Inspection on 29/10/08 for Roundtrees

This inspection was carried out on 29th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Roundtrees 15/04/08

Roundtrees 23/10/07

Roundtrees 21/06/06

Roundtrees 17/11/05

Roundtrees 26/05/05

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Roundtrees 340 Beverley Road Kingston upon Hull East Yorkshire HU5 1LH     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: Christina Bettison     Date: 2 9 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 33 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 33 Information about the care home Name of care home: Address: Roundtrees 340 Beverley Road Kingston upon Hull East Yorkshire HU5 1LH 01482342404 01482342404 vivian.bone@milewood.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Milewood Healthcare Limited care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 9 The registered person may provide the following category of service only: Care Home only Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Learning Disability, Code LD - maximum number of places 9 Date of last inspection Brief description of the care home Milewood Healthcare own Roundtrees, one of a number of homes the company owns in the area. It is registered to provide personal care and accommodation for up to 9 adults aged 18 to 65, of either gender with a learning disability. The home is on Beverley Road, a main bus route into the city centre. There is a range of local shops and amenities close by. There is an enclosed rear garden and parking is limited to nearby street parking. On the ground floor is a large through lounge and dining room, a kitchen, laundry and one rear bedroom. There is no passenger or chair lift and no wheel chair access. Private accommodation is provided in 9 single bedrooms 8 of which are upstairs on the first and second floors all of the bedrooms have en suite facilities. There is also a bathroom with WC, shower room without WC and 2 more WCs all located upstairs. Weekly fees range from 1,389 pounds to 1,800 pounds, additional Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 9 Brief description of the care home 1:1 funding is provided for some people. Additional charges are made for the following: newspapers/magazines and sweets, hairdressing. Information on the service is made available via the statement of purpose, service user guide and inspection report. Care Homes for Adults (18-65 years) Page 5 of 33 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 quality rating for this service is 1 star. This means that the people who use the service experiences adequate quality outcomes. This visit was unannounced and took place over 8 hours on 29th October 2008. This home was last inspected on the 15th April 2008 and a random inspection on 11th August 2008. During the visit we observed how staff interacted with people to find out what it was like for the people living in this service. Care Homes for Adults (18-65 years) Page 6 of 33 We spoke to the acting manager, area manager and staff members on duty on the day of the visit, we also spoke to people who live in the home. We checked documents that related to peoples care and safety. These included care plans, daily records, risk assessments, staff supervision and training records. We looked at the environment and checked maintenance records to make sure the house was safe and well maintained for the people who live there. Before the site visit we also looked at a range of other information we had received about the service since the previous inspection. This was a key inspection and was carried out by Regulation Inspector Tina Bettison, accompanied by a second inspector George Skinn. We would like to thank the people who live at the service and the staff for their co operation during our visit. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? People are now being reviewed on a six monthly basis and care plans updated to reflect their changed needs. Plans are now in place to guide staff in how to manage peoples individual needs in times of stress and anxiety. Restrictions and limitations for people have been removed meaning that peoples rights are better respected. Risk assessments have been prepared for areas that may pose a risk to people or others. Some people are now attending college and activity plans are in the process of being prepared. Health plans are in place and people are having better access to medical care. Staff working on a POVA first are closely supervised and a record maintained. Care Homes for Adults (18-65 years) Page 8 of 33 The home has been significantly refurbished to provide a warm and comfortable place for people to live. New staff are given a basic induction and registered on an induction programme that meets the common induction standards. A business plan is now prepared incorporating the findings from the Quality Assurance activity. What they could do better: 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 33 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 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples individual needs are assessed prior to admission however, the home may receive unsuitable referrals for admission due to its registration category. Evidence: There have been no new admissions to the home since the previous inspection. One person has been supported to move back to the area they came from, nearer to family and in a more independent setting and another person has moved back in with family. There are currently four people living in the home. At previous inspections it was noted that most of the people that live in the home have needs relating to their mental health as well as a degree of learning disability. The home is registered to admit people whose primary need is a learning disability. The service needs to carefully consider its registration category to ensure that people who may be admitted to the home in the future are compatible with the people currently residing there and that their complex needs can be met. Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: Care Homes for Adults (18-65 years) Page 12 of 33 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. The provision of detailed care plans and individual guidance in the management of behaviours means that peoples needs are being met however where people are making unwise decisions that may place themselves at the risk of self harm and self neglect, risk assessments and plans need to be prepared to cover these high risk areas. Evidence: Two care files were examined and both of them contained a full assessment and detailed service users plans that guide staff in how to meet peoples complex needs. Risk assessments had been completed to support the care plans. Care files contained a key information sheet, a summary of the persons history, self medication assessments and people had a key to thier room where they wanted one. Some documents had not been dated and signed and this must be addressed. Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: Since the previous inspection all of the people had been reviewed by the Local Authority and those who needed one had had a CPA review. At the previous inspection it was noted that people had limitations and restrictions placed on them e.g. managed alcohol consumption, limited numbers of cigarettes etc. We were informed that now none of the people have any restrictions placed upon them and the placing Local Authorities had stated that the people who live at Roundtrees all have capacity to make decisions such as this. However, it was noted that some decisions that people are making have the potential to place them at the risk of self harm i.e chain smoking, excessive use of alcohol and self neglect in respect of personal hygiene and environmental hygiene. Detailed risk assessments need to be completed that highlight the potential for self harm and care plans need to be prepared and implemented to help people to understand the risks and work with them to minimize the risks. In this home people on occasions display behaviours that can be difficult to manage, since the previous inspection detailed behaviour management plans have been prepared that are individual to the people and give staff clear guidance on what they can do to protect the person and those around them from the risk of harm. These now include any use of restrictive physical interventions to be used and when. The majority of staff have been trained in the use of RPI. The acting manager told us that placing Local Authorities from out of Hull have agreed to the Behaviour Management Plans and the use of specific restrictive techniques however we were told that representatives from Hull City Council have refused to agree to them. The numbers of incidents between the people that live in this home have reduced. Care Homes for Adults (18-65 years) Page 14 of 33 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. Some people have the opportunity to engage in a range of activities that meet their needs, wants and aspirations however this needs to be extended to all of the people living in the home. Evidence: Two care files were examined as part of the inspection. Both contained an activity plan and daily records to evidence what activities had taken place. For one person their weekly plan and records evidenced that they were now attending college to undertake a painting and decorating course and people spoken to told us that they go shopping, participate in household chores, go to the pub, for meals out and go on home leave regularly to see their relatives. Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: However in one persons care file their activity plan stated household chores, hair cut/post office, pub trips, personal shopping, free time, meals out and arts and crafts. The records evidenced lots of time spent in their room or the garden and the occasional trip out to the pub. One person we spoke told us they liked music, watching TV, smoking, playing board games, karaoke and chatting to the staff. They were keen to show us their activity plan but this detailed different activities to those they said they preferred. When asked if they had helped to put it together they said they had not and that Leah had done it. It stated on their planner that on that afternoon they would be going to the library they looked surprised and asked if they did that. Later on they got their library card and went off to the library. Activity plans need to be put together with the people that live in the home that reflect their aspirations, needs, wants and hobbies and these need to take place. We were told that only one person had been on holiday in that year- a fishing trip, all of the people must have the opportunity to take up a 5 day holiday or a series of 1 day outings of their choosing. Observations indicated that on the whole staff interacted well with the people that live in the home and that they managed difficult situations well. The people that live in the home all have their own TV, music systems and personal items in their bedrooms. People told us that they liked the food and could choose what they wanted to eat. The staff prepare the meals with people helping if they wanted to, it was safe and they were able to. The kitchen was clean and tidy and the environmental health team had assessed the kitchen under the Food Safety Act and given it a rating of A which is excellent. Care Homes for Adults (18-65 years) Page 16 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples basic health needs are generally met, the home has developed health action plans and medication is well managed however the lack of health screening and records do not evidence that all of peoples health needs are being met. Evidence: Two care files were examined as part of this inspection. Both contained a basic health plan however the managers told us that they had been having difficulty in getting the Community Team Learning Disability to assist in the process of health screening and the development of health action plans. The people that live in the home are often difficult to motivate and will often choose not to access health provision. However there was evidence that some people had seen the GP, the consultant Psychiatrist and community nurse and social workers. Health screening must take place for people and health action plans must be more Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: detailed to take into account the promotion of healthy lifestyles and there must be evidence that where people are refusing to access health provisions that relevant people have been consulted and are aware and that the individual themselves is made aware of the risks of not having regular medical care. Medication systems were examined, the home does not have any controlled drugs on the premises but has the necessary cabinet in place should it be required. The home has policies and procedures to cover the management of the medication systems. Staff have received some training in medication but are all currently undertaking the Assett training, (Assett are an independent training provider) the manager told us that when this is completed, she will assess everyones competence. There were protocols in place for the administration of medication on as and when basis PRN and people had been assessed for self administration of medication. Care Homes for Adults (18-65 years) Page 18 of 33 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 home has a satisfactory complaints system, whistle blowing policy and procedures to ensure the protection of people from the risk of harm and the development of detailed plans for the management of difficult behaviour means that staff have the required guidance and people are better protected from the risk of harm. Evidence: The home has a formal complaints procedure. There have been no complaints to the home or CSCI since the previous inspection. At the previous inspection it was noted that people had limitations and restrictions placed on them e.g. managed alcohol consumption, limited numbers of cigarettes etc. We were informed that now none of the people have any restrictions placed upon them and the placing Local Authorities had stated that the people who live at Roundtrees all have capacity to make decisions such as this. However it was noted that some decisions that people are making have the potential to place them at the risk of self harm i.e chain smoking, excessive use of alcohol and self neglect in respect of personal hygiene and environmental hygiene. Detailed risk assessments need to be completed that highlight the potential for self harm and care plans need to be prepared and implemented to help people to understand the risks and work with them to minimize the risks. Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: There have been 3 safeguarding adult referrals made to Hull City council since the previous inspection, one of these has been investigated by the police and there was insufficient evidence to proceed and a subsequent investigation by the home also found insufficient evidence to undertake any action. Two others are currently in the process of being investigated by the police and social services department. All incidents are being referred to the local authority in accordance with procedures and notified to CSCI as per regulation. The majority of staff have received training in safeguarding adults. Care Homes for Adults (18-65 years) Page 20 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home which is safe and in general, clean and tidy and meets their needs and the refurbishment programme is continuing, however attention needs to be focused on making the home more comfortable and homely and some people need more support to keep their rooms clean. Evidence: The home is on Beverley road, a main bus route into the city centre. There are a range of local shops and amenities close by. There is an enclosed rear garden and parking is limited to nearby street parking. On the ground floor there is a large through lounge and dining room, a kitchen, laundry and one rear bedroom with an en suite bathroom. There is no passenger or chair lift and no wheelchair access. There are 7 single bedrooms 6 of which are upstairs on the first and second floors. There is also a bathroom with WC, shower room without a WC and 2 more WC,s all located upstairs. Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: The home has seen major improvements since previous inspections, the small cramped downstairs office has moved to an empty single bedroom on the second floor, the lounge and dining room have been redecorated and a new leather suite and laminate flooring purchased. The hall and landing have been redecorated and new carpeting fitted and all of the bedrooms now have en suite facilities. It is planned to replace all of the windows in the home but we were told this has been delayed due to planning consent. As part of the inspection an environment check was completed and the findings are as follows Attic room This room is vacant and is undergoing refurbishment Room 6 This room is currently vacant. The ceiling has collapsed following a flood from the attic room due to the sani flow system failing. The ceiling has been replaced and will soon be redecorated. Room 7 We were unable the look at this room due to person refusing us entry. Room 5 This room was very untidy and unhygienic. The carpet was very dirty, it looked like it hadn,t been vacuumed for weeks. The bathroom was very dirty, the