Inspection on 27/02/09 for Saltshouse Road

This inspection was carried out on 27th February 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Saltshouse Road 11/12/06

Saltshouse Road 22/12/05

Saltshouse Road 07/07/05

Saltshouse Road 25/01/05

Saltshouse Road 12/08/04

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Saltshouse Road 199a 201a 203a Saltshouse Road Hull East Yorkshire HU8 9HG     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: Beverly Hill     Date: 2 7 0 2 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 29 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Saltshouse Road 199a 201a 203a Saltshouse Road Hull East Yorkshire HU8 9HG 01482618096 01482329337 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) : Avocet Trust care home 8 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 8 The service at 199a-203a Saltshouse Road is managed by Avocet Trust who rent the premises from Sanctuary Housing. It is one of a small number of similar services that Avocet provides. Avocet Trust is a registered charity. 199a-203a Saltshouse Road consists of three separate units registered to provide care for 8 service users with a learning disability. The property is set back from the main road in the corner of a new residential estate, built in the old grounds of Tilworth Grange Hospital. 199a has three bedrooms one upstairs; all other accommodation is at ground floor level. 201a has two bedrooms and 203a has three. All bedrooms are singles four of which have ensuite facilities. Each unit has its own lounge, dining room, laundry room and shared bathroom. All units have their own front door and separate garden areas to the rear. The properties adjoin each other and share a large communal patio / garden at the front. Nearby there is a range of local shops, pubs, and health services. Public transport to various parts of the city is easily accessible and in addition some of the service users have leased their own cars; arranged through their mobility benefits. Care Homes for Adults (18-65 years) Page 4 of 29 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 form this service is 1 star. This means that the people that use this service experience adequate quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key unannounced inspection on 11th December 2006 and Annual Service Review on 20th December 2007. It includes information gathered during a site visit to the bungalows, which took approximately eight and a half hours. The quality rating for the home has reduced as a direct consequence of the way a safeguarding of adults referral was managed by the service. The service did not follow Care Homes for Adults (18-65 years) Page 5 of 29 safeguarding policies and procedures and as a result an allegation was not investigated at the time by the local authority, which is the lead agency for any safeguarding investigation, and residents were placed at risk. We were unable to speak to the residents living in the bungalows due to their complex needs. However, we had discussions with the manager, senior management, care staff members and one relative. Information was also obtained from surveys received from residents, relatives and care staff. Comments from the discussions and surveys have been used in the report. We looked at assessments of need made before people were admitted to the home and the homes care plans to see how those needs were met whilst they were living there. Also examined were medication practices, activities and social stimulation provided, how residents were encouraged to use community facilities, nutrition, complaints management, staffing levels, staff recruitment, induction, training and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also discussed with staff their understanding of how to maintain privacy and dignity, and how they ensured that people could make choices about aspects of their lives and remain as independent as possible. We checked out how staff ensured people were protected and safe and that the environment for them was clean. We observed the way staff spoke to people and supported them. The home had returned their Annual Quality Assurance Assessment (AQAA) within the agreed timescales. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. We would like to thank the people that live in Saltshouse Road, the staff team, and management for their hospitality during the visit and also thank the people who completed surveys. 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 as recommendations, but only when it is considered that people who use the service 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? What they could do better: All staff had completed training in how to safeguard vulnerable people from abuse and all were aware of how to keep people safe. However information passed to senior managers about a specific allegation of abuse had not been dealt with in accordance with multi-agency policies and procedures. Staff at all levels need to adhere to safeguarding policies and procedures. The manager should apply for registration with the Commission quickly to ensure managerial stability in the home. Care Homes for Adults (18-65 years) Page 7 of 29 The home could improve the way complaints are responded to so complainants are kept aware of investigations within agreed timescales. This was a recommendation from the last inspection but has not been consistently met. The forms used to document complaints should be readily available to care staff on a day to day basis so the initial complaint is recorded appropriately. Some care staff are receiving more formal supervision than others but none are receiving the minimum amount of six sessions a year. It is important that care staff are able to discuss any issues they have with their line manager. The home should continue to work towards 50 percent of care staff trained to NVQ level 2 in care. The home has a system in place to monitor the quality of the service it provides. This includes audits and questionnaires to people. The home could broaden the questionnaires to include staff, health professional visitors and care management. This was a recommendation from the last inspection but has still not been met. The home should provide a thermometer in the area where medication is stored to ensure it is stored at the correct temperature. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 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 29 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 home ensures that peoples needs are fully assessed prior to admission. This enables staff to be sure residents needs can be met in the home. Evidence: Three care files were examined as part of the inspection. All contained assessments of need and care plans completed by the local authority. The home added to these with their own assessments and risk assessments, and also obtained assessments completed by other health professionals. The information was used to provide plans of care for people and formal reviews were held to keep the information up to date. The residents had all lived in the home for several years and there had been no new admissions since the last inspection. Care Homes for Adults (18-65 years) Page 10 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that peoples assessed needs are documented in care plans with good risk assessments to enable a measured approach to risk taking. Evidence: Three care files were examined during the day and all contained a wealth of information from assessments, risk assessments, personal profiles, monitoring charts and daily records with which to formulate care support plans to meet identified needs. Each contained a comprehensive overview of the resident and how they preferred to be supported with reference to likes and dislikes. The care plans were detailed and gave good guidance to staff on how to meet needs in a consistent way. The manager confirmed that empowering residents to make their own decisions was something she had taken the lead on in the company and was currently focussing on ensuring specific documentation was completed by residents and their keyworkers. This included crucial decision-making information and and was used to inform personCare Homes for Adults (18-65 years) Page 11 of 29 Evidence: centred planning. The care support plans were person centred and attention was paid to how people communicated their needs in non verbal as well as verbal means. Pictures were used in the care support plans to make them more accessible to the person they were about and staff told us how they used pictures and symbols to work with residents to establish their views on an ideal home for them. There was evidence that care support plans had been updated when needs had changed or further information had been obtained. Care plans were audited and evaluated and reviews were held internally and with the local authority to check progress. Review meetings involved family and relevant professionals. The whole care file was well organised into sections and easy for staff to access. Staff spoken with were proud of the work that had gone into the care files and confirmed they had time to read and update them. Each resident had a range of relevant risk assessments with clear guidance to staff in how to minimise any perceived or actual risk. There was evidence that these were kept under review. Care Homes for Adults (18-65 years) Page 12 of 29 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. Staff ensured that residents maintained a good quality of life by promoting independence and choice, providing opportunities for activities, occupational stimulation and access to local community facilities, and by ensuring that links to family and friends were maintained. Evidence: We were informed that none of the residents were able to participate in work placements. However, staff ensured that residents maintained a good quality of life by promoting independence and choice, providing opportunities for activities, occupational stimulation and access to local community facilities, and by ensuring that links to family and friends were maintained. Surveys from relatives stated that staff always kept them informed of important issues although in one instance this had been delayed, which had caused some distress for the relative. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: Residents had weekly plans (in symbol format) that detailed their activities such as shopping for food supplies, household tasks, visiting local markets, clothes and personal shopping, lunches out in local cafes, trips to the cinema, drives out to the coast, bowling, visiting garden centres and pubs, having manicures, and one to one activities such as puzzles and games. Some residents access local community centres, hydrotherapy sessions and enjoy relaxing foot spas. Others liked to bake or be supported to cook and one resident attended a community farm to assist in the care of the animals. Most were in contact with their families and spent quality time with them. We saw in one file that family birthdays had been noted and the resident was supported by staff to purchase birthday cards for them. The residents enjoyed a holiday each year and staff told us they had just planned and booked this years holiday with