitments records were sampled. The records indicate that staff are properly recruited and vetted and include evidence of references and Criminal Record Bureau checks. Work permits are also checked as part of the recruitment process to ensure that staff are eligible to work in the UK. In the annual quality assurance questionnaire, completed by the manager, as part of Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: the inspection, she reports that 80 of staff have now achieved National Vocational Qualifications (NVQs) at level 2 or above. These courses equip staff to carry out their work competently. A new member of staff explained that she had been completing an induction programme with support and supervision from the manager and that training courses were being planned for her to attend shortly. This was verified by the manager. Induction paperwork demonstrates that new staff are taken through a comprehensive induction programme to underpin their work at the home. Training information provided by the manager shows that all except two new staff have completed learning disability award framework training. This is good training to underpin staff practice, prior to moving on to NVQs. Three staff confirmed that they are provided with regular training updates to support safe care practices, such as moving and handling, food hygiene, first aid, safeguarding against abuse, medication and epilepsy. This is verified in staff training records provided by the manager. Examples of other training courses include, equality and diversity, communication and challenging behaviour. The manager reports that some staff have now completed pressure area care awareness training, oral care and diabetes, and there are plans for more staff to be trained. Only a small number of staff have been trained in dementia training (2) and autism (3). The manager agreed to increase the number of staff trained in these subjects, to ensure staff are further equipped to meet peoples needs. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitable arrangements are in place for monitoring the quality of the service and for ensuring a safe living environment for people. Evidence: The manager holds the Registered Managers Award and has completed the National Vocational Qualification, level 4 in Care. Her qualifications and longstanding management experience equip her for the role of Registered Manager. Surveys were sent to the people at the home and their relatives last year, to seek their views on the home and the manager said that she would be repeating this exercise again shortly. The manager has a range of monthly checks that she carries out to check the home is running smoothly, such as checking money, care files and risk assessments. The checks are then reported to a senior manager to help her in monitoring the home. Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: A senior manager visits the home routinely to carry out her own monitoring visits. The two most recent reports of these visits have not conatined much information, due to a change in the paperwork format. The senior manager explained that this has been acknowledged and a new format for these reports has now been introduced. This allows the senior manager to more comprehensively report the findings of these visits. Staff meeting records show that meetings regularly take place to discuss policy and practice at the home. The manager said that three people have recently paid to have their bedrooms decorated. This is not allowed as the cost of redecorating the home is included in the fees. This was discussed with the Director for People In Action. She explained that this is due to an error and said that the people at the home would be promptly reimbursed for the costs of the decor. This has since been confirmed in writing by a senior manager of the organisation. Lockable storage arrangements are in place for the safekeeping of peoples monies. Two peoples expenditure records were seen. The records include two staff signatures to account for all money that is spent. Receipts are being retained as evidence of items purchased and the shift leader checks the record to ensure it is correct as money is passed between shifts. Periodic audits are also being carried out by a financial manager in the organisation. The fire safety records were sampled. The log shows that fire alarms and emergency lights are being routinely tested and that fire drills are carried out at the home. Discussions with two people at the home demonstrated a good understanding of the fire safety procedure. Maintenance certificates provide verification that the fire safety equipment is being routinely maintained by a professional contractor. The fire officer report, carried out 29th September 2008 identifies a need for for new fire door seals in some areas of the home. The manager confirmed that this is being addressed. A landlord gas safety certificate shows that gas appliances have been properly checked to ensure they remain safe to use. Similarly the records show that electrical equipment is routinely checked each year by a suitably trained person, to make sure it remains safe to use. A hot water log is being kept updated at the home, as verification that hot water temperatures are being checked to ensure that people are not placed at risk of scalding. Care Homes for Adults (18-65 years) Page 28 of 32 Care Homes for Adults (18-65 years) Page 29 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 30 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 6 Proceed with plans to provide people with an accessible summary of their care plans where appropriate, so that they hold a clearer understanding of what support they may expect from staff at the home. Proceed with plans to encourage choice at mealtimes and to provide opportunities for people to develop more cooking skills, to further increase their independence. Action should be taken to make it easier for staff to adjust the bedroom radiator temperatures without resorting to lifting the radiator covers off. This is necessary so that temperatures can be easily adjusted to the level that is comfortable for people. 2 17 3 24 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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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