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Inspection on 17/11/08 for Smith Crescent Care Home

Also see our care home review for Smith Crescent Care Home for more information

This inspection was carried out on 17th November 2008.

CSCI found this care home to be providing an Good 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Smith Crescent Care Home 44 Smith Crescent Greenhill Estate Coalville Leicestershire LE67 4JE The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rajshree Mistry Date: 1 7 1 1 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. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 32 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Smith Crescent Care Home 44 Smith Crescent Greenhill Estate Coalville Leicestershire LE67 4JE 01530831767 01530835046 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) : Leicestershire County Council Social Services care home 6 Number of places (if applicable): Under 65 Over 65 6 3 1 0 0 0 learning disability physical disability sensory impairment Additional conditions: No falling within category SI may be admitted to the home unless that person also falls within category LD ie dual disability No one falling within SI may be admitted into the home when there is 1 person of category SI already accommodated within the home No one falling within the category PD may be admitted into the home when there are 3 persons of category PD already accommodated within the home No one falling within category PD may be admitted into the home unless that person also falls within category LD ie dual disability Persons admitted into the home who fall within the category PD may only be accommodated on the ground floor Care Homes for Adults (18-65 years) Page 4 of 32 Date of last inspection Brief Description 44 Smith Crescent is a care home offering respite care and accommodation for six younger adults (under 65 years of age) who have a Learning Disability. The home is also registered for a limited number of spaces for people who, in conjunction with their Learning Disability, have a Physical and/or Sensory Impairment. Smith Crescent has six single bedrooms without ensuite facilities. The home has a rear garden which is well maintained and which is accessible to people living in the home. The home is owned by Leicestershire County Council Social Services Department and situated close to Coalville town centre, close to shops, pubs, and other amenities, and it is accessible by private or public transport. Accommodation is provided over two floors with access between the floors being via stairs or a passenger lift. Communal areas are provided on the ground floor, with access to the new, spacious, conservatory. Bedrooms are located on both floors. The fees for this establishment are arranged on an individual basis, through the Social Services, and are according to the needs of the people. The latest copy of the Inspection Report by the Commission for Social Care Inspection is available at the home. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 32 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We as it appears in this Inspection Report refers to The Commission for Social Care Inspection. We did this key (main) inspection by visiting 44 Smith Crescent on the 17th November 2008. The visit started at 2.30pm and lasted 5.5 hours. As part inspection, we also looked at the Annual Quality Assurance Assessment (AQAA) completed by the registered manager, sent to the CSCI. This information sent each year, tells us what they think of the service they provide. We also looked at the other information sent to us. As part of the inspection we sent out Have Your Say About 44 Smith Crescent surveys to people who use the service, their relatives and the staff. Six surveys were sent back to us by people using the service and their relatives. We received no surveys from staff. To find out about the service given to people using 44 Smith Crescent, we talked to two people who live at the home, we looked at how people lived and asked staff about how they helped people to make sure their needs were met. We also looked Care Homes for Adults (18-65 years) Page 7 of 32 at the care plans, medication records and daily notes for three people. This is called case tracking. What we have written below is based on what we saw and what we were told on the day of the visit to the home. What the care home does well Smith Crescent has information about the home is written in an easy way to understand, using pictures and symbols. It tells people about what they can do when they live at the home and what to do if they are not happy. We saw people were relaxed at home, watching television or talking to staff. One person said Ive lived here before, I know the place, its alright. People go to college and day centres, which shows they can still do what they enjoy everyday. We saw that the staff were friendly with the people who live in the home. We saw staff treat people well. Staff were talking with people to find out what they day was like that showed they were interested in the person. Staff were seen helping people to make choices about the evening meal and how to spend the evening. One person said they enjoy watching wrestling: WWF and RAW and I like Horatio in CSI Miami. Care Homes for Adults (18-65 years) Page 8 of 32 The care files showed what help people needed and how staff should best help them to make sure they are safe. We found staff read the information about people that live at the home, to make sure they give the right help and support everyday. This meant people got the right support from staff, making sure they get their medication on time. The staff are experienced and trained to look after people that come to live at the home for a short break. Staff have specialist training to make sure people are safe. They know how best to talk or by signing make sure people are happy. One person told us in the surveys that they know who to speak with if they were unhappy: