Inspection on 14/01/09 for Ronak Home

This inspection was carried out on 14th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ronak Home 01/07/08

Ronak Home 17/07/07

Ronak Home 10/04/06

Ronak Home 11/08/05

Ronak Home 14/04/05

Ronak Home 15/10/04

Ronak Home 10/05/04

Similar services:

Ashlong House

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Edenvale

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Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ronak Home 120 Alderman`s Hill London N13 4PT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Ray     Date: 1 4 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Ronak Home 120 Alderman`s Hill London N13 4PT 02088823586 02084479105 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : MHJ Crausaz Ltd care home 10 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 10 The maximum number of service users who can be accommodated is: 10 The registered person may provide the following category/ies 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 categories: Learning disability - Code LD Date of last inspection Brief description of the care home Ronak Home is operated by MHJ Crausaz Ltd. This company has other homes locally. This home is registered for ten adults, aged between 18 and 65 years, who have a learning disability. The majority of current residents are non-verbal and a number have a diagnosis of autism. The home is a semi-detached three storey house with a garden. There are ten single bedrooms, of which eight are en suite. The home is situated close to the facilities of Palmers Green and is opposite a large park. There are good public transport services locally. High staffing levels and some day services are provided by the company in line with the residents individual needs. The homes stated aims are to provide care and support to ten younger adults who have learning disabilities. At the time of the inspection the range of fees at Ronak were 1612 to 3334 pounds a week. Care Homes for Adults (18-65 years) Page 4 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspection took place on the 14 January 2009 and was unannounced. The inspection lasted for nine hours and was the key annual inspection. The inspection looked at how the home was performing in terms of the key National Minimum Standards for Younger Adults and the associated regulations. The inspector Jane Ray was accompanied for part of the inspection by, Barbara Young Chair of the Care Quality Commission who was shadowing her to get a better understanding of the inspection process. The inspector was able to observe the support given to the current residents and to talk individually to one of the residents. The inspector was also able to spend time Care Homes for Adults (18-65 years) Page 5 of 32 talking to the manager and area manager as well as six of the care staff who were working. During the inspection the inspector briefly met two relatives and also spoke to two other relatives after the inspection. The inspector did a tour of the premises and also looked at a range of records including resident records, staff files and health and safety documentation. The home had provided the inspector with a completed self-assessment questionnaire (AQAA) prior to the last key inspection but this had not been updated since then. What the care home does well: What has improved since the last inspection? What they could do better: A number of areas for improvement were identified at this inspection. The manager needs to amend his management approach to ensure that he provides effective leadership that is open, positive and inclusive so that the staff work as effectively as possible to support the residents. A full quality assurance exercise needs to take place this year that provides good feedback on how the service can improve. Staff need to have regular supervision that enables them to raise issues of concern. Further work is needed to ensure all the residents have access to regular and varied community based activities. The residents must be enabled to have a morning and evening routine that reflects their age, interests and lifestyle. The residents personal monies need to be safeguarded by ensuring that complex decisions about how their money is spent is discussed and agreed with appropriate professionals from their placing authority. Residents also need to have care plans that support them to achieve their aspirations by having clear goals. They also need to have contracts between themselves and the home that clearly identifies the levels of staff support they can expect to receive. Records of assessments and review meetings should be available so staff can access the information as needed. Care Homes for Adults (18-65 years) Page 7 of 32 The home environment needs to have repairs completed in a timely manner to ensure it is kept safe for the 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 8 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be assured that they will be thoroughly assessed and have opportunities to visit the home as part of deciding if the service is right for them. Staff have a wide range of skills and experience to enable them to meet the residents complex needs. There still needs to be further clarity on the service that will be provided to each person to be recorded in his or her individual contract. Evidence: We arrange short stays for prospective service users. During this time we will be constantly assessing and evaluating whether we can meet their needs. If in agreement we will arrange their admission. (Extract from the AQAA prepared by the home) Since the last key inspection there have been no new admissions to the home. We looked at four case notes and three of these contained contracts between the home and the residents. The deputy manager explained that the final contract was complete but not in the file. Some of the residents have very specific agreements with their placing authorities in terms of levels of staff support they receive both in and out of Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: the home. This needs to be included in their contract so there is clarity about the service they should be receiving. Two of the four case notes we inspected had comprehensive assessments prepared by the staff in the home. These records have been seen at previous inspections but