Inspection on 23/10/08 for Preceptory Lodge

This inspection was carried out on 23rd October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Preceptory Lodge 15/11/06

Preceptory Lodge 06/03/06

Preceptory Lodge 13/09/05

Preceptory Lodge 01/03/05

Preceptory Lodge 14/09/04

Preceptory Lodge 04/03/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Muston Road (70)

Grayling

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Preceptory Lodge Preceptory Lodge Temple Hirst Selby North Yorkshire YO8 8QN     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: Carol Haj-Najafi     Date: 2 4 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (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 35 Information about the care home Name of care home: Address: Preceptory Lodge Preceptory Lodge Temple Hirst Selby North Yorkshire YO8 8QN 01757270095 Telephone number: Fax number: Email address: Provider web address: preceptory@btinternet.com Name of registered provider(s): Name of registered manager (if applicable) Mrs Christine Widdowson Type of registration: Number of places registered: Mr Donald Smith care home 4 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: 4 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 Preceptory Lodge provides personal care and accommodation for four service users with Autism in a domestic environment. The home is situated in the private grounds of Preceptory Farm. Preceptory Lodge is registered for four adults, currently there are three service users living in the home. The home is located between Selby and Doncaster and transport is provided for access local amenities and leisure activities. The home was first registered in March 2003 and is privately owned by Mr D Smith. Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 4 Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 last key inspection was carried out in November 2006. Before this key inspection we reviewed the information we had about the home and the manager completed an annual quality assurance assessment (AQAA). We used this information to help us decide what we should do during our inspection. Surveys were sent out to people who live at the home, their relatives and people who work at the home. Five surveys were returned. Comments from the surveys have been included in the report. We did not tell people that we were doing our inspection before we visited the home. An inspector was at the home over two days. The first day we visited between Care Homes for Adults (18-65 years) Page 6 of 35 10:00am and 12:30pm. We left after lunch because people were going swimming. We agreed to return the following day and were at the home between 9:30am and 2:00pm. We spent a total of 7 hours at the home. During the visit we looked around the home, talked to people who live at the home, staff, the registered manager and the owner. We also looked at care plans, risk assessments, daily records and staff records. At our inspection the manager told us the fees range between 1272 pounds and 1765 pounds. What the care home does well: What has improved since the last inspection? What they could do better: Care plans should be better organised and more accessible. This will make sure the care plans are working documents and owned by the people who live at the home. Risk assessments should be specific so they clearly identify risks and how they should be managed. This will help make sure people are safe and can take responsible risks. Some incidents should be recorded more carefully and if staff use physical intervention this should be followed up to establish what happened and if action was appropriate. After an incident the care plan and risk assessment should be reviewed. This will make sure peoples rights are protected and care needs are properly identified and met. Medication should be written out more carefully to make sure the instructions for administration are correct. This will help make sure medication is administered properly. Staff should receive more training. This will make sure people have the right skills and knowledge to do their job properly and safely. A more robust recruitment process should be followed when staff are employed. This will make sure people who live at the home are protected. Care Homes for Adults (18-65 years) Page 8 of 35 Staff should have more opportunities to receive supervision from the manager and attend staff meetings. This will help staff develop and understand the homes aims and objectives. Better quality monitoring systems should be introduced. This will make sure the home is providing a safe and quality service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 35 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 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are properly assessed before they move into the home and they are assured their needs will be met. Evidence: The same people have lived at the home for the last fifteen months. One person is hoping to move in at the beginning of November; the manager was still completing the admission process with this person when we carried out our inspection. The person has visited the home and spent time with people who live there so everyone can get to know each other. One person who lives at the home said, (name of person) has stayed a few times and hes alright. One staff member said the move is being planned carefully to make sure people are compatible. We talked to the manager about the pre admission process. She said they have already gathered a lot of information but were still were still completing their assessments. They have obtained information from others who could contribute. Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: Several people, including the person who is hoping to move in and their advocate, attended a meeting to plan the move and to make sure the right support systems are in place. Care Homes for Adults (18-65 years) Page 12 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are identified and met although some gaps in the care planning process could result in some care needs and aspirations being overlooked. Evidence: We received surveys from two people who live at the home and talked to two people. They are happy with the care and support they receive. One person said, I am well looked after. Another person said, I like living here. Staff said the home provides a very good service and makes sure peoples needs are met. Staff surveys told us they are always given up to date information about the needs of the people they support. We received one relative survey. This told us the service always meets the needs of their relative, and they always get enough information to help the person make decisions. When asked what the service does well, they said, Support, motivate, Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: promote independence...they are very caring towards service users. All this gives me piece of mind. In the AQAA the manager said, We provide specialised Autism care for adults which pays particular attention to their ambitions. We provide opportunities for service user and staff alike to develop in areas of strengths and weakness. We promote inclusive living and empower service users to make choices about things that effect them. We looked at everyones care plans and assessments. These were well written and described how peoples needs should be met. The care plans identify the type of support that should be given to help people deal with specific situations and what preventative measures should be in place to avoid certain situations arising. One plan states that the person may touch tables in a ritualistic way and staff should not intervene in any way with these behaviours. This is clear guidance that tells everyone how the persons needs should be met. Care plans identify how peoples independence and choice should be promoted. There is also good information about individual routines and what people like and dislike. Keyworker meetings are recorded and these identify changes in care needs and healthcare updates. Formal reviews have been held for two people, and the manager said she was arranging a review for the other person. The review reports are very detailed and provide good information about each person. Daily records also had good information about peoples needs. Staff record incidents in the daily notes and an additional record is completed. These are generally well recorded but we did identify two incidents that were not recorded properly. A serious incident had taken place but had only been recorded in the persons daily record. The daily record said a person who lives at the home had stood up to attack a staff member. Another staff member grabbed the person in a bear hug. This should have been recorded on an additional form to make sure serious incidents can be monitored. It should also have been followed up to establish what had happened and if the action was appropriate. The care plan and risk assessment should also have been reviewed. Another incident was recorded on the appropriate forms but staff actions were unclear. The record said the person had slapped a staff member with force in the face and had been promptly escorted to their room and told he could have breakfast when he calmed down. There was not enough information about how the person was escorted or how long it was before he had breakfast. This incident should also have been Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: followed up. The manager said they have a no restraint policy. It is clear from these records that staff are using physical intervention and have restricted a persons right to eat their breakfast. We have additional information about this in the complaints and protection part of this report. Risks to people who use the service have been identified and assessed and there is information to help staff manage and minimise risks. Although some information was not specific enough and it was not clear how some potential risks had been identified. One assessment identified that a member of the public could be injured or offended but there was no evidence to say how this risk had been identified. The manager said she didnt think there was a risk to members of the public and agreed to review the assessment. Vague terms such as aggressive behaviour and verbally aggressive have been used. Assessments should identify specific behaviours so these can be properly assessed. People who live at the home had signed agreements to confirm they are happy with the plans and assessments. Each person has three files, a care planning and risk assessment file, a medical/healthcare file and a daily record file. These files contain all the relevant information but because information is in different documents it is hard to find. For example keyworker meeting minutes had details of changes in needs but this had not been transferred to care plans. Review reports had details of goals but these were not in the goals and aspirations section in the care plans. Important information can get lost and people will not know which are current needs. The care plans are not ‘working tools’ and people who use the service do not appear to have real ownership. Staff acknowledged they do not regularly use the care plans but said they know people very well. They said they regularly use the daily record file which also contains some key guidance, for example a specific drinks routine for one person. One staff member said they have their own care plan for people but it is not written down. It is important that care plans are accessible and used as working documents. This will give people more ownership of their plans and help everyone work consistently and understand how peoples needs should be properly met. Care Homes for Adults (18-65 years) Page 15 of 35 Care Homes for Adults (18-65 years) Page 16 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are happy living at the home and have a stimulating and fulfilling lifestyle. Evidence: People at the home told us they are happy living there. We observed the care being given to people. This included how staff interact with people at the home. Staff were polite and chatted to people. There was good banter between staff and some people who live at the home and everyone appeared very relaxed. When asked what the home does well, one staff said, Its very relaxed, its home for people. One person said, We go out a lot and do a lot of different things. He said he enjoys walking, swimming, playing golf and had just come back from holiday. We looked at Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: the daily records which confirmed people have an active lifestyle. In the three weeks before