shower cubicle was loose and the toilet had faeces all around the bowl, there were clothes piled up around the room, cigarette burns in the bedroom and bathroom. In addition to this the bedding was stained and soiled, there were no pillowcases or duvet cover on the bedding. There were wires trailing on the floor and the wardrobe door was open with clothes falling out. This was discussed with the manager on the day, who felt that she had to respect the wishes of the person to live like this. However it was explained that some decisions that people are making have the potential to place them at the risk of self harm and self neglect in respect of personal hygeine and environmental hygiene. Detailed risk assessments need to be completed that highlight the potential for self harm and care plans need to be prepared and implemented to help people to understand the risks and work with them to minimize the risks. Room 2 This room was very tidy, with a clean bed and clean settee. The person had a new TV and DVD player and plenty of wardrobe and storage space. This person obviously takes pride in their room and understands that they should help to keep it Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: clean. Room 3 This room is currently vacant but it was clean, tidy and had a bed, wardrobe and chest of drawers. Room 1 This is a new room that has been refurbished since the previous inspection. It was clean, tidy and had a bed, wardrobe and chest of drawers and a TV. All bedrooms had a lock and some people had keys to their room and all had a lockable cabinet fixed for safe storage of medication, money or personal items. The lounge and dining room both appeared quite austere and not inviting and welcoming with laminated flooring. The lounge had a new leather suite and large TV and in the dining room the table and chairs didn,t match. The manager told us that some of the chairs had been broken and she was about to purchase a new dining table and chairs. We didn,t examine the kitchen at this visit because previous visits had found it to be clean and tidy and the Environmental Health department had recently assessed the kitchen for cleanliness, policies, procedures and practice and given it rating of A which is excellent. Care Homes for Adults (18-65 years) Page 23 of 33 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. Peoples needs are met by caring and competent staff however staff vacancies, sickness and absences mean that there are not always enough trained and competent staff on duty meaning that all of peoples needs may not be met. Evidence: We were informed that the home currently has 8 staff in total, not including the manager. Of these 8 one has only recently commenced and is on their second week of induction, two members of the senior staff are on long term sick leave, one member of staff is suspended and because the deputy manager is acting up as manager the deputy post is vacant, another member of staff has recently resigned. Two new staff have recently been appointed and are due to commence soon. This has all led to significant staff shortages within the home, staff have been drafted in from other homes within the company. The rota showed that their should usually be 3 staff on duty plus the manager however staff told us that sometimes they have only had two on due to the staff shortages, however the home only have four people living there currently. One of the people Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: receives 1;1 funding however this is not clearly shown on the rota and this needs to be addressed. Staff told us that the home are short staffed and this means that sometimes people can,t go out. One member of staff spoken to from another home within the company had been at the home since the Monday of that week at 9.00am and would not be going home until Thursday morning. Examination of staff files found that new staff complete a basic in house induction and are then registered on the induction that meets the common induction standards. A new member of staff spoken to told us that his inital induction had covered everything he would have expected and that the staff team had been really good and very supportive. Staff that start working at the home on a POVA first are mentored by other staff and are not allowed to work unsupervised, a record of this is maintained. The new member of staff spoken to confirmed that this was the case and that he was always totally under supervision and was aware that this would be the case until his full CRB clearance came through. All staff were up to date with their mandatory training and had completed other relevant training such as the mental capacity act, POVA and mental health awareness. The home are still using their own in house training packs but also using external provision to raise the quality of the training provided. All of the permanent staff had completed an annual appraisal. 6 of the current staff have an NVQ level 2 and 4 are undertaking NVQ level 4. Care Homes for Adults (18-65 years) Page 25 of 33 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. Significant improvements have been made in the development of plans for the management of behaviour, risk assessments, health plans and the removal of restrictions and limitations, however the service needs stable consistent management arrangements in order to develop further and to ensure that the people that live at the home are helped to fulfill their potential and are kept safe from the risk of harm. Evidence: This service has not had stable management arrangements for over a year. The Manager recently appointed has resigned from the post and the deputy manager is now acting up, this has been agreed for a period of 6 months and then this will be reviewed. The deputy manager has her NVQ levels 2 and 3 and is currently undertaking the level 4 and has undertaken all basic training and other relevant training specific to the client group and her role. She is being supported by the area manager. Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: A random inspection was undertaken on 11th August 2008 and a Code B notice was issued at the home because at this time we believed that the home were in breach of regulations and that people were not being safeguarded from the risk of harm. The manager at the time agreed to comply within 8 weeks. However at this visit inspectors were satisfied that the requirements had been met and that we would not need to issue statutory requirement notices. Significant improvements had been made in the plans that guide staff in how to manage peoples behaviour in times of high anxiety and aggression, risk assessments for areas that may pose a risk to people themselves or others, health plans, and the removal of restrictions and limitations that do not respect peoples rights and free will. However further development is still required in a number of areas as detailed within this report and the current standards need to be maintained. Consistent stable management arrangements are crucial if this service is going to develop further. The QA process has been implemented within the home and this consist of a year long plan that includes monthly monitoring of care plans, medication systems and accidents. On a quarterly basis health and safety and a medication audit is undertaken and on a six monthly basis a full home health and safety audit is completed and submitted to HQ. In addition to this regulation 26 visits are undertaken by the area manager, staff meetings and meetings for the people that live in the home are every two months. Minutes of these were seen to evidence this. On a yearly basis questionnaires are sent out to relatives, the people that live in the home and professionals and are evaluated by HQ and a summary report completed. All of this information is collated within the business plan. As part of this visit the maintenance and servicing records were examined and all found to be up to date. As part of our ongoing monitoring of this service we asked the area manager to send us the monthly regulation 26 visits reports and a copy of the business plan. Care Homes for Adults (18-65 years) Page 27 of 33 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 33 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 2 14 The service must review its registration category. to ensure that the people referred for a service are compatible with the people currently living there and that thier needs can be met. 31/01/2009 2 9 13 Where people are making 31/12/2008 unwise decisions that may affect their health safety and well being - risk assessments and care plans needs to be prepared and implemented. to demonstrate that the home are helping people to understand the risks and working with them to minimise the risks and helping them to keep safe from self harm and/or self neglect. 3 12 16 The people that live in the home must be supported to plan and take part in activities of their choosing. 31/01/2009 Care Homes for Adults (18-65 years) Page 29 of 33 So that all of their diverse needs are met 4 13 16 The people that live in the home must be supported to take part in activities and events in the community and be assisted to act appropriately. so that people feel welcomed as part of their local community. 5 19 13 Health screening needs to be completed and health action plans need to be further developed. to ensure that people receive better support to meet their health needs. 6 20 13 Staff administering medication need to be assessed and deemed as competent. to ensure that people are kept safe from the risk of harm 7 24 23 Attention must be given to making the home more comfortable and homely. so that people live in comfortable home that meets their needs. 8 30 23 People must be supported to 31/12/2008 ensure that their bedrooms are kept clean and hygienic. to make sure that peoples health, safety and welfare is maintained and that they 31/01/2009 31/01/2009 31/01/2009 31/01/2009 Care Homes for Adults (18-65 years) Page 30 of 33 are protected from the risk of harm. 9 33 18 Where people are receiving funded for additional staff hours this must be clearly shown on the rota. to ensure that people are receiving the service that is commissioned from the LA and peoples needs are being met. 10 33 18 The home must have 31/12/2008 sufficient staff on duty at all times to be able to meet the assessed needs of the people that live in the home e.g a minimum of two staff who have received training in how to manage difficult behaviours and in the use of RPI. to ensure that both staff and the people who live in the home are protected from the risk of harm. 11 37 9 The home needs stable and consistent management arrangements so that the home can develop further and people are kept safe from the risk of harm 31/03/2009 31/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 All documentation relating to the identification and meeting of peoples needs should be signed and dated so that it is Care Homes for Adults (18-65 years) Page 31 of 33 clear when documents are reviewed and updated and by whom. 2 6 The home should ensure that the placing local authorities agree to individuals behaviour management plans and techniques to be used with individuals, in particular the use of RPI All of the people that live in the home must have the opportunity to take a five day holiday or a series of 1 day outings of their choosing so that they are given a break away from the people they live with and have enjoyable different experiences. 3 14 Care Homes for Adults (18-65 years) Page 32 of 33 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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