Inspection on 22/12/08 for Sharea

This inspection was carried out on 22nd December 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Sharea 24/01/08

Sharea 12/09/07

Sharea 31/08/06

Sharea 20/12/05

Sharea 07/07/05

Sharea 10/11/04

Sharea 18/05/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Sutton Lodge Nursing Home

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

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: Sharea 69 Reigate Road Hookwood Surrey RH6 0HL     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 Jewell     Date: 2 2 1 2 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. 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 36 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 36 Information about the care home Name of care home: Address: Sharea 69 Reigate Road Hookwood Surrey RH6 0HL 01293776248 F/P01293776248 info@avenuestrust.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Avenues Trust Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 6 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Additional conditions: 6 6 The maximum number of service users to be accommodated is 6. The registered person may provide the following category/ies of service only: Care home only - (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 (LD) Physical disability (PD). Date of last inspection Brief description of the care home Sheara is a care home registered to provide care and accommodate up to six people who have a learning disability. Residents are aged under 65 years and have a sensory impairment (SI). The home is managed by Avenues Trust Limited who are a large organisations specialising in caring for people who have a learning disability and also manage many other registered homes across the county. The premises are owned by a housing Care Homes for Adults (18-65 years) Page 4 of 36 Brief description of the care home corporation who are contracted to maintain aspects of the premises. The premises consist of a converted domestic bungalow situated just off a main road on the outskirts of Reigate. Local amenities are a car journey away. The premises are presented across two floors with access to the first floor via stairs. The people whom the home supports accommodation consist of six single bedrooms with the use of communal toilets and bathing facilities. Communal space consist of a large combined lounge dinning room, kitchen, laundrette. There is a large secure rear garden which has a large patio area. The front provides for off road parking. Care Homes for Adults (18-65 years) Page 5 of 36 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 information contained in this report has been comprised from an unannounced inspection over six half hours and information gathered about the home before and after the inspection. Staff at the home had completed an Annual Quality Assurance Assessment form prior to the inspection and some of the information contained in this document has been used to inform the inspection the home. Feedback comment cards were sent to the home in advance of the site visit for the home to distribute and six were returned. A summary of their feedback is contained in this report. There were six people whom the home supports residing at the home at the time of the inspection. People who live at the home, at the organisations request, are referred to as the people who are supported and hereafter referred to as this. The home is currently Care Homes for Adults (18-65 years) Page 6 of 36 without a registered manager and the person appointed by the provider to manager the home in the interim, hereafter referred to as the person appointed to manage, facilitated the inspection. The organisations area manager was also present for parts of the inspection. The site visit involved a tour of the premises, examination of the homes documentation and in-depth discussion with five staff and three relatives were also consulted about their experiences at the home. The inspector spend time observing the people whom the home supports in their daily routines and in their interactions with staff. This was in order to assess the well-being of people being supported who are not able to verbally share their experiences of the home. What the care home does well: What has improved since the last inspection? The previous shortfalls noted a the last inspection have been addressed this has helped to improve the people whom the home supports safety through the regulation of hot water and the removal of potential hazards in the garden. Consistent feedback was received regarding the gradual overall improvement in the home and the services if offers over the last ten months, this has been attributed to the appointment of a person to manage and new area manager. Following a period of instability in the staff team the staff group now includes a core group who have worked at the home for a number of years. Their experience, together with training indicates that they have a good level of competence and are motivated in working with the people whom the home supports. Relatives commented There seams to be different staff on whenever I visit little consistency in staffing which is not good and it makes it difficult to speak to staff if you don’t know them and Has a different keyworker again although some staff have been there a long time seem to see different faces all the time. Care Homes for Adults (18-65 years) Page 8 of 36 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. Care Homes for Adults (18-65 years) Page 9 of 36 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 10 of 36 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 11 of 36 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. Although there is some literature about the home they need to fully reflect the range of services and facilities available at the home and be in a more accessible format for those people for whom the home is intended. The home is able to identify and meet most needs of the people whom it supports. The way in which prospective individuals would be assessed ensures that the home admits only those people whos needs could be met by living at the