them. Residents in each of the bungalows used their mobility allowances for the purchase of cars for their personal use. The residents in one of the bungalows liked cats and had two, Lily and Lucy, which they helped to care for. Staff prepared the meals but there was evidence that residents were supported to shop for food supplies and had input into the menus. Health eating was promoted but this continued to be balanced with special treats, likes and dislikes, individual choices and preferences. Care plans detailed any support required or specialist equipment used. Kitchens were well equipped and each bungalow had a pleasant dining room where meals could be taken together as a group. Care Homes for Adults (18-65 years) Page 14 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are planned for and met in the home. Medication is managed in a safe and responsible way. Evidence: From examination of the three care files it was clear that residents complex health needs were planned for and met. They had access to a range of health professionals that included GPs, dentists, opticians, community nurses, specialist nurses, dieticians, speech and language therapists and consultants via out-patient clinics. Staff had developed health action plans for each resident and maintained good records of health interventions and access to services. There were nursing care plans and epilepsy management plans in place for specific residents. Accidents were recorded and body charts completed when any bump or knock resulted in a mark to the skin. Staff told us that they had received training in how to deliver abdominal massage and some residents had benefited from this. Weight was recorded and healthy eating promoted where required. There was evidence that a dietician had been involved for one of the residents whose care was examined. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: Documentation and discussions with staff assured us that residents privacy and dignity were promoted. Staff were observed speaking to people in a kind and caring way and there was clearly a good rapport between them. Each resident had a designated key worker and relationships had been built up between them and with the persons close family. The care support plans gave detailed information in how people wanted to be supported and the preferences they had for rising, retiring, activities, bathing, meals, appearance, clothes etc. Staff were aware that best interest meetings had to be held for decision-making when it was decided the resident was unable to make an informed choice about health care and treatment. All staff had completed medication training since the last inspection and had their practice observed to check their competence. Medication was well managed; stored appropriately, signed into the home and signed when administered to people. Staff complete a weekly stock check and were aware of whom to contact for emergency advice. It is recommended that a thermometer be situated where the medication is stored in each bungalow to monitor the temperature to ensure it remains no higher than 25 degrees centigrade. There are currently no residents self-medicating and no-one is prescribed any controlled drugs. Care Homes for Adults (18-65 years) Page 16 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has been slow to respond to a complainant and did not follow safeguarding policies and procedures fully. This means that residents may have been put at risk of further harm. Evidence: Avocet Trust has a corporate complaints policy and procedure that consists of four stages from informal, minor complaints that can be dealt with quickly by staff or the manager, to more in-depth complaints requiring a more formal response. Documentation highlighted that senior managers had been slow to acknowledge receipt of a complaint from a concerned relative. The complaint has evolved into a safeguarding of adults investigation and senior managers must take guidance from the local authority before proceeding. Staff members were aware of what to do if residents or family members complained and they stated they would try to deal with issues straight away. They did not have access to the complaints forms but they stated any issues would be recorded and passed onto the manager. The home had access to the multi-agency policy and procedure for protecting vulnerable adults from abuse. Care staff have received training in how to use the policies and procedures and how to keep people safe and protected. The new manager Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: has also just completed the local authority safeguarding training course specifically for managers regarding the referral and investigation procedure. Discussion with a relative, staff members and senior managers of Avocet Trust, and examination of documentation indicated the safeguarding policy and procedure had not been followed. A staff member had reported an allegation of physical abuse in the correct way but the investigation had been completed in-house instead of referral to the local authority, as the lead agency for safeguarding adults. The investigation was not completed or resolved fully. During the visit we had a discussion with the local authority to alert them to the incident. A safeguarding alert form was completed and sent to the local authority on the next working day following the inspection. An investigation is underway. Care Homes for Adults (18-65 years) Page 18 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a safe, attractive and homely place to live, which meets their individual needs. Evidence: There has been little change to the environment since the last inspection. 