Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 10/07/08 for REACH Sistine Manor

Also see our care home review for REACH Sistine Manor for more information

This inspection was carried out on 10th July 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

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

REACH has good procedures in place for assessing the needs of prospective users of its services, including this home. Referrals are assessed by experienced managers and the process allows all parties, the prospective resident and his or her family, the referring care manager, and home staff and current residents, time to consider whether the home can meet the person`s needs. The home is making good progress in developing a more accessible format for its care and support plans. This is particularly noticeable in the `preparation for review` notes which now include scanned in pictures and reflect greater user involvement. The home offers a wide range of activities to people living there. These include attendance at college, using the amenities of the local community, and art therapy and massage in the home. There is a positive and supportive ethos in the home. Residents and staff were noted to be at ease together. The home provides a spacious environment which generally enables people to find an area to suit their mood - whether that is to be with others, on their own or in the garden. There are well established safeguarding adults procedures in place. Procedures are thorough, the subject is included in the staff training programme and the home liaises well with statutory organisations such as the local authority and CSCI.

What has improved since the last inspection?

The home is making good progress in developing a more accessible approach to care planning which encourages the involvement of people living there. The manager is now registered with CSCI and has started the NVQ level 4 course, the Registered Manager`s Award (`RMA`). There appears to be a wider range of activities and residents are having more opoportunities to participate in activities in the wider community. There is an ongoing investment in the home environment which creates a more pleasant lace for people to live in. Over the past year bedrooms have been redecorated, new carpets have been laid in some areas of the home, and new garden furniture purchased. The manager reports that staff retention has improved. This has led to minimal use of agency staff and a higher level in continuity of care for people living in the home.

What the care home could do better:

The home should continue to seek opportunities for increasing the range of activities for residents.The home should build on the progress it has already made in developing more accessible care and support plans for residents. Further work is required to make the complaints procedure more understandable to residents.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: REACH Sistine Manor Stoke Green Stoke Poges Bucks SL2 4HN     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: Mike Murphy     Date: 1 0 0 7 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 31 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 31 Information about the care home Name of care home: Address: REACH Sistine Manor Stoke Green Stoke Poges Bucks SL2 4HN 01753531869 01753511873 sistine@Reach-disabilitycare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): REACH Limited The registered provider is responsible for running the service Name of registered manager (if applicable) Luz Elena Johnson Type of registration: Number of places registered: care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of servuce users who can be accommodated is 18. The registered person may provide the following category/ies of service only: Care Home only - Code PC to service usesr of the following gender: Either Whose primary care needs on admission to the home are within the following category/ies: Learning Disability - Code LD Physical Disability - Code PD maximum number of places 3. Date of last inspection Brief description of the care home Sistine Manor is a large and spacious detached house, which offers residential care to adults with learning disabilities. The home is located on the edge of Stoke Poges village and within reach of the amenities of the village and Slough town centre. It is also Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 0 18 18 Brief description of the care home conveniently situated for Wexham Park Hospital. The home is set in large enclosed grounds and there is sufficient on site parking to the front and side of the home. The home is registered for 18 service users between the ages of 18 and 65 and at the time of this inspection, there were 14 service users living at the home. 16 of the 18 places are in the main home. Two places are in a separate building, the `Coach House, and are considered suitable for service users who have more independent living skills. The home is run by REACH (Rehabilitation Education And Community Homes Limited), which has its head office in Gerrards Cross. Care Homes for Adults (18-65 years) Page 5 of 31 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: This unannounced inspection was carried out over the course of one day in July 2008. It was a key inspection which focused on the key standards in Care Homes for Adults (18-65). The inspection included a visit to the service, conversations with people living there, conversations with the registered manager and staff, examination of records (including care plans), a tour of the home and grounds, consideration of information provided by the registered manager in the annual quality assurance assessment (AQAA), consideration of the contents of CSCI survey forms returned up to the point of writing this report, and observation of practice. Care Homes for Adults (18-65 years) Page 6 of 31 The inspection also included the involvement of an expert by experience accompanied by a personal assistant. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. What the care home does well: What has improved since the last inspection? What they could do better: The home should continue to seek opportunities for increasing the range of activities for residents. Care Homes for Adults (18-65 years) Page 8 of 31 The home should build on the progress it has already made in developing more accessible care and support plans for residents. Further work is required to make the complaints procedure more understandable to residents. 