home. Evidence: There is some information about the home and the services and facilities it provides. This includes a statement of purpose and service user guide. These documents are largely generic based and in a written format. These documents did not reflect the full range of services and facilities available at the home or were not in a format accessible to the people the home supports in order to help inform interested parties what to expect when residing at the home. The person appointed to manage and the area Care Homes for Adults (18-65 years) Page 12 of 36 Evidence: manager have devised a development plan which identifies areas of shortfall in the services and areas for future service development this includes the need to improve the homes statement of purpose and service user guide into a more accessible format and agreed to undertake these improvements in accordance with the timescales set out in homes development plan. There have not been any new admissions to the home since 2000. Therefore, this standard was assessed in respect of the admission procedure for any future prospective people whom the home would support. The person appointed to manage was aware of the admission criteria for the home and knowledgeable about admissions practices that would ensure a comprehensive range of information is gathered about prospective people whom the home would support. This would then inform their decision whether their needs could be met at the home. The majority of people whom the home supports are assessed as having medium to high levels of needs and include residents who have physical needs, learning disabilities and all of whom are visually impaired and who are older. Through observation, looking at records and speaking to relatives and staff evidence was gathered that the home is meeting most needs of the people whom it supports. People whom the home supports have a relaxed and gently lifestyle suitable for the age range or people accommodated at the home. However as highlighted under section 14 and 33 of this report further work must be done to review the deployment of staff to ensure that there is sufficient staff on duty to be able to meet the social and physical needs of people whom the home supports throughout the day. During the course of the inspection people whom the home supports demonstrated many signs of wellbeing this included smiling, affection towards staff, freedom to move around the home and follow their own personal routines. The person appointed to manage stated that any prospective people whom the home would support would be provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home with their family and representative. The length and type of any visit would depend on the individuals needs and preferences. The people whom the home supports are provided with a written contract of the terms and conditions of residency in a written format. The area manager spoke of the organisational plans to develop this into a more accessible format for people with a visual impairment and learning disability to be able help aid their understanding of their rights and responsibilities while residing at the home. Care Homes for Adults (18-65 years) Page 13 of 36 Care Homes for Adults (18-65 years) Page 14 of 36 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. People being supported at the home benefit from a good care planning process, which provides clear, up to date information about their needs and goals and the support needed to achieve them. The home balances well the rights of people being supported to take reasonable risks as part of an independent lifestyle. People being supported are involved in decisions about their lives in accordance with their range of preferences and strengths. Evidence: Three individual plans of care were inspected and were found to contain detailed up to date information on the needs of people being supported and the appropriate guidance for staff on how meet these needs. There were several examples noted of good Care Homes for Adults (18-65 years) Page 15 of 36 Evidence: practices in the care planning process, this included the development of clear behavioural management plans and the use of person centred planning. Changes in people being supported needs and preferences were identified through the review of care plans. Although it was not always recorded when a review had taken place and the person appointed agreed to address this. Annual placement reviews are also held with the placement authorities, relatives spoke of attending annual reviews and being actively involved. Staff consulted with were knowledgeable about the individual needs and preferences of the people whom they supported. This included an awareness of the subtle signs of well or ill being especially where verbal communication is not the main method of communication. Staff were observed using a variety of communication tools to provide appropriate choices regarding food, drink and personal care. A tactile board is used which displays various objects to signify occupations and activities. A staff member said that they often make choices on behalf of the people they support based on their knowledge of their likes and dislikes, another member of staff spoke of how they provided an appropriate level of choice to an individual when supporting them to dress. Staff spoke of the recent opportunity sessions that were undertaken with regard to sampling a variety of different foods in order to help identify further food preferences of the people being supported. People supported at the home participate in the day to day running of the home in accordance with the range of their individual preferences and strengths. One person being supported was observed being involved in making a light snack for themselves. The home has a developed system in place for enabling people they support to take responsible risks as part of an independent lifestyle. For example core risks faced and posed by the people being supported are assessed and any measures to reduce or mange the risk is recorded for staff to follow. Although staff demonstrated an awareness of good practices about