Yes, I would speak with .... or another member of staff. The home is well decorated, clean and tidy. Furnishings are homely, which makes it a family home feeling. There is equipment to help people around the home and help with peoples physical needs. People are involved to recruit new staff to work at the home, with some support from the clerk. This shows people are have a say in who works at the home. Care Homes for Adults (18-65 years) Page 9 of 32 What has got better from the last inspection There are parts of the home that have been decorated to make it homely. There is a new conservatory built through the main lounge, which people can use. There is a new wet room, which has special equipment to help people that have difficulty with walking or standing to shower safely. Two staff have been recruited to help support the people that live at the home. Staff have had more training to help them support the people living at the home the right way. Some staff have done the national vocational qualification and learning disability qualification to help them understand people and provide better support people with a learning disability. Care Homes for Adults (18-65 years) Page 10 of 32 What the care home could do better The information about the home is being updated by the registered manager to make sure people have the right information to help them. No one living at the home now are taking very strong medication called controlled medication. If a person were to be taking this medicine, it would have to be stored in a controlled medication cupboard, which makes sure that the home will store the medicines in the right way that is legal. Care Homes for Adults (18-65 years) Page 11 of 32 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Rajshree Mistry Commission for Social Care Inspection Eastern Regional Office CPCI Capital Park Fulbourn Cambridge CB1 5XE 01223 771300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 12 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 13 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who are considering using Smith Crescent have their care needs assessed before they move to the home to ensure these can be met. Evidence: We read the information people receive about Smith Crescent, which includes the statement of purpose and the service user guide. The information is available in an easy read with the use of pictures and symbols that helps people to understand. The content provides information about the aims and objectives of the home. It has details of what people can expect to receive during their stay at the home. The key policies and procedures are included such as the complaints procedure to help people raise concerns and complaints. The registered manager told us that this information being updated. The information we received from the registered manager stated people are encouraged to have tea visits or overnight stay before choosing to move to the home for a longer stay. One person we were case tracked said they had stayed at Smith Crescent before so were happy to use Smith Crescent again for a short break. Comments received from another person living at the home included; Ive lived here before, I know the place, its alright. This supported the survey responses we received from people that use Smith Crescent, which indicated that they received enough Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: information about the home and were asked if they wanted to move in. We read the care files for the three people we case tracked. All three people had different care needs ranging from minimal support to needing assistance with all personal care needs and with meals. One person we case tracked had just moved into the home for a short break. The care files all contained a copy of the assessment of needs completed by the social worker. The assessments were comprehensive looking at the individual personal care needs, communication, health conditions, medication and diverse needs such as attending college, day centre, family support and the input to meet specific health condition. We observed two senior staff reading the assessment to familiarise themselves with the needs of the new person. Staff said they have become familiar with the people that regularly use Smith Crescent for short breaks but always read the assessments as some peoples needs change on every visit. This showed staff followed good practice to make sure the needs of individual people were known. Care Homes for Adults (18-65 years) Page 15 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at Smith Crescent have their care needs met safely, are supported to make decisions and personal choices. Evidence: We read the care files for the three people we case tracked. The care plans outlined the individual care needs with regards to their personal care, health care and daily living such as attending college or the day centre. The information was reflective of the assessment of care needs. It gave clear guidance to staff to follow to ensure their safety whilst their independence was promoted. The registered manager told us the care plans are not development in alternative format such as pictorial format, as people use Smith Crescent for short breaks, from a few days to a week every few months. We saw evidence of assessments of risks completed on a range of issues from moving and handling, challenging behaviours and specific dietary and health care needs. The care plans clearly set out the measures to be taken to minimise each risk and provided guidance for staff to follow to ensure safety. The staff said care plans are not at Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: present available in alternative formats such as easy read or with pictures and symbols. However, the registered manager was already aware of the need to make information more accessible to the people using the home and is in the process of updating all documentation used in the home. We observed the senior staff developing