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 31 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 31 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. The needs of people considering using the service are assessed by experienced managers to ensure the service is able to meet those needs. People offered a place may visit the home prior to deciding whether they wish to live there. Evidence: REACH has good systems for assessing the needs of prospective users of its services. Referrals are made to the organisations head office in Gerrards Cross. Senior and experienced managers consider the referral. If it is appropriate then the manager gathers further information and makes arrangements to visit the person at their current place of residence. The manager conducts an assessment of the persons needs. The process includes liaison with relevant health and social care professionals. The information acquired is then considered by REACH and an appropriate vacancy in on of its homes identified. Compatibility with current residents is considered. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: Arrangements are made for the prospective resident to visit the home. This is followed, where appropriate, by extended visits. If all goes well then a trial admission of three months or so is arranged. A review is conducted with all parties at the end of this time. A permanent place is offered if all agree that the home is appropriate to the persons needs. Care Homes for Adults (18-65 years) Page 12 of 31 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. Comprehensive care plans are in place for each person living in the home. The home is developing a Person Centred Plan (PCP) format approach to care plans with the aim of enabling residents to be more involved in their own care. Evidence: A care plan is in place for each resident. Care plans are in person centred plan (PCP) format and the home is making progress in developing this approach. Overall however, care plans, although much improved, are still relatively complex and there is scope for further rationalisation and improved presentation of information. Care plans include a photograph of the person, a personal pen picture, a list of things the person likes and doesnt like, care guidelines, care guidelines, weekly diary, daily notes (written three times a day in a separate diary) and notes in preparation for review meetings. Care plans included numerous pictures of people, places and objects which are important to the person. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: Care guidelines cover such aspects as the support required at meal times, person hygiene, bedtime routine, communication, behaviour, risk assessment and management (when, for example crossing the road or going out shopping), and for at least one person the use of TEACHH cards (TEACHH is a structured approach to communication in autism which is considered to be effective for some people). Weekly diaries included participation at a wide range of activities including (among others): outings to the park, going to the library, cookery, swimming, clubs, sessions in sensory room, speech therapy, photography at Langley College, art therapy, going to the local British Legion Club, going to the cinema, shopping, and working in a stables. Matters that were recorded as being important to the person included contact with family, holidays, time out of the home, books and videos, celebrating Muslim events such as the festival of Eid (after Ramadam), and having friends in the home. Notes in preparation for review meetings were of a particularly good standard. They were comprehensive,were written in a style which appeared to reflect the views of the person, and included pictures. Staff encourage people living in the home to participate in day to day activities, be involved in their PCPs, and make choices on what they want to do. The expert by experience noted When asked if there was anything they would change here one resident answered NO and if the resident was happy there they said YES. One service user said that the staff help him to work out what he puts in his Person Centred Plan [and looked happy with this as he said it]. He also named many staff members who he liked. Processes for conducting risk assessments are well established in the home and cover a wide range of activities - both those which are specific to individuals and those which potentially affect everyone living in the home. Care Homes for Adults (18-65 years) Page 14 of 31 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. Residents lead varied lifestyles according to their individual needs, abilities and interests. This ensures that people experience a range of therapeutic, social and leisure activities and are supported in maintaining involvement with the local community. Evidence: People living in the home participate in a range of activities. One group of residents was away on holiday during our visit. One resident talked about lots of holidays that people had been on (some abroad). He was due to go abroad for a few months to stay with family and mentioned going to stay with his family in London regularly. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: A staff member said the home made use of holiday cottages so that residents could relax and have their own place. A variety of places were visited. Residents made use of college courses: two were interested in photography, had their own equipment and had been proud of having their pictures displayed in an exhibition at college. One of those mentioned different pieces of camera equipment with great interest. One resident was doing a cookery course and said they enjoyed it. One person had been offered a job at a garden centre. Going out for walks, to the cinema, to shows, plays, pubs, shopping for food and personal items were all mentioned by residents and staff. Buses, cabs, trains and the house car are all used. One resident said Like buses, another mentioned groups they had seen at concerts and going on a picnic. Residents have times to cook food that they have shopped for, with help from staff (key workers). One