confidentiality, ensuring that sensitive information is kept secure and knowledgeable about the circumstances under which information must be shared with management and others, some personal support information was displayed in bedrooms which did not promote confidentiality and the person appointed to manage agreed to review this practice. Care Homes for Adults (18-65 years) Page 16 of 36 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. Although the people being supported by the home participate in some activities additional opportunities to access the community is needed to further enrich individual’s lives. Most daily routines are determined by the people being supported, however further work is needed during the late evening to ensure that residents needs and preferences are able to be met. People being supported by the home benefit by being enabled to maintain relationships with their families and friends. Mealtimes and arrangements for eating are tailored to meet the individual resident’s needs and what events and activities were occurring that day. Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: Some opportunities are available for the people being supported to continue to use practical life skills in order to maintain their lifestyle. This included involvement within individual levels of preferences and strengths in domestic and other light housekeeping tasks. Each person being supported has a flexible weekly plan of events and activities, this included going out shopping and visiting some community facilities. Consistent feedback was received on the restrictions the semi rural location of the home places on being able to go out. Staff spoke about not being able to easily walk to local facilities with a staff member commenting bit scary sometimes having to walk along a main road. Therefore staff said they are reliant on staff who are drivers and the availability of suitable transport. People being supported at the home who were mainly based at home for the majority of their week it was not always clear what organised events and daily activities they were involved in. A relative commented TV is usually on but not sure who it is for they need more stimulation. The needs of one person being supported had changed and it was assessed that they now needed an additional member of staff when accessing the community. Staff spoke how this now limited this individual going out as there was not always sufficient suitable staff available and therefore they did not go out as much. It was reported that the organisations policy of male carers not escorting people whom the home supports on a 1:1 basis on holiday prevented one individual having the opportunity to go on holiday this year. A staff member spoke of the short break holiday they had recently been involved in. When asked if there were any areas in which the home could improve upon two staff members and a relative spoke about the need to increase the opportunities to go out. It was evident that people the home supports are enabled and encouraged to maintain family links through visits to their family, having family visit them at home and through telephone contact. Relatives commented always make me feel welcome offered drinks and No restriction on visiting always made to feel welcome. During the inspection people being supported were observed to move around the communal space freely, choosing which rooms to be in and what level of company they wanted to enjoy. People whom the home supports were able to choose when to spend time on their own, and can do so in their own bedrooms. Staff work hard to enable the people they support to make some choices about their daily routines. However it was not always clear whether the people the home supports preferences were able to be observed with regard to the night time arrangements. This is with regard to the people being supported into their night clothes before 9pm as staffing Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: levels are reduced to one person after this time and it was reported that therefore one person could not support all of the people living at the home to get ready for bed by themselves. It was reported that no people being supported go to bed before 9pm. The home has been required to review the deployment of staff to ensure that there is sufficient numbers of staff on duty as is appropriate to meet the needs of the people whom the home supports. Menus showed that a varied and balanced diet is provided which includes fresh produce. Various mealtime arrangements were in place on the day of the inspection to suite individual routines. Staff spoke of the flexibility in the menus and that several alternative meals can sometimes be prepared to meet the range of preferences of the people being supported. Specialist dietary input has also been sought in the past to ensure that any specialised diets are being catered for appropriately. There was a strong emphasis on managing the food budgets with staff mindful of ensuring budgets are kept within. Care Homes for Adults (18-65 years) Page 19 of 36 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. People being supported by the home benefit from personal and health care support that is sensitive and which encourages them to remain as independent as possible and which ensures they receive prompt medical intervention. The system for the administration of medication are good with clear arrangement being in place to ensure that the people being supported medication needs are met. Evidence: All persons supported by the home are assessed as requiring some level of personal support. When asked what the home does well staff and relatives consistently feedback that the homes provides good personal care. During the inspection visit staff were observed to support and care for the people they were supporting in a sensitive manner whilst encouraging independence. Good attention was given to the personal appearance of people being supported, which was age appropriate and afforded choice. A relative said that their relative personal appearance is good, wearing appropriate clothing with good levels of personal hygiene. Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: Staff enable the people whom they support to ensure that their health needs are met, with care plans containing a record of any visits or contact with health care professionals. There was evidence of current involvement from General Practitioners, specialist nurses and chiropodists. Records showed when concerns have been raised by staff regarding the health care needs prompt action has been taken to seek medical input. However a relative expressed their concern that a staff member did not understand some basic health care prevention and treatment which eventually resulted in their relative having to have medical intervention and treatment. The system for the administration of medication are good with clear and comprehensive arrangement being in place to ensure people being supported medication needs are met. Good practices were noted in the clear instructions on the administration of As required medication which ensured that staff had the guidance on the individual instructions as to when to administer these medications. To further improve practices it is recommended that hand written Medication Administration records (MAR) charts and entries are signed and dated by the staff member completing it and entries are also checked and countersigned for accuracy by a second member of staff in order to fully eliminate the associated risk when copying by hand prescribed instructions. Staff spoke knowledgeable about the aging process and the effect on the people they support, including their changing health care needs and on the type of activities they participate in. The person appointed to manage was knowledgeable on the level of need at which point the home would no longer be able to safely meet. Care Homes for Adults (18-65 years) Page 21 of 36 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 complaints procedure contains the information needed for the people being supported and their representative to make a complaint. There are now additional procedures and practices in place that supports the protection of vulnerable adults. Evidence: There is a written complaints procedure in place for people being supported, their representative and staff to follow should they be unhappy with any aspects of the service. Although it is recognised by staff that the people they support would require full support to make a complaint and were knowledgeable on how they would support people living at the home to do this. The person appointed to manage reported that there have been no formal complaints made since the previous inspection. Relatives consulted with said that they were aware of how to raise any concerns and felt able to approach the person appointed to manage with any concerns they may have. A relative however felt that senor management in the organisation were not always approachable. There are written policies covering safeguarding adults and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: report any concerns they may have to a responsible authority for investigation. Staff members consulted with all said that they had undertaken safeguarding adult training and demonstrated an understanding of their roles and responsibilities under safeguarding adults. There has been one safeguarding referral made to the police and social services since the last inspection. Staff at the time followed the correct safeguarding procedures and promptly reported concerns to the relevant authority for investigation. As a result of the police and social services investigation shortfalls in practices identified have now been addressed, disciplinary action taken against staff still in employment and further practices put into place to safeguard people being supported at the home. Care Homes for Adults (18-65 years) Page 23 of 36 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 whom the home support live in a clean and homely environment with their personal accommodation individualised to suite their taste and preferences, however further work is needed to ensure that the environment is suitable for the needs of the people being accommodated. Evidence: The home is located in a semi rural location and is a converted domestic dwelling. The premises are owned by a housing association that is also responsible for most maintenance and external decoration of the home. Much effort is made to create a homely feel to the home. Variable feedback was received regarding the environment a sample of comments included: I think pretty good in most parts could do with a bit of a touch up here and there but generally ok and Environment needs a complete overhaul needs brightening up. Consistent feedback was received regarding the frequent delays in getting repairs completed which has resulted in radiators not being replaced and leaks not being addressed promptly. There was no plan of redecoration and repair to demonstrate that the home is being proactive in ensuring that a well decorated and maintained home can be achieved. Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: There is a rear secure garden which has a large crazy paved patio area which contains seating and plants. Access to the patio is not level with a slight step, there was no clear risk assessment in place to establish the suitability and safety of use of crazy paving for people who have a visual impairment. Although the inspection was undertaken in winter the patio area could not be safely accessed by people whom the home supports independently. During the inspection the area manager spoke about fitting a slight ramp to aid independent access. Part of the garden is grassed and there is a swing and garage. There was a strong unpleasant smell from the garden which was reported to be from the sess pit. The person appointed to manage said that they have repeatedly had issues with the odour. A relative also commented There is a terrible smell in the garden its really unpleasant in hot weather and when you are in the garden. They keep saying they are sorting it but its still there. It has now been required that the home consult with the relevant agency in order to address the odour. Bedrooms were seen