have recently been removed as part of the preparation for person centred planning. These assessments provide a good summary of the needs of each person and need to be made accessible to staff in the case notes. The AQAA explains the assessment and admission process offered to prospective new residents. This is clearly comprehensive and offers an appropriate process for future residents to move into the home. We discussed the current needs of the people who live in the home with the manager and care staff. They have very specific individual needs linked to their learning disability, complex behaviours, autism and epilepsy. The staff spoken to had a very good understanding of the individual needs of the residents. In addition it was observed that the staff were supporting the residents with great skill and sensitivity. The staff spoken to said that since the last inspection they had received training on meeting the needs of the people living in the home, which has included epilepsy and makaton sign language training. The manager also explained that some of the staff have also received training to help them to plan accessing community based activities with the residents. Care Homes for Adults (18-65 years) Page 11 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home can be confident that they will be supported to have a person centred plan and risk assessments. This will facilitate the residents to receive the support they want and to make choices in their daily lives. Evidence: We encourage residents to make and form decisions, explain consequences and understand their right to take risks. (Extract from the AQAA prepared by the home) I am adding pictures of the activities I do into my care plan. (Quote from a resident) I get invited to my relatives review meetings. (Quote from a relative) We inspected the person centred plans for four people currently living in the home. We also spoke to the manager and care staff about the person centred plans. All of the people whose records were inspected had person centred plans in place but these were Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: at different stages of development. These are replacing the previous care plans and are written in an accessible format. They clearly state what people like and dislike and give clear guidance to the care staff on what they need to know to support the individual successfully. The person centred care plans have been prepared by the keyworkers who have consulted with relatives and other care professionals. The person centred plans have not yet helped the residents to identify any key goals or areas they would like to progress in their daily lives. The files did also not always include a record of their last review meetings with other care professionals. This meant it was not possible to tell if reviews had taken place or if there was any action agreed at this meeting that needed to be followed through. Each resident had a named key worker and co-key worker. The staff were asked about their role as a key worker and this showed that the support they provided was very comprehensive including helping with personal shopping, attending healthcare appointments, ensuring all the residents personal care needs were met and organising leisure activities. The staff explained that they will shortly be having a reallocation of key workers. The four residents whose case notes were inspected all included individual risk assessments covering all areas of potential risk and these identified what action the home would take in response to the identified risks whilst at the same time promoting each persons independence. These had been reviewed and were up to date. Each person living in the home had individual behavioural guidelines as part of their assessment and risk assessments and these were clearly written and gave appropriate guidance to the staff. We observed the people living in the home and their interaction with the staff. It was positive to note that they were being facilitated to make choices including when they wished to move around the home, when they were ready to eat and in some cases what they wanted to eat or drink. The staff were observed to be very aware of both verbal and non-verbal communication. They were also able to describe how they facilitate choices by for example offering a choice and observing the residents response. The manager explained that they are working with the occupational therapist to look at how they can develop systems such as through the use of pictures or objects to try and improve communication and choice further for residents who are non verbal and do not use a sign language. The manager explained that they currently have joint staff and resident meetings called house meetings. The record of the meetings was inspected and it could be seen that staff sometimes want to discuss issues where there are strong feelings. It is not Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: appropriate to have these meetings with the residents. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported to develop their independent living skills and to eat a healthy and nutritious diet. Residents are not currently being supported to access a sufficiently varied range of community based activities. Routines have developed in the home that may not be enabling people to go to bed at different times. Evidence: I go to church and to visit my sister. I also have a friend who works in a charity shop. (Quote from a resident) There are not enough activities and there is not enough money to take out the residents, which means some residents get stuck in the house. (Quote from a member of staff) Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: We treat our service users as normal individuals who have the right to experience every day the ups and downs of life. (Extract from the AQAA prepared by the home) I feel my relative needs more motivation through a structured programme of activities. There is no plan or routine (Quote from a relative) Whenever I ask they bring my relative to visit me at home. (Quote from a relative) The staff spoken to explained that the people living in the home were being supported by staff to develop their independent living skills in line with their individual needs. For example some residents are being supported to be more independent in