resident talked of Gardening with [name of staff member]. Weekly diaries in PCPs included participation in sessions in: cooking, college (photography), cinema, shopping, British Legion club, trips out, bowling, swimming, doing own laundry, contacts with family, going to clubs (Wednesday Club and Thursday Club), tennis, and holidays. A relative wrote I am happy with the schedule of activities planned for [name] who is very active and needs a lot of stimulation. [Name] seems to enjoy being at Sistine Manor which is very important. Staff do not enter bedrooms without the permission of the resident. The manager said that people living in the home may have a key to their room if they wish but the front door needs to be locked for safety reasons. Residents are involved in selecting places to go on holiday and trips out. Residents are consulted on menus. Picture menus are available to help with choices. A cook prepares the main meals on weekdays. Staff and residents prepare the meals at weekends.Breakfast consists of cereal, toast, tea, coffee and fruit juice. Breakfast at weekends may include toasted tea cakes, crumpets, waffles, or be a traditional English cooked breakfast. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: Lunch is a main course followed by fruit. Choices from menus around the time of this inspection included: White Fish and Salad, Chicken with Potato Salad, Sausages with Mash and Peas, and Beef Burgers and Salad. A packed lunch is available for those who are out for the day. The evening meal is the main meal of the day and is a two course meal. Choices from menus around the time of this inspection included:Spicy Lamb Tagine with Rice followed by Fruit Salad; Cod and Chips with Salad followed by Jelly; Cottage Pies and Salad followed by Fruit Salad; and Shepherds Pie with Cabbage followed by Jelly. A fish dish is usually served on Fridays. At lunch on the day of inspection some residents were helped by staff, use was made of plate guards and individual cutlery and beakers as needed. The staff were observed to be friendly and helpful:it was good to see people having time to eat their food at their own pace. Bowls of vegetables and then fruit were put on the tables for diners to choose from and serve themselves if they can. Staff helped them if they could not. Residents were encouraged to clear the tables after the meal - and thanked by staff for their efforts. Residents took their time having the meal; there was time to chat and relax. No one was rushed. The food we saw was pleasant and varied with choices available. Residents were encouraged to say what they wanted on the menu and shopped for the meals they were cooking. Care Homes for Adults (18-65 years) Page 17 of 31 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. Arrangements for liaising with health and social care services in the community are good. Arrangements for the control and administration of medicines are satisfactory. These aim to ensure that residents healthcare needs are met. Evidence: Personal support is provided by staff as required. Staff were observed to offer and provide support on a number of occasions during the day of inspection. Staff and residents were noted to be at ease with each other. All residents are registered with a local GP practice. Specialist services such as psychiatrists are accessed through the GP. The registered manager thought that there was a need for more psychologists and speech and language therapists in the area. A chiropody service is available at an additional payment. NHS dentists are accesed through a health centre in Slough. An independent optician practice is available in the Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: local area. A physiotherapist who is also a massage therapist visits every two weeks and provides sessions in the sensory room. An art therapist also visits every two weeks. One member of staff who is qualified in their own country is developing music therapy in the home. The home supports people with health screening. It is doing well in supprting female residents with well woman screening. This is acknowledged by a relative who wrote [Name] has [condition] and her needs are met at the home. The breast screening programme was also set up specifically for female residents. In the AQAA the registered manager wrote that over the next 12 months the home aims to Obtain Well Men checks for those service users who wish. A healthcare professional respondent to the CSCI survey wrote that they have not had need to raise concerns about the homes approach to meeting the health care needs of residents and that From my perspective I see no area for improvement. Arrangements for the control and administration of medicines are satisfactory. Staff practice is governed by REACH policy and procedures. Staff training is CD-ROM based with staff not being permitted to administer medicines until deemed competent to do so by the registered manager. Records are maintained of medicines supplied and of those returned to the pharmacy. Individual records include a photograph of the resident, a medicines administration record and a protocol for the administration of as required medicines where indicated. Checks on medicines form part of the Regulation 26 visits by senior managers. Reference texts for staff includea current edition of a BMA textbook and a copy of the current Royal Pharmaceutical Society of Great Britain guidelines on medicines in social care. The registered manager should also download a copy of current CSCI guidelines. Care Homes for Adults (18-65 years) Page 19 of 31 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. Arrangements are in place to ensure that complaints by people living in the home are appropriately managed and responded to. The interests of people living in the home are protected by the homes arrangements for safeguarding adults which include links with a local advocacy organisation. Evidence: The home has a complaints policy and procedure. It was last reviewed by managers in March 2008. The complaints procedure is also available in Widget form and through a series of photographs of managers. Widget is not routinely used in communications between staff and residents. The photographs were displayed under the heading complaints but the document on display did not include any text or