to be personalised in accordance with the individuals taste and preferences, one resident also has a separate quiet room which contains a variety of soft play equipment. There is a standard bath and assisted bath, feedback was received that due to the declining mobility of some residents a shower /wet room would be beneficial. There are some aids and adaptations to assist people living at the home with mobility, this includes grab rails and assisted bath, however it was not clear if any assessment has been undertaken to establish the level of aids which could be used to support peoples independence with a visual impairment. In light of the issues also raised regarding the accessibility of the garden, some peoples whom the home supports decreasing mobility it has been required that a qualified person has made an assessment of the premises, in relation to the suitability of equipment and environmental adaptations. All areas inspected were observed to be cleaned to a good standard. Systems are in place to support the control of infection and staff said that they had access to equipment including disposable gloves and aprons to minimised the risk of infection. Care Homes for Adults (18-65 years) Page 25 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Following a period of instability in the staff team the staff group now includes a core group who have worked at the home for a number of years. Their experience, together with training indicates that they have a good level of competence and are motivated in working with the people whom the home supports. However, staff deployment needs to be reviewed to ensure that there is sufficient staff on duty throughout the day to ensure that residents assessed needs and preferences can be met. Staff are robustly recruited in order to promote the safety of the peopel living at the home. Evidence: It was observed throughout the day that the staff understood their roles and had good planning skills. The tasks of the day were organised at handover and the individual staff appeared confident in carrying them out. Staff were clear on their roles as a keyworker however relatives said that they did not know who the current keyworker was as these changed frequently in order to liaise with them . The staff team is reflective of the gender mix of people whom the home supports. A staff member said Usually three staff on duty could do with more sometimes so we Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: could do more outings. At night there is one staff member, the person appointed to manage said that one persons needs are currently being monitored at night as their support levels have increased significantly. Feedback from a staff member was that only occasionally do you need additional help at night and spoke of the on call system that the organisation has in operation should they need telephone support or advice during the night. The area manager confirmed that the person appointed to manage can increase staffing levels should the needs of the people they support suddenly change. After nine pm there is one staff member on duty, the inspector was informed that all of the people being supported at the home need various levels of assistance with their bedtime routines and that no individuals are usually in bed before nine pm. This resulted in the people being supported being assisted with their night time routines before nine pm as one member of staff would not be able to provide this level of support after nine pm. The home was unable to evidence that this practice was based on the needs and preferences of the people being supported. The home has been required to review the deployment of staff to ensure that there is sufficient numbers of staff on duty to ensure that at all times adequate staffing levels are maintained to ensure the health and welfare of the people they support. The person appointed to manage and area manager confirmed that the staffing arrangements at night have been reviewed in light of fire safety considerations and practices are in place that enable the safe evacuation of the home by one member of staff and that Surrey fire and rescue service have been made aware of the fire safety arrangements at night. Staff spoke about the positive changes that have occurred with the recent decline in the use of bank and agency staff. There is a core group of staff who have worked at the home for a number of years and who provide some continuity for the people they support. Relatives commented There seams to be different staff on whenever I visit little consistency in staffing which is not good and it makes it difficult to speak to staff if you don’t know them Has a different keyworker again although some staff have been there a long time seem to see different faces all the time. In information submitted to the Commission as part of the inspection process, four staff members have completed National Vocational Qualifications to at least NVQ Level 2. The person appointed to manage was aware of the need to increase the number of staff attaining this qualification. Staff on duty said that they had undergone all of the mandatory training in Fire, Food safety, safeguarding adults and manual handling needed to help them work safely with residents. Staff spoke of also undertaking specialist training in areas such as learning disabilities, epilepsy and visual impairment. A staff member felt that the range of Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: training available by the organisation was very good. The staff files contained a staff information sheet. These sheets were signed by the human resources department and evidenced the information that was stored on the main staff files at the company’s head office. Three staff files were seen and evidenced that the required information and documents were obtained prior to staff commencing employment in order to help safeguard the people being supported at the home. Staff are supported to only work within the range of their expertise and training and to seek advice from the person appointed to oversee the management if they are unsure of situations. Staff said they felt well supported