199a-203a Saltshouse Road consists of three separate units registered to provide care for eight people with a learning disability. The properties are set back from the main road in a corner of a residential estate. Two of the bungalows have three bedrooms and one has two bedrooms. All the bedrooms are for single occupancy and are nicely furnished and decorated reflecting the occupants taste and preferences. Four of the bedrooms have en-suite facilities, one of which includes a bath. All bedrooms and bathrooms have privacy locks. Each unit has its own lounge, dining room, kitchen and shared bathroom. Avocet has purchased a hoist and bathing aid since the last inspection to assist one resident with their mobility. The bungalows have separate garden areas to the rear but share a large garden and patio area at the front. The bungalows were clean and tidy but also homely and well decorated. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: Each bungalow also has a utility room with domestic appliances for laundry. Equipment in the home is well maintained and serviced in line with manufacturers instructions. The home is close to local amenities and public transport systems. There is car parking for approximately five cars. Care Homes for Adults (18-65 years) Page 20 of 29 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 were supported by a caring and competent staff team. The home ensured that staff were recruited appropriately and was addressing gaps in staff supervision. Evidence: The home had sufficient staff on duty throughout the day and night to meet the needs of people living there. Some residents had one to one support for specific activities funded by the local authority. There was a core group of staff that had worked in the home for several years and knew the residents and what their needs were very well. There had been some staff turnover since the last inspection but new staff members had settled in well and staff spoken with described a good team spirit within the three bungalows. There was also evidence from discussions that staff had developed warm and caring relationships with the people they supported. Current staff vacancies were being filled by regular bank staff until recruitment has been completed. Surveys from relatives were complimentary about the staff team, they let me know if shes not well, she couldnt be better looked after if I looked after her myself, we think they are angels they way they look after her, dedicated people, lovely carers, they couldnt do more, they have cared and loved her for years, she is well and happy, that is all I need to know, the permanent staff are extremely skilled in dealing Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: with her, and I am quite satisfied that these carers do look after their patients and give them all the support they need. The home had a training plan that covered skills for care induction with an external assessor in addition to the two-week in-house induction prior to the start of shift work. Mandatory training was included, such as first aid, medication, moving and handling, health and safety, infection control, care of substances harmful to health, fire safety and safeguarding adults from abuse. There were also service specific courses available including epilepsy management, eating and swallowing, pica, bowel massage, how to manage behaviours that could be challenging to others and specific medication administration. Mental capacity, best interest and deprivation of liberty training has been arranged for staff but not completed yet. As well as training within the company, staff were able to access some training courses provided by the Local Authority and Primary Care Trust. Staff spoken with and surveys received from them were happy with the training provided and felt they had sufficient skills to meet the needs of people in their care. They did feel that more training in areas of mental health were required to ensure staff were fully equipped with knowledge and skills to meet the needs of one specific resident. One person stated in a survey that the two-week induction was, informative but difficult to take everything on board in such an intensive two week block and it would have been more helpful if broken down into smaller units Documentation examined during the visit indicated that seven care staff and two regular bank staff had gained a National Vocational Qualification (NVQ) in care at level 2 or 3, and three senior care staff had gained NVQ at level 4. This equated to 43 percent of staff trained to this level and was a good achievement. In addition six staff are progressing through level 2. When they have completed the course the requirement for 50 percent of staff trained to NVQ level 2 or above will have been exceeded. Staff recruitment files were located at headquarters and were not assessed at this inspection. However, previous inspections had detailed that the company had robust policies and procedures in place regarding the recruitment of new staff members and ensured that all the required checks were in place prior to the start of employment. The home had a staff supervision system in place but when documentation was checked there had been some slippage. The new manager had started to address this and had prepared a new supervision schedule and had delegated some supervisory responsibilities to senior care staff. Records seen covered staffing, key worker issues, documentation, personnel matters and training needs. Staff spoken with told us there Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: was a lot of unrecorded day to day