diagram to set the context. The home received one complaint since the last inspection. The operations manager responded in the absence of the registered manager who was on leave at the time. CSCI has not received any complaints about this service since the last inspection. The home has a copy of the REACH policy on the protection of vulnerable adults (now, safeguarding adults). It had a copy of the current issue of the Buckinghamshire joint agency procedure on safeguarding adults in the managers office. The subject of Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: safegarding adults is included in the induction of new staff. An advocate used to visit the home monthly until recently. The manager reports that she is awaiting notification from the advocacy service that a replacement has been appointed and will be able to resume The organisation maintains good liaison with statutory services, including CSCI, with regard to reporting events which may compromise the safety or welfare of residents in its services. There have been no safeguarding adults investigations in this home since the last inspection. A policy on whistle blowing is in place. The staff training programme includes training in dealing with challenging situations through Non Crisis Intervention (NCI) training. According to records a training session took place on 8 April 2008. Arrangements are in place for safe keeping of residents money. These are governed by a policy which was last reviewed in April 2008. The home manages some money for all residents. The home has facilities for secure storage of money and valuables. Records are maintained of all transactions and receipts are retained. The Regulation 26 visits to the home by managers include a check on the arrangements. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a spacious, clean, comfortable and well maintained environment for residents. The home is reasonably well located for the amenities of the local area and enables residents to access a range of social, recreational activities and support services. Evidence: The home is a large detached house in the village of Stoke Poges, Buckinghamshire. Slough town centre is a relatively short distance by car, bus or taxi. There is plenty of parking space to the front of the house. An area of lawn to the side, and a large and secure garden to the rear. Entry to the home is controlled by staff. The gates are closed at night to prevent parking in the grounds by people who have no business in the home. It is a spacious home. The main house accommodates 16 residents and an adjacent coach house accommodates 2 residents. The accommodation in the main house is over three floors. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: The ground floor accommodation includes a large entrance hall, kitchen, two dining rooms, a large lounge, a sensory room, WCs, and a bedroom which includes en-suite facilities (shower and WC). There is also a staff work station. Across a small courtyard is a games room, laundry, store room, and the entrance to a two bedroom flat. The flat was not in use at the time of this inspection. The accommodation comprises a living/dining room, two single bedrooms, kitchen, bathroom and WC. There is a large entrance hall.Two sets of stairs lead from the ground floor to the first floor. The lounge is large, bright, well decorated and well furnished. Large windows give a view out onto the rear garden. It has a large plasma TV, music centre, radio, magazines and a variety of games. There are two dining rooms; one large and open where the majority of people dined on the day of the inspection, and a smaller room, adjacent to the sensory room. Bedrooms vary in size. Those seen during the inspection visit were a good size, well decorated and furnished, and personalised by the resident. One resident said that he had help from a member of staff to choose the colours of his room, the bedding and furniture. The resident was keen to show us his video and DVD collection and family pictures on the wall. He had a TV, DVD and video in the room as well as a stereo, plenty of shelves and things of his own thet he enjoyed showing us. There are nine WCs and five bathrooms around the house. The managers office is on the first floor. A medicines room is on the second floor. The kitchen is suitably equipped for current needs. The kitchen, courtyard store room and laundry were all well organised, tidy and clean on the day of the inspection visit. The garden is large and pleasant with areas of lawn, mature shrubs and trees. It was well tended. It has plenty of seats including a swinging bench. It provides a pleasant outdoor space for people living in the home and staff and is well used. It seems a secure area for vulnerable people. The home was well clean, well decorated and well furnished and is a safe and pleasant to live. Residents seemed relaxed and comfortable there. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported by adequate number of appropriately trained and supervised staff. Communication between residents and staff may on occasions be impeded where English is a second language. Evidence: Staffing levels at the time of this inspection maintained six staff in the morning, six in the afternoon and evening, and two at night. These figures do not include the manager. There is always a manager on call. On the day of the inspection visit the home had two and a half (full time equivalent) vacancies for care staff. The manager was due to interview four candidates during the week after the inspection and the manager was optimistic on filling some of the vacant posts. One respondent to the CSCI survey wrote Staff are very caring and helpful....my only criticism is that the standard of English among some staff (verbal and written) is sometimes a barrier to effective communication. Earlier in this report we refer to the good relationship between residents and staff and that they were at ease together. There was a positive atmosphere in the house on the day of the inspection visit. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: Five personnel files were examined. All included a recent photograph of the person, the results of a POVA First check before taking up post, an Enhanced CRB certificate, a completed application form, a health questionnaire, and two references. The quality of in which application forms were completed varied. The status of referees was generally satisfactory with most applicants providing their current or most recent employer for at least one reference. The manager said that ...staff recruited from abroad have, by Home Office requirements, a level of knowledge which is equivalent to NVQ 3 or more. ESOL (English as a Second Language Training is also provided. For the purposes of inspection in registered care services NVQ equivalence is a matter for an appropriately qualified NVQ provider who should consider the relevance of the persons experience to the care setting. Newly appointed staff undertake an induction period of three months. The induction conforms to Skills for Care induction standards. The organisation maintains an ongoing programme of staff training. The programme to December 2007 included: POVA (now Safeguarding Adults), Infection Control, Medication, Breast Awareness, NCI (Nonviolent Crisis Intervention), Mental Capacity Act, Valuing People, Moving and Handling, Food Hygiene, Health and Safety, First Aid, Fire Safety, Confidence Scenarios, Autism (in 2006), Epilepsy and the administration of Rectal Diazepam, NVQ 2 and 3. Team Leader Coaching, and Employment Law. The training programme for April 2008 included: NCI, Supervision and Appraisal, Fire Safety, Infection Control, Health and Safety, Medication (CD-ROM based), Food Hygiene and NVQ workshops. The registered manager said that the home currently exceeded the minimum standard for NVQ qualified staff having 3 staff qualified to NVQ 2 and 5 staff qualified to NVQ 3. Personal supervision is well established in the home and is carried out monthly. Notes are maintained. All staff have an annual appraisal. Care Homes for Adults (18-65 years) Page 25 of 31 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. This is a well managed home which is providing good care outcomes for people living there. Arrangements for health and safety are thorough and aim to ensure a safe environment for residents, staff and visitors. Evidence: The registered manager has worked in the home for over five years. First of all as a team leader, then in 2006 as manager, and in 2007 was registered with CSCI. The registered manager is a qualified physiotherapist in her own country. She is therefore sufficiently experienced in health and social care services. The registered manager has commenced training for the Registered Managers Award and expects to have completed the course by June 2009. She is accountable to the operations manager. A significant quality assurance activity is the annual audit. This was last carried out in May 2007. An internal house audit was carried out in May 2008. Both audits lead to an Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: action plan, the implementation of which is reviewed quarterly. Outcomes of 2007 and 2008 audit activity included improvements in the environment, the development of PCPs, staff training, and increasing the range of activities. The registered manager said that the 2008 stakeholder audit was under way at the time of this inspection and that the outcomes would be made known over the next couple of months (this inspection was carried out in July 2008). One method of assessing the quality of the service was through informal feedback. The manager said that over the past year there had been many positive comments made by care managers and relatives at review meetings. Arrangements for maintaining a safe environment appear satisfactory. The organisation has engaged Peninsula business consultants to advise on health and safety matters in its residential services. An extensive policy and guidance manual is available for reference. A report of a health and safety audit by Peninsula was dated 5 November 2007. The home has not had a visit by the fire authority or environmental health officers since the last inspection. The home carried out its fire safety risk assessment in June 2008. Contracts are in place for the maintenance of fire safety equipment and emergency lighting. Gas appliances were being serviced on the day of inspection. Practice in the kitchen and food store room is generally satisfactory. However, it was noted that meat was defrosting on a work surface. Frozen food should be defrosted in a fridge. Two out of three electronic thermometers in fridges and freezers were showing exceptionally high temperatures. One of these was immediately replaced by the manager. Others did not appear to have been set up properly and following adjustment gave the correct reading. These indicate a need for staff training, clear standards of practice and closer monitoring on practice in the kitchen. Regulation 26 visits are regularly carried out by the care services manager. Reports are comprehensive and include reference to some health and safety matters. Good systems are in place for reporting and recording accidents. Care Homes for Adults (18-65 years) Page 27 of 31 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 28 of 31 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 42 13 The Registered Manager must ensure that safe standards of practice are maintained in areas where food is handled at all times. To ensure that residents are staff are protected from unsafe food. 20/08/2008 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 13 The registered manager should continue to develop a range of activities, particularly in the community, appropriate to the needs of people living in the home. It is recommended that the registered manager seek the opinion of a dietician on the meals provided in the home. It is recommended that the registered manager obtain a copy of the current CSCI guidelines on the administration of medicines in care homes. It is recommended that the registered persons continue to develop the homes complaints procedure to make it more accessible to people living in the home. The registered persons should facilitate access to relevant support where required to ensure effective communication Page 29 of 31 2 3 17 20 4 22 5 33 Care Homes for Adults (18-65 years) between staff and residents in the home. Care Homes for Adults (18-65 years) Page 30 of 31 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. Care Homes for Adults (18-65 years) Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!