to undertake their roles. Care Homes for Adults (18-65 years) Page 28 of 36 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. Although the current person appointed to manage is motivated and respected there is a need to ensure a consistent clear leadership and direction to ensure that the areas for service improvement are addressed. A range of regular health and safety checks helps to promote the health and safety of the people whom the home supports. There are mechanism in place for the home to now regularly review aspects of its performance through a program of self-review and feedback Evidence: There has been number of changes in management and area management over the previous three years, the home has been without a registered manager since October 2007. The lack of continuity in management has impacted on the quality of the services it provides as bore out by the number of shortfalls noted in this report and Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: safeguarding referral. The person currently appointed to oversee the management of the home was in the process of applying to the Commission to become the registered manager. All persons consulted with spoke positively about them with particular reference to their hands on management style. A sample of comments included: great with the guys she gets your brain going, fantastic, hands on so knows what is going on in the home really nice helpful Manager ok reliable Manager very helpful very supportive kind thoughtful confident in Jo and very professional. The person appointed was motivated to improve practices at the home and demonstrated an understanding of the daily running of a care home, however discussion occurred on the further work needed to aid their understanding of their roles and responsibilities under the national minimum standards. There were several mechanisms in place to help assess the quality of the services and facilities. This includes the recent completion of a development plan which identified areas of shortfall in the services and areas for further service development. The area manager confirmed that feedback surveys have been developed to obtain feedback on the services provided and the performance of the home and sent to relatives and other stakeholders. The results being sent to the organisation who will in tern forward on this feedback back to the home to address. Written guidance is available on issues related to health and safety. Records submitted by the manager prior to the inspection stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. This includes monthly health and safety checks undertaken by the home. Following concerns noted at the previous inspection regarding the delivery of excessive hot water, the person appointed to manage confirmed that mixer values have now been fitted to hot water outlets in order to regulate hot water within a safe temperature range. Systems were in place to support fire safety, which included: regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The person appointed to manage reported that they have undertaken a fire risk assessment which recorded significant findings and the actions taken to ensure adequate fire safety precautions in the home. The person appointed to manage confirmed that all of the requirements made from a fire safety visit in October 2007 have now been addressed. This includes meeting the shortfalls noted at this fire safety visit that there are sufficient number of competent persons available to effectively implement emergency procedures at all time. The area manager confirmed that night time fire safety arrangements will be kept under review in light of any changes in needs of the people whom the home supports needs. Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: The area manager undertakes the required monthly audit of services and facilities and completes a written report on their visit. Although newly appointed to this position they were also motivated in identifying and addressing areas for future service improvement. Care Homes for Adults (18-65 years) Page 31 of 36 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 32 of 36 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 18 To review the deployment of 16/03/2009 staff to ensure that at all times adequate staffing levels are maintained to ensure the health and welfare of service users. To ensure that services users individual preferences and assessed needs are able to be observed with regard to their bedtime routine and opportunities to access the community. 2 10 That the registered provider shall having regard to the size of the home, the statement of purpose, and the number and needs of service users carry on or manage the care home with sufficient care, competence and skill. 16/03/2009 Care Homes for Adults (18-65 years) Page 33 of 36 To ensure that the home is being managed competently and effectively. 3 23 That the registered person demonstrates that a qualified person has made an assessment of the premises, in relation to the suitability of equipment and environmental adaptations. 16/03/2009 To ensure that the environment is fit for purpose. 4 23 That the registered person undertake appropriate consultation with the authority responsible for environmental health with regard to addressing the strong unpleasant odour in the garden. To ensure that service users live in a pleasant environment . 5 16 That opportunities are 16/03/2009 provided for service users to participate in valued and fulfilling activities both at the home and within the community. n order to further enrich service users lives 6 23 That a plan of re-decoration 16/03/2009 and repair be developed, to ensure that all areas are maintained and decorated to a reasonable standards and 16/03/2009 Care Homes for Adults (18-65 years) Page 34 of 36 which includes timescales for their completion. To ensure that service users live in a well decorated and maintained home. 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 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (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. 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