a care plan for the newest person that had just arrived at the home. Information gathered from the individual in relation to their routine and preferences was reflected in the care plan. The care plans varied depending on individual peoples care needs. We read a very detailed and comprehensive care plan for two people, one requiring physical support, which required staff to be trained in moving and handling and feeding via a tube (PEG). Another care plan we read detailed the safety techniques used to ensure the person and other people were safe, known as SCIP, (strategies for crisis intervention and prevention). We observed people were making their own decisions from what the wanted to do after coming home from the day centre or college to choosing the evening meal. We saw people choosing to relax in the lounge watching television, others sat with staff in the dining room and one being supported in the privacy of their own bedroom. We saw staff talking with people to decide how they wish to spend the evening. We spoke with two people of which one we case tracked. They told us they felt confident to tell the staff what they want and were happy. The daily records we read for the people we case tracked showed people were able to continue living their choice of lifestyle and having their own routines supported. These ranged from attending college, day centre and going shopping with staff. Staff we spoke with and their training records viewed showed they had received specialist training and had skills to work with the people that live at Smith Crescent. Training ranged from SCIP, sign language, which is a form of communication to moving and handling and safe administration of medication. This supported the information we received from the registered manager stating staff are trained in SCIP techniques and are able to work with and support individuals in a consistent manner. The people we case tracked do not manage their own money. However, the senior staff described and showed us the system for managing peoples money. The records showed a clear record of transactions, which is signed by two staff. This demonstrated that whilst people had their money held in safekeeping, it was available to them and a clear record is kept. Care Homes for Adults (18-65 years) Page 17 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at Smith Crescent experience and supported to enjoy their everyday lifestyle, daily routines and offered a good choice of meals to suit. Evidence: The information we received from the registered manager before the site visit stated people are supported to access activities in the community e.g. shopping, eating out, leisure centre, going to church, places of interest, college and day centres. We read the care plans for the people we case tracked, which stated the educational activities people attended such as the day centres and colleges. We saw peoples leisure interests recorded by staff from discussion with the individuals and their family or main carers. The social interests ranged from swimming, shopping doing arts and crafts. Staff told us they play bingo, have barn dances and celebrate Christmas at the home. At teatime, people were seen returning home from their day centres, which showed people are able to continue their daily routines. People were settling home, freshening Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: up and getting ready for the evening. We saw one person doing college work. They told us they enjoy going to college and have to record their daily food intake as part of their healthy living plan. Staff asked if they wanted to help with the food shopping, which showed people were encouraged to be involved in domestic tasks that promoted their independence. The newest person that moved to the home on that day told us they enjoy watching wrestling; WWF and RAW and I like Horatio in CSI Miami. Later on, we saw people in the dining room, enjoying singing and dancing with staff, whilst other people spent time in their bedroom and the lounge watching television. We saw the new conservatory that leads from the lounge and provides people with additional area, which people can use in addition to the existing areas in the home. The registered manager told us that conservatory is not used fully as the sofas are being re-holstered and laminate flooring needs making safe. Staff we spoke with demonstrated how the plan activities with the people living at the home, which are planned with individuals for the short time they are living at the home. Staff said there were limitations due to lack of transportation available especially at this time of the year. Staff confirmed that although people come to Smith Crescent for a few days, contact with family is encouraged and maintained. This demonstrated continuity and communication to ensure peoples wellbeing. The daily records showed people we read reflected peoples wellbeing and what they did each day, during their stay at the home. The care files stated the preferences of meals, likes, dislikes and special dietary needs. The surveys responses we received from the people using Smith Crescent indicated people made choice about their daily life and social activities. Therefore, the evidence we found during the site visit supported the information we received from the registered manager before the site visit. The information we received from the registered manager before the site visit stated the home employs a cook who provides a varied menu and home cooked health and balanced meals. Staff records showed staff have received training in the safe handling of food. The staff on duty were seen preparing the evening meals for people as they returned home from the day centres. Staff were seen offering people the choice of meals in the evening, communicating using sign language in one instance. One person said they only wanted a round of toast and tea as they had hot meal for lunch. People said they were happy with the choice of meals offered, as