the inspection one person had been out to Doncaster, Selby, shopping twice, swimming, walking twice, had a meal out and had been on holiday to Spain. These activities were all carried out with staff support. We looked at another persons daily records. They had been to a car boot sale, swimming, out for a drive, played golf, several meals out and shopping. Staff said people have a very good social and recreational life. One staff said, Its great, a nice environment and people who live here enjoy it. We arrived unannounced at the home. People were going swimming after lunch so we stayed two and a half hours and arranged to go back the following day. The registered provider has a day centre that people can attend Tuesday- Thursday. One person goes most days, another person said he goes sometimes but likes to join people when they go walking. In the AQAA the manager said, Service users are involved in community activities at every opportunity. Staff always promote health eating encouraging service users to eat a well balanced meal while providing choice at the same time People told us the meals are good. One person who lives at the home said, Staff do the cooking and they are good at cooking. One staff said people are given a well balanced diet and variety. The home has a menu and everyone uses this when they do the food shopping. Staff record meals so nutrition can be properly monitored. Care Homes for Adults (18-65 years) Page 18 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are well met. Medication procedures are in place but these are not always carefully followed and this could result lead to medication not being administered correctly. Evidence: Staff said the home is good at meeting people’s personal and healthcare needs. One staff said people are supported to make sure they are clean. Another staff said, The home provides an atmosphere and good working practices that caters for each individual. One person who lives at the home said they enjoy having a bath and have one twice a day if they want. Daily records had good detail of what people do, personal care and any changes in care needs. They told us that people have good daily support with their personal care and staff are vigilant and look for changes in well-being. We looked at information that showed us peoples health is properly monitored. Healthcare plans identify peoples healthcare needs. Weight is monitored and Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: healthcare appointments are clearly recorded. Some information about an optician appointment had not been recorded on the appointment sheet and the keyworker review did not record the last date of appointment. The manager confirmed the person had attended the appointment through the financial record but acknowledged this should have been recorded on the appointment sheet and on the keyworker record. One person who lives at the home said they go to Selby for their healthcare appointments. They said they tell the staff if they are unwell and either go to bed or see the doctor. One person is not registered with a local GP but are still registered with a GP from where they previously lived. The manager said this has been agreed with the GP, family and other professionals. The decision should be formally risk assessed and action to access the GP and any other relevant detail should be recorded in their care plan. We looked at medication systems. Medication is well organised and, generally, systems are in place to make sure the right medication has been administered. This includes additional counting of medication each day. The last inspection identified that staff should complete an accredited medication training course. The manager confirmed staff did this, however, because there has been a new staff team since the last inspection most of the current staff have not completed this training. The manager showed us written confirmation from a local college that staff are starting an accredited medication course. In the AQAA the manager said they have a medication policy and procedure in place and this was reviewed in February 2008. One person has their medication in a drink because this helps them take it. Staff said the person is aware of this but it was not recorded in their care plan. It is important to make sure this is assessed, agreed and recorded. The persons medication administration is hand written by staff because the medication is not supplied locally. It did not contain all the relevant information from the medicine bottle or any directions for giving the medicine with drink. Medication is stored in a medication cabinet which is housed in a locked cupboard. On the first day of the inspection the medication cabinet did not lock. This was fixed when we returned the following day. Care Homes for Adults (18-65 years) Page 20 of 35 Care Homes for Adults (18-65 years) Page 21 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main, systems are in place to make sure people are safeguarded. Very occasionally staff are using physical intervention to manage physical aggression, however, this has not been properly recorded and monitored so does not safeguard peoples rights. Evidence: Surveys told us that people know what to do if they want to make a complaint. One person who lives at the home said he would tell Christine (the manager) and she will sort it out or tell the staff. In the AQAA the manager said, We deal with complaints efficiently so that they do not turn into a larger problem. They told us they have not received any complaints in the last 12 months. It took the manager some time to find the complaints procedure, and in the procedure our contact details were out of date. The complaints procedure and contact details for CSCI should be readily available so people know the procedure to follow and who to contact if they want to make a complaint. Staff were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They were also able to describe the different types Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: of abuse. The home has made one safeguarding referral to the local authority in the last twelve months. This was dealt with appropriately. As recorded in the individual needs and choices section of this report, on occassions, staff have used physical intervention to manage physical aggression although this has not been properly recorded, monitored and followed up. The manager said they have a no restraint policy. It is clear from records that staff are using physical intervention. We looked at two people’s financial records. All transactions were recorded and receipts were obtained for any purchases made. Care Homes for Adults (18-65 years) Page 23 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in an attractive, homely and clean environment. Evidence: A person who lives at the home showed us around. The home is furnished and decorated to a high standard, and was clean, tidy and well organised. The home is located away from the main road and the owner of the home provides transport so that people can access local amenities. There are extensive gardens to the home with a paved patio area to the rear of the building. Within the grounds there is a day service facility to enable people to take part in activities and a summer house with a pool table. Builders were working within the grounds when we visited. The owner said they are building a swimming pool, gym, sauna and snooker room, which people who live at the home can use, and hopes the work will be finished in a month. Each bedroom is decorated to suit peoples personal tastes. Communal areas in the home are bright and spacious and there are toilets and bathrooms that are easily accessible. Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: The home has a maintenance programme and all the required safety checks are carried out. There are separate laundry facilities. Protective clothing such as gloves are available and all dangerous substances are stored securely. The owner lives next to the home and visits daily. He has completed a report every month and identified any environmental problems. Care Homes for Adults (18-65 years) Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are supported by a caring staff team. Staff may not have the right skills and knowledge because they have not received enough training which could result in peoples needs not being properly met. Evidence: People at the home told us staff always treat them well and listen and act on what they say. A relative said staff always have the right skills and experience to look after people properly. Staff told us they have enough support, experience and knowledge to meet the needs of the people who live at the home. One staff said, We give good quality, staff work well together and there is good humour. The home has had a new staff team in the last six months. Only the manager and one staff are existing workers. The manager said this has caused some difficulties in terms of staff cover and training but they have now appointed a new staff team so they can address the staffing issues. Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: In the AQAA the manager said, All new staff complete skills for care induction package. We looked at two staffs induction . These confirmed that they had completed each module of the basic induction programme and the manager had assessed these to make sure they were completed correctly. A staff member who started work at the end of August had completed the basic induction programme but had not completed two additional modules, medication and adult protection. One staff member said they had a very good induction and it covered everything. A new employee started working at the home two weeks before the inspection. They had not started their induction programme but were working with people who live at the home unsupervised. They had accompanied one person who lives at the home for a walk and had supported people with personal care. The manager said this had occurred because she had taken some people on holiday but it was not usual practice. An induction programme should be planned when a person starts working at the home. In the AQAA the manager said, We have a rolling programme of training consisting of medication, abuse, adult protection, Non Violent Crisis intervention, first aid, autism, epilepsy, food hygiene, health and safety. We looked at training records for four staff including the manager and found that the rolling programme is not working effectively. Staff had not completed some training or received refresher training so are not appropriately trained for some aspects of their work. None of the staff working at the home have completed up to date fire training. Some training was out of date which included first aid and food hygiene. People at the home have specialist needs. Some staff have done autism training but would benefit from other specialist training. This should include mental health and epilepsy. The homes does not have a staff training or development programme so staff training needs are not identified. Training policies do not clearly identify when people should do refresher courses so some training is difficult to plan. The manager has NVQ level 2 and has started NVQ level 4 in care. One staff member has started NVQ level 3. No other staff have or are working towards NVQ awards. The manager agreed that they must look at training as a priority and has taken steps to address training shortfalls. All staff are starting an accredited medication course and Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: are booked on a Non Violent Crisis Intervention Course. Staff told us they have regular contact with each other and the manager because they are a small staff team. They said communication is good. However, staff have not received regular staff supervision and only one staff meeting has been held in the last twelve months. Structured systems should take place to make sure information is passed to everyone and people have an opportunity to look at their own development. A member of staff that has recently started working at the home talked about the recruitment process. They confirmed that they attended an interview, and had to wait for a criminal records check and satisfactory references before they could start work. We looked at staff files for three people that had recently started working at the home. Each file had interview notes that confirmed people had been asked questions that relate to the work they would be expected to do. Each file had an application form and confirmation that a satisfactory criminal records certificate had been obtained. However, one application form had gaps in the employment