terms of their personal care, others are learning to make use of public transport and others are being supported to assist with the shopping. The development of independent living skills was also reflected in the residents person centred plans. We spoke to the staff, resident and looked at the residents activity records to get an understanding about the activities that are taking place. One resident talked about how he attends a range of college courses including art, cookery, gardening and IT. The manager explained that one of the residents goes to a specialist day centre five days a week. The other six residents are supported by staff to participate in a range of activities. Four staff commented that since the last inspection the residents were not joining in with so many activities. The reasons given were having less access to a driver and vehicle, not having money for activities and staff availability. The activity records were inspected for four residents and these did show that most of the external activities consisted of going to the park over the road and the local shops. The deputy manager explained that some residents are also attending a trampolining session in a local leisure centre. It is however evident that the residents are participating in less community based activities and that the variety of activities has reduced. The manager explained that he has delegated responsibility to key workers to arrange activities and a number of suggestions have been made of activities they would like to try with the residents. It was felt that some more practical support from the manager in accessing new activities might help to resolve this issue. The home has also has an external fitness instructor who comes once a week to the home to do an exercise session with the residents and an aromatherapy masseur on a monthly basis. The residents have also been supported to have some individual sensory or musical equipment. These all help to stimulate and provide entertainment for the residents. In addition one resident has a treadmill that is kept in the lounge and this provides Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: regular exercise. All the residents had a holiday in the Isle of Wight during the summer. The AQAA identified that the residents have different ethnic and cultural backgrounds. One person is Muslim and in line with her relatives wishes, does not eat pork, wears some traditional clothing and joins her relatives to celebrate some festivals. Other residents go to church and one of the residents explained how a volunteer comes to the home each Sunday to take him to church. The manager explained that the people living in the home have close contact with their relatives, who either come to visit them or they are supported to go home. Since the last inspection one resident received a visit from relatives who he had not seen for many years. In terms of the routine in the home two staff said that by the time the night staff arrive at 8pm, most of the residents are in their rooms in their night clothes even if they have not yet gone to sleep. One resident said that if he gets up early and comes downstairs staff will sometimes say it is too early and suggest he goes back to his room. The manager acknowledged that at the moment there are not activities taking place in the evening. We saw the record of food eaten in the home and this was a healthy and nutritious diet. The person centred plans provide the details of each persons dietary preferences. One resident said he was trying hard to eat a healthy diet. The staff said they do the shopping at a local supermarket and then buy additional fresh food during the week. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are supported in a manner that protects their privacy and dignity. Each person is supported to access professional healthcare input based on their individual needs. Evidence: The home offers consistency and continuity of care from a balanced staff group offering gender and age related preferences of support where practical. (Extract from the AQAA prepared by the home) If I want privacy I go to my room. (Quote from a resident) The staff let my relative go out with wet hair, sometimes they lack common sense. (Quote from a relative) We observed during the inspection that the people living in the home were given support with their personal care based on their individual needs. The residents were all well dressed and groomed and what they were wearing was very age appropriate. Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: Most of the people living in the home have en-suite bathrooms and this helps to maintain their privacy. The healthcare records were inspected for the four people living in the home. They had all been supported to access the GP, dentist and optician in the last six months. Previous healthcare records had been archived and so it was not possible to see when residents had last seen the psychiatrist or other healthcare professionals. One person had a record of receiving some specialist healthcare checks. All the people living in the home are supported to check their weight on a monthly basis. The recording of their weights was confusing as sometimes it was in kilograms and at other times in stones and pounds and so it is recommended the each persons weight is recorded consistently. This recommendation is restated from the previous inspection. The medication system and records were not inspected, as the system was unchanged from the previous inspection. It was however noted that medication training was up to date for all the staff administering the medication. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home have access to an appropriate complaints procedure. Procedures and training on safeguarding vulnerable adults are in place to protect the residents. Staff have been trained on how to appropriately support people who have complex and challenging behaviours. Residents personal monies may not have been always used appropriately. Evidence: We welcome complaints and suggestions as a way of improving our service. (Extract from the AQAA prepared by the home) If I was not happy I would go to the office and speak to the manager or deputy and they would do something about it. (Quote from a resident) We looked at the complaints record and saw that there had been three complaints since the previous inspection and these had been addressed appropriately. An appropriate format is available to record complaints and this monitors the time taken to resolve the complaint. The complaints procedure was also inspected and this was in a format accessible for the residents. The inspector saw that the home had a protection of vulnerable adults procedure prepared by the company. The staff training records were inspected and showed that Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: all the permanent staff had received training on safeguarding vulnerable adults. Since the last inspection there has been one safeguarding issue in the service that was not substantiated. The staff attended the strategy meeting and contributed appropriately to the process. The staff training records also showed that almost all of the permanent staff had received training on how to work positively with service users who have complex challenging behaviours. The staff were able to describe how they support residents when they are unsettled and this is very appropriate. They were observed during the inspection speaking to the residents in a very calm manner. A member of staff who was interviewed explained that one residents personal monies had been used to buy a television that is in the lounge. The manager confirmed this purchase had taken place and the records of this expenditure were seen. The manager explained that the resident would damage any items in his bedroom and was often in the lounge watching the television. It was also seen that this residents monies had been used to buy replacement toilet seats and mattresses for items he had damaged. Whilst the decision to purchase this television was recorded as part of the residents person centred plan there was no written evidence from professionals from his placing authority that they had been consulted and felt this to be an appropriate use of the residents monies. This needs to be addressed to ensure that residents monies are appropriately safeguarded. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are benefiting from an environment that is clean, tidy and homely. Work is needed to ensure ongoing maintenance issues are addressed. Evidence: We individually personalize service users rooms including having their own furniture. (Extract from the AQAA prepared by the home) We did a tour of the building and the home was clean and tidy. The furniture in the communal areas is designed to meet the needs of the residents by being strong and yet a style that is in keeping with the home. Each resident has a single room. Two residents have a futon bed, one because he had previously wanted to sleep on the floor and has been supported to move onto a low bed and the other because his epilepsy puts him at risk of falling. One resident who has mobility issues has a ground floor bedroom and a bathroom with a shower and shower chair that meets his specific mobility needs. Hygiene is promoted in the home by antibacterial hand wash and disposable hand towels being available in shared bathrooms and toilets. A number of improvements had taken place since the last inspection including the provision of new flooring in parts of the home including the ground floor bedroom. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: Decoration work was ongoing at the time of the inspection. The people living in the home frequently damage the fabric of the building. There were a number of areas that were observed as being in need of repair including some kitchen cupboards and one en suite bathroom wall. The manager explained that the previous handyman had left but on the day of the inspection the new handyman had started and was observed visiting the home to arrange the repairs, which need to take place. It was also observed that the fire doors throughout the home were appropriately closed. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are supported by a committed and stable team of staff. The staff are receiving a range of ongoing training. This enables them to work to a high standard and deliver good care. Evidence: Staffing levels offer a good skill mix. The majority of staff have a minimum of an NVQ level two. Staff support each other and share skills and knowledge. (Extract from the AQAA prepared by the home) We checked the rota for the home and this showed that there is a team of nineteen staff working in the service. The staffing structure consists of the manager, deputy manager and a team of support workers. There is also a cleaner who works twenty hours a week. During the day there are seven staff on duty and at night there are two waking members of staff. The manager and deputy are shown as being supernumerary. The staff turnover has been low with no staff leaving since the last inspection. Most of the staff spoken to during the inspection had worked in the service for several years. The manager and care staff explained that staff team meetings take place on a Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: monthly basis. The staff said that the manager restricts what they can discuss in a staff meeting, which makes it hard to address the issues they want to raise. The record of staff meetings was viewed and the last meeting included a summary prepared by the manager saying what could or could not be discussed. This gave the impression that the meeting would be very tightly controlled. The manager said he was changing the arrangements for the meeting and would be asking staff to prepare specific topics they wanted to raise. The AQAA prepared by the home stated that twelve staff have completed an NVQ in care and four are working towards the qualification. We looked at the recruitment records for the one member of staff who has joined the team since the last inspection. It was found that they had two references, ID, POVA check and a CRB disclosure. The staff had completed an induction checklist. We inspected the training records. The home has a training matrix and this was up to date and so it was possible to accurately tell who had received training and when this had taken place. An ongoing training programme is in place including all the mandatory training. We spoke to the staff who were able to describe their ongoing training and said they found this very useful. We looked at the supervision records. This is carried out by the manager and deputy. It could be seen that a number of staff had not had regular supervision with gaps of more than two months between sessions. The format used for supervision is appropriate and includes a record of any action agreed. The recorded supervisions tend to list what the staff member has and has not done but shows little room for a broader discussion of issues. One member of staff said they did not feel their supervision reflected their performance saying, if you read my supervision record you would not think I was a capable member of staff. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A permanent manager is in place who has started the registration process. Staff views are very mixed on whether they feel supported or valued by the manager. Health and safety measures are in place to safeguard the people living in the home. Evidence: I have not had any differences with the manager but I know colleagues who have had differences. (Quote from a staff member) The manager does not make us feel valued. (Quote from a member of staff) The manager has now been working at the home for fourteen months. He has recently started the registration process. Four staff raised concerns about the managers, staff management style. Two staff however felt that he is supportive and his management style has become more accommodating. The manager explained that he has been trying to be very clear Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: about staff responsibilities and is wanting, to delegate tasks so that staff can develop their skills. He did however acknowledge that he would benefit from spending more time working alongside the care staff rather than being in the office. The records of staff supervisions and team meetings certainly give the impression that the manager has a very directive approach. Where staff need additional support such as in organising activities for the residents and addressing issues with placing authorities the impression gained by the inspector is that the manager could be more hands on and supportive. The manager acknowledged that he needs, to work further on his staff management skills. The area manager also explained that the company is providing management training for all the managers in the organisation. The Regulation 26 monthly monitoring visits to the home had taken place regularly and the manager was able to access these reports so that he can follow through any action that is needed. The manager said that he had not updated the AQAA or passed on the Commissions questionnaires to residents, staff and care professionals. The manager acknowledged that the homes own internal quality assurance exercise last year had not included the views of relatives or care professionals. He had this years questionnaire available to send out. Seeking the views of relatives and care professionals is particularly important for this service, as most of the residents are unable to verbally communicate their views. The home has written to confirm that since the last inspection all the maintenance checks have been completed. The staff training records show that the staff have either completed or are booked to attend health and safety training including food hygiene, moving and handling, first aid and infection control. Seventeen of the nineteen staff have completed fire safety training. Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 5 5 The registered person must 28/02/2009 ensure each residents contract reflects any specific arrangements such as one to one staff. This is to ensure they receive the correct service. 2 6 15 The registered person must support the residents to have a person centred plan that includes their goals. This is to ensure that progress with meeting the residents aspirations can be monitored. 28/02/2009 3 13 16 The registered person must 14/02/2009 ensure all the residents are offered regular opportunities to access a range of community based activities. This is to ensure the residents have a full and active lifestyle. Care Homes for Adults (18-65 years) Page 29 of 32 4 16 12 The registered person must ensure residents are supported to have a routine that reflects their age, choices and lifestyle. This is to ensure their routine is based on their needs and not on the needs of the service. 28/02/2009 5 23 13 The registered person must 31/01/2009 ensure that where complex decisions are needed about the use of residents personal monies that this is done in consultation with other care professionals. This is to ensure the residents personal finances are safeguarded. 6 24 23 The registered person must 31/01/2009 ensure that all building repairs take place in a timely manner. This is to ensure a safe environment is provided for the residents. 7 36 18 The registered person must 28/02/2009 ensure that all the staff have regular supervision which is a two way process. This is to ensure staff are appropriately supported and have an opportunity to discuss any concerns. 8 38 9 The registered person must ensure the manager has the correct skills and experience to effectively manage the service. 14/02/2009 Care Homes for Adults (18-65 years) Page 30 of 32 This is to ensure there is an open, positive and inclusive atmosphere in the home where the staff are supported to work for the benefit of the residents. 9 39 24 The registered person must ensure a full quality assurance review takes place in the home. This is to ensure that relatives, residents and all other stakeholders are able to offer comments to enable the service to improve. 30/06/2009 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 2 The registered person should ensure each residents assessment is available in their case notes so that relevant information can be accessed as required. The registered person should keep records of previous review meetings accessible so that follow up meetings can be arranged in a timely manner and any agreed actions can be implemented. The registered person should separate the resident and staff meetings so that the specific needs of each group of people can be appropriately met. The registered person should ensure that where the staff record the residents weight that the record of measurement is consistent. 2 6 3 8 4 19 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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