supervision with monthly house meetings and seniors meetings to enable issues to be discussed and addressed. An appraisal system had been set up to ensure staff received an appraisal at the same time each year. The new manager had audited staff information and had found some documentation missing so was in the process of setting up new files. Care Homes for Adults (18-65 years) Page 23 of 29 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. The service was well managed within the home, although senior management need to ensure safeguarding polices and procedures are followed to ensure full protection for residents. Evidence: There had been a change in management since the last inspection with a new manager starting in post in October 2008. She has eight years experience in the learning disability field of care and although she has completed her Registered Managers Award, she is just awaiting validation of it. She has up to date mandatory training and has completed a range of other courses relevant to her role. She has two medication training courses booked in March 2009. The manager stated she was well supported by senior managers and had access to supervision, advice and support from them as required. She confirmed that senior management visited the home on a monthly basis but documentation indicated the last occasion when a report of a visit required under regulation 26 of the care homes Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: regulations was completed was October 2008. These reports need to be completed monthly following the visits. There was an issue with the previous manager and senior managers not following safeguarding policies and procedures and completing an investigation internally. However, the new manager has recently completed the local authority course, specifically for managers, in how to safeguard vulnerable adults from abuse. She states she is fully aware of her responsibilities in this area and will ensure procedures are followed. The manager needs to apply for registration with the Commission. Staff members spoken with described the manager as approachable, supportive and, a good team player. The company had a quality assurance system in place that consisted of monthly audits, and surveys to relatives to obtain their views on how the home is managed. It is recommended that other relevant parties are surveyed for their views including visiting health professionals, care management and staff. The staff completed a monthly monitoring form for each resident that detailed, for example, whether there were any health concerns, what appointments they had attended, family contact, if documentation was up to date and whether a review of their care had taken place etc. The audits covered areas such as the environment, care support plans, accidents, health and safety issues, risk assessments, finances and medication etc. The home was a safe place to live and equipment was serviced and maintained well. Staff had completed health and safety training, including first aid, basic food hygiene, fire and infection control. The building was secure and any repairs needed were requested via headquarters and, according to staff, completed quickly. The home managed a small amount of personal allowance for residents and individual finance logs were maintained for all transactions. Residents had their own bank accounts but bank statements received were addressed to a counter-signatory at headquarters. Money is withdrawn from the residents bank accounts for their expenditure on a fortnightly basis. This process has improved the accessibilty of money for the residents. Care Homes for Adults (18-65 years) Page 25 of 29 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 26 of 29 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 23 13 Safeguarding of adults policies and procedures must be followed by all levels of staff to ensure the protection of vulnerable adults. This will ensure that issues are dealt with swiftly by the appropriate agencies. 31/03/2009 2 43 10 The responsible individual must ensure that they are aware of speciific safeguarding policies and procedures and follows these when information comes to their attention. This will help to ensure that residents are protected from harm and the appropriate authorities are informed of concerns. 31/03/2009 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 Care Homes for Adults (18-65 years) Page 27 of 29 improving their service. No. Refer to Standard Good Practice Recommendations 1 20 A thermometer should be situated where the medication is stored in each bungalow to monitor the temperature to ensure it remains no higher than 25 degrees centigrade. Complaints forms should be accessible to staff so they can document concerns or complaints using the correct paperwork. The complaint policy and procedure should be followed regarding timescales for acknowledging the complaint and resolution. This will ensure people are kept up to date and informed about the progress of any investigation. Staff should receive a minimum of six formal supervision sessions a year. This will ensure that issues can be discussed and documented and actions planned to address any shortfalls in practice. The manager should apply for registration with the Commission quickly to aid management stability in the home. Other stakeholders should be surveyed for their views on how the home is managed to broaden the range of views, for example, staff, care management and visiting health professionals. 2 22 3 22 4 36 5 37 6 39 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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