history. Another form had an employment history but it did not correspond with what was written in a reference. Each file had at least two references. One file did not have an employment reference. A note was on the file that the manager had asked one ex-employer for a reference but the applicant had not included this employer in their employment history. Care Homes for Adults (18-65 years) Page 28 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home receive a good quality service but because the home does not have an effective quality monitoring system in place it is not achieving all its aims and objectives. Evidence: The manager was registered with us in August 2007. She has completed a management course in health and social care and is completing an NVQ level 4 care award. The manager said there is a clear management structure in place and she receives good support from the senior manager. People told us the home is well managed. One staff member said, The manager is very approachable. Another staff member said, Communication is good. In the AQAA the manager said, The home is managed in an open and transparent manner. The philosophy of the home is to always work in the best interest of the service user whilst adhering to all policies and procedures. At all times the health, and Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: wellbeing, safety and protection of service users is of paramount importance. The owner lives next to Precepatory Lodge and has daily contact with the people who live at the home, staff and management. One person who lives at the home goes walking with the owner and his dog most days. The owner completes monthly visits to the home to check it is providing a satisfactory service and writes a report. These are called regulation 26 visits. During the last six months there was information about the environment but no information to say that records had been checked. We asked the manager about systems they use to check the quality of the service. She acknowledged that they had not sent out surveys to people for a long time and did not know where the last quality assurance information was held. The organisation has just introduced an annual quality assurance audit tool that looks at all areas of the home. They had not started using the audit but the manager showed us the documentation. A manager from another home and the manager from Precapatory Lodge will go through each area to make sure the right systems are in place and the home is achieving a good standard. If the audit had been completed before the inspection it would have highlighted most of the shortfalls we identified. The manager said she has only had limited time to spend on management tasks during the last few months because she has spent a lot of time covering shifts but should have more time now the staffing situation has improved. No concerns around safe working practices were seen on the day of the inspection. In the AQAA the manager told us relevant policies and procedures are in place and equipment has been serviced or tested in line with manufacturers guidance or regulatory body. Care Homes for Adults (18-65 years) Page 30 of 35 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 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 When a persons right is limited in a crisis situation it must be properly recorded and investigated, then followed up through the assessment and care planning process. This will make sure peoples rights are protected. 30/12/2008 2 20 13 Medication administration records must have clear instructions for administering medicines This will make sure the correct procedure is followed and people receive the right medication 31/12/2008 3 23 13 The manager must review the homes policy on physical intervention and make sure appropriate measures are in place and are consistent with how physical aggressive is managed. 30/12/2008 Care Homes for Adults (18-65 years) Page 32 of 35 This will protect the rights of people who live at the home. 4 34 19 A thorough recruitment process must be carried out before any person is employed at the home. This will help make sure the correct people are employed so people who live at the home are protected. 5 35 18 People who work at the home must receive appropriate training that gives them the knowledge and skills to carry out their work. This will make sure peoples needs are met and people are safe. 31/12/2008 31/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 Care plans should be a working tool used by people who live at the home and all staff involved. The plans should be easily used and contain all the relevant information about peoples needs. This will make sure people who live at the home have ownership of the plan and receive the right care to meet their needs. Risk assessments should clearly identify risks. This will make sure everyone understands the risk and the appropriate action to take to minimise the risk so people will be safe. Where people are not accessing local health services an assessment should be completed to make sure people can still receive the right support. The complaints procedure and contact details for CSCI should be readily available. This will make sure people Page 33 of 35 2 9 3 19 4 22 Care Homes for Adults (18-65 years) know the procedure to follow and who to contact if they want to make a complaint. 5 33 Staff should have opportunities to attend staff meetings so they have opportunities to talk about the home. This will help everyone understand how to work consistently and achieve the homes aims and objectives. The staff training and development plan should be introduced to make sure staff training needs are identified and met. Staff induction should take place when someone first starts working at the home. This will make sure they have the right information and knowlegde before they work unsupervised with people who live the home. Staff should receive regular formal supervision to make sure they have opportunities for personal development and to discuss their performance. The homes quality monitoring systems should be implemented to make sure it is achieving its aims and objectives. 6 35 7 35 8 36 9 39 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (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. 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