they appeared to be balanced, nutritious and appealing to the people living at the home. This was consistent with the responses received in the surveys. Staff are trained to assist people with special feeding arrangements. Staff were seen being sensitive and respecting peoples privacy when they prepared to assist people with their meals. Care Homes for Adults (18-65 years) Page 19 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at Smith Crescent have their health and personal care needs are met by trained staff who promotes their health and wellbeing. Evidence: The surveys responses we received from people using Smith Crescent indicated people have their health care needs met on time. The care files we read had information about peoples individual personal care and health needs including medication, level of support and assistance with mobility and transfers and the use of specialist equipment. We saw staff reading information about the needs of the new person moving into the home. This showed staff were proactive to ensure peoples health and wellbeing is promoted. This supported the information we received from the registered manager before the site visit and the surveys from the people using Smith Crescent. Smith Crescent is equipped with specialist equipment, hoists, a passenger lift and a new wet room with a ceiling track hoist that helps people who need support with mobility due to physical disability. Staff training records showed staff had received training in moving and handling, use of peg feed, which is the use of specialist equipment to assist people with feeding. The records for one person we case tracked included the support provided by the District Nurse, which showed the home ensures Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: health care support is available to people during their stay at the home. We observed staff preparing to themselves to assist people to meet their personal health and care needs. This demonstrated trained staff meet peoples health and care needs that promotes their wellbeing. The senior staff told us all medication is booked in when a person moves into the home. The medication is labelled and stored in a locked medication cabinet. We observed one person who is able to self medicate, check and confirm the medication and signs the medication records along with the member of staff. This showed where people manage their own medication, this is promoted, whilst procedures are followed to ensure peoples health and wellbeing. The medication and medication records for two people viewed, were signed and showed records accurately reflected the medication taken. Staff training records showed staff receive regular training and updates in the safe handling of medication. This supported the information we received from the registered manager before the site visit. Smith Crescent at present does not have people on controlled medication. We advised the registered manager to seek advice from the pharmacist to ensure the controlled medication storage complies with the new legislation under the Misuse of Drugs (Safe Custody) Regulation 1973. The information we received from the registered manager before the site visit identified improvements that are planned for the next 12 months. These include to liaise with other professionals so that information in assessments and care plan is kept up to date and accurate and provision of training opportunities for staff. This demonstrated that home recognises the importance of working with professionals and continuous development of staff skills to ensure peoples health and wellbeing is maintained and promoted. Care Homes for Adults (18-65 years) Page 21 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at Smith Crescent are confident that their views, opinions are respected and acted upon and protected from harm, abuse and neglect by trained staff. Evidence: The complaints procedures is displayed in the home and included in the information people receive about the home before or when they move into the home. The complaints procedures is set out in an easy read style and supported with pictures and symbols, which helps people using Smith Crescent to have a better understanding of how to express concerns or make a complaint. We observed there is an open culture that allows people who live at Smith Crescent to express their views and concerns in a safe and understanding environment. People that we spoke with during the site visit and the responses received in the surveys showed people know who to speak with if they are unhappy and how to complain. The comments we received included Yes, I would speak with .... or another member of staff. Smith Crescent has not received any concerns or complaints. The Commission for Social Care Inspection has not received any expressions of concerns or complaints about the home or the care and support people using the home receive. The staff we spoke with demonstrated by giving examples of recognising if someone was unhappy from their facial expressions, lack of motivation, agitation or may Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: present challenging behaviours that may place themselves and others at risk. Some staff are trained in the use of sign language that helps people who use signing as a form of communication. Staff are trained and use techniques to safely support people that place themselves and others at risk. This is known as SCIP training, which stands for strategies for crisis intervention and prevention. We saw assessment of risk and care plans using SCIP, for a person we were case tracking, which ensured their health and safety. Support officers said they are trained in SCIP, training certificates were in staff files and this supported the information we received from the registered manager before the site visit. Staff we spoke with demonstrated a good understanding of safeguarding issues, which means promoting the wellbeing of people using the service from harm, risk and abuse. We observed how staff responded to people respectfully, giving them attention and time to express themselves. Staff were confident to report poor or unsafe practice used witnessed, using the homes whistle-blowing procedure. The staff training records showed staff had received training in the safeguarding adults from abuse procedures. The staff training matrix updated by the registered manager showed staff completed specific training to work with people that have a learning disability. These included learning disability qualification and national vocational qualification, which recognises the value of having a knowledgeable and skilled staff team. The people living at the home have their own daily expenditure that is held in safekeeping at the home. The registered manager described the arrangement for managing peoples money, which is recorded at the time they move to the home and reconciled to keep an accurate record. The records viewed supported the process described and demonstrated peoples money held in safekeeping is managed. Staff recruitment records showed staff were appointed with satisfactory preemployment checks. Staff told us as part of the recruitment and selection process, people living at the home are supported to informally interview applicants. This showed people living at the home contributing to the recruitment of staff at the home to make sure the right staff are employed. Care Homes for Adults (18-65 years) Page 23 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People live in a homely, warm, clean, safe, comfortable and well-maintained environment suitable for their needs. Evidence: Smith Crescent is a detached property that has level access at the front of the home and some off the road car parking spaces. The home is in a residential area, blending in with the area and has good access to the local community. The home is clean, has the feel of a family home, with pictures the walls and ornaments. There is a large lounge that leads onto the new conservatory and a dining room close to the kitchen. This supported the surveys responses received stating the home is fresh and clean. We saw people relaxing in the lounge watching television, others were in their bedrooms or sitting in the dining room with the staff. The bedrooms are located in the ground and first floor, which is accessible via the stairs or the passenger lift. Each bedroom is individual in character with complimentary furniture and furnishings to create a homely feel. There is a bathroom and toilet on the first floor and a new wet room on the ground floor, which has a ceiling track hoist to assist people with a physical disability and promotes independence. It was evident that the home has access to specialist equipment such as hoist, profile beds and shower chairs to support people with a physical disability. Care plans we read also showed Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: moving and handling risk assessments were completed and care planning reflective safety measures such as two staff to assist people, which ensures their health and safety. This supported the information we received from the registered manager before the site visit and the surveys we received from people using the service. The laundry room is located away from the kitchen and staff do peoples laundry. Staff training records showed staff had received training in health and safety, moving and handling, food hygiene and infection control. We saw staff wearing gloves in preparation to assist people with personal care tasks and the equipment to assist people with their meals. We saw supplies of protective clothing in the bathrooms for ease of access. Where staff require specific training or an assessment of staff competency, records viewed demonstrated staff have these skills to meet peoples care and support needs that promotes their wellbeing. Care Homes for Adults (18-65 years) Page 25 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at Smith Crescent are protected by robust staff recruitment process, are supervised, experienced and trained to meet individual personal care and support needs. Evidence: The people living at Smith Crescent appeared to enjoy a positive relationship with the staff on duty at the time of the site visit. Staff were seen welcoming people as they returned home from the day centre, clearly aware of peoples individual preferred routines. This supported the survey responses we received indicating staff treat them well; listen and act on what they say. The registered manager and the staff on duty confirmed whilst they have had to use agency staff recently, to support the new supporting living accommodation next to Smith Crescent, but the staffing levels are generally good. The registered manager told us they have recently recruited two staff and awaiting receipt of pre-employment checks. The staff recruitment was in response to staffing that now covers three services in total: permanent residential care home and supported living accommodation, adjacent to 44 Smith Crescent. This demonstrated staffing levels and management is reflective of the needs of the people using the home. We wanted to find out how staff were recruited and whether recruitment promotes the Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: health and wellbeing of people who use the service. Staff described the recruitment process, which involves an informal interview carried out by the people living at the home with the support of the clerk. This showed people positively influenced staff recruitment to make sure the people with the right skills and qualities work at the home. We looked at the records of three staff and found that they had undergone a robust recruitment process, which included an interview, receipt of two satisfactory written references and a check as to a persons suitability to work with vulnerable people, which includes finding out if they have a criminal record. This means all staff have had a criminal records bureau (CRB) disclosure. This supported the information we received from the registered manager before the site visit. The information provided by the registered manager before the site visit states staff have a national vocational qualification (NVQ) and a learning disability qualification (LDQ), specific to work with people with a learning disability. The registered manager confirmed during the site visit that over 50 of staff have attained NVQ level 2/3 in care. Staff told us they had received training directly related to their specific role and specialist training to provide care and support to the people living at the home. The staff training records and matrix viewed included topics related to staff induction, LDQ; NVQ; health and safety. There were training certificates and competencies for strategies for crisis intervention and prevention (SCIP); sensory impairment; sign-along (signing; communication using hands); autistic spectrum disorder; PEG feed; safe handling of medicines; first aid and includes support officers who are NVQ assessors. Observations made during the site visit and discussion the staff on duty demonstrated they have a good awareness of peoples needs, how best to support them through experience and training they receive. Staff were confident to support people living at the home, were not to be phased by challenges people may present and recognised the importance and value of continuity of care. We saw there was a relaxed and an open culture, where staff morale appeared to be good, which promotes teamwork that benefits people living at the home. Staff said they benefit from having the support from colleagues, support officers and management. Staff confirmed they received regular and timely supervision meeting with their line manager, where they discuss work issues, identify training and development needs. This supported the contents in the staff files and the information provided by the registered manager before the site visit. Care Homes for Adults (18-65 years) Page 27 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People using Smith Crescent for short breaks, benefit from a well run home, confident that their views are heard and have internal monitoring systems that measure the quality of the service. Evidence: The registered manager of Smith Crescent, Anne Frewin, has many years experience of working with people with a learning disability. She has gained a national vocational qualification (NVQ) at level 4, has attained the Registered Managers Award, the A1 assessor award and the internal verifier award. From our discussions with the registered manager and the deputy manager it was evident that there have been changes made to oversee the management and the day-to-day staffing of Smith Crescent and the two adjacent services: permanent residential care home and the supported living accommodation. The registered manager told us has attended updates in training to maintain their knowledge and skill base in line with changes in regulations and current best practice. Additional refresher training has been identified for staff that supervise to ensure their skills are maintained. The registered manager is at present looking to identify suitable Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: mental capacity training to ensure the she and the deputy manager have a better understanding and are aware of their responsibility in accordance with the act and the organisational requirements. Staff we spoke with were confident to raise issues with the registered manager. They commented on the positive and inclusive management style she has, listening to views of staff in relation to staffing issues, people living at the home, their relatives and the care management team. There are clear staff roles and responsibilities of staff and work well as a team in relation to meeting peoples needs and communication. People receive a questionnaire, in an easy read style, in the information, they receive when they move to the home, to complete at the end of their short break. Whilst this appears to be a good way for people using the home and their relatives to voice their opinion, experience and satisfaction levels of the service, not many are returned. The registered manager told us people use Smith Crescent for regular short breaks for carer respite or when their existing care and support arrangement is not working. However, care files that we read did included comments about individual preferences in respect of their expectations and lifestyle, which the home try to meet. The registered manager and staff also gave examples of how they maintain contact with the family and the care management team to ensure peoples experience of the service is good. We saw the monthly visit reports completed by a representative of the Responsible Individual for the local authority. The visit reflected the checks and audits carried out, discussion with the registered manager, staff and people living at the home at the time and identified shortfalls that need addressing. This demonstrated there is an internal system of monitoring the management of the home. The information provided by the registered manager before the site visit details the regular maintenance of equipment and systems in the home, including the heating and electrical systems along with hoists, the passenger lift, fire fighting equipments and systems. Care Homes for Adults (18-65 years) Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes  No  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 30 of 32 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description 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 Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 Advise should be sought from the Pharmacist to ensure the controlled drugs storage complies with the new legislation under the Misuse of Drugs (Safe Custody) Regulation 1973. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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