Inspection on 20/11/08 for Station House

This inspection was carried out on 20th November 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Station House 02/01/07

Station House 23/02/06

Station House 05/07/05

Station House 21/02/05

Station House 02/09/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Station House Station Road Admaston Telford Shropshire TF5 0AP     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: Deborah Sharman     Date: 2 1 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. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 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 31 Information about the care home Name of care home: Address: Station House Station Road Admaston Telford Shropshire TF5 0AP 01952242648 01952740262 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Cheryl Elizabeth Jackson Type of registration: Number of places registered: Overley Hall School Limited care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Station House is a detached property situated in Admaston, Telford. The home offers access to local amenities that include a post office, public house, grocery store, hairdressers and church. The property is in keeping with the local community. The home is registered with the Commission for Social Care Inspection (CSCI) to provide accommodation and personal care for a maximum of four people with a learning disability. Ms Cheryl Jackson is the Registered Manager of the home. She has been employed by the organisation for numerous years before taking up the managers position at Station House in 1997. Fees are charged annually but are paid four times per year. The range of fees have not been made public as they should have been and should be sought from the service 4 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The Quality Rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. One Inspector carried out this unannounced key inspection over two days. It was necessary to return on the second day to access some records which were not accessible to us on the first day. On the first day we inspected from 9.30 until 4.00. On the second day we inspected between 10.30am and 1.00pm. As the inspection visit was unannounced this means that no one associated with the home received prior notification and were therefore unable to prepare. As it was a key inspection the plan was to assess all National Minimum Standards defined by us as key. Care Homes for Adults (18-65 years) Page 5 of 31 These are the National Standards which significantly affect the experiences of care for people living at the home. Information about the performance of the home was sought and collated in a number of ways. Prior to inspection the Commission for Social Care Inspection was provided with written information and data about the home in an annual return. We had sent surveys to people who live and work at Station House and also to independent health professionals who have contact with the home. As a consequence of time constraints we brought the inspection forward and so at the point of inspection did not have completed surveys available to us, as the return date for them had not yet passed. However they were available to us at the point of report writing. It is currently our policy not to send surveys to relatives and as many live at a distance we were not able to speak to relatives on the day of inspection. However satisfaction surveys had been carried out by the service and relatives thoughts about the service were available to us in this format. During the course of the inspection we used a variety of methods to make a judgement about how service users are cared for. The manager was available throughout the day to answer questions and support the inspection process. We also spoke to staff and observed practice including at lunchtime when we were invited to join staff and residents for lunch. We assessed the care provided to two people using care documentation and we sampled a variety of other documentation related to the management of the care home such as training recruitment staff supervision accidents and complaints. We toured the premises and we were able to observe the care of residents during this time. All this information helped to determine a judgement about the quality of care the home provides. What the care home does well: What has improved since the last inspection? What they could do better: We have identified a number of areas for improvement. These include the following. There should be better evidence of how peoples health needs are being met. This should include improving how such matters are recorded to help plan, account for and follow through medical advice provided. The manager must ensure a best interest meeting is held about an identified service users unmet health need and in the event of delays organising this, should consider reporting the matter to Telford and Wrekin under Safeguarding. To reflect upon how to implement safeguarding procedures in practice ensuring all issues are reported appropriately. Medication systems need to be robust so audits of medication records can demonstrate people are receiving their medication as prescribed. This must include recording medication audits and any findings and actions taken. The manager should also assess staffs ongoing competency to administer medication. When people apply for employment, their employment history should be obtained so references can be sought from the most appropriate people particularly former and most recent care employers. Care Homes for Adults (18-65 years) Page 7 of 31 The services Quality Assurance system should be extended so the service can identify its own development needs and plan to meet them. The planned redecoration and replacement of flooring and the lounge suite should be implemented. . Station House is currently not providing people living there with an annual holiday on the basis that they wouldnt adapt or cope with this. Discussion showed that holidays may not have been individually considered however. Therefore the manager and staff with the support of the organisation need to consider this in respect of each person. The manager and staff group should reflect on how language used within the home may unwittingly infantalise the adults living there. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 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 can be confident that the care home can meet their needs. This is because there are accurate assessments of needs which are continually reviewed for new and settled residents. These tell the home all about them, their hopes and aspirations as well as the support they need. Evidence: We last inspected almost two years ago. There is a settled group of four people living at Station House and there have not been any vacancies in this time period. Consequently nobody new has moved in and there have been no changes. At the last inspection we assessed how the most recent person had been supported to move in and judged that this had been managed well. He was starting to settle down when we visited in 2006 after a very turbulent time initially. It is a credit to the home that he has made exceptional progress since. A staff member told us that this was due in part to having set goals and boundaries for him along with a consistent staff approach. Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: We could see that the manager regularly reassesses the needs of people already living at Station House and new needs are identified. Brochures required by regulation are available to tell people about the services that Station House provides. Although there is no possibility of a new admission currently these documents have been recently reviewed and are up to date. We have advised the Manager that weekly fees should be included to ensure that the information is openly available to people who may enquire. Care Homes for Adults (18-65 years) Page 11 of 31 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. Guidance is provided to staff to help them to provide care and manage risk in accordance with the needs, preferences and choices of those who live at Station House. Evidence: Written plans of care are in place for each person living at Station House. They are clearly presented and are detailed. Dream books have been compiled in appropriate formats to describe peoples individual preferences. Risk assessments are in place too and these had been recently reviewed to ensure they accurately reflect current risks. One person went swimming whilst we were there. Staff told us that this was the persons first swimming session for sometime and they were unsure how he would react. To ensure safety, a staff member visited the pool a few days in advance of the visit and two staff accompanied him. We can see that the manager has reassessed peoples needs and that care plans are updated every six months with it being clear when changes have been made. For the person whose care we looked at in detail the Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: funding authority have not attended a review since 2003. The manager can demonstrate she has taken steps to include them on a number of occasions including writing to express her concerns. She has not received a reply. In the mean time a change in his health is of concern and we have strongly urged that a Best Interest meeting is held under the Mental Capacity Act. This will be discussed further under personal Care and Health Standards later in this report. We joined staff and residents for lunch and could see how residents are offered choices. Staff explained how pleased they are that residents are gaining skills and confidence to express choices and we could see this in action at the table. Care Homes for Adults (18-65 years) Page 13 of 31 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 enjoy a range of social, leisure and educational opportunities. People also enjoy their meals which meet their cultural and dietary requirements. Evidence: Staff are motivated to provide people living at Station House with a range of activities and are continually reviewing opportunities for people. We could see photographs of residents enjoying themselves at a number of different places including Warwick Castle, Longleat and on regular barge trips. We could see that one person had celebrated his 21st birthday by eating out with staff and peers. In addition to regular day trips, most people have timetabled activities such as attending college and for another person this is a goal. We could see that there are recorded activity programmes in place for each person that are reviewed and changed every six months and that they are adhered to. For example one person was reintroduced to swimming Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: on the first day of inspection. Staff had been keen to give the person this opportunity. It involved a lot of prior planning to assess the risks and liaison with the leisure centre staff to agree an acceptable way of promoting the persons dignity at the public session. Two staff accompanied him. They had been unsure how he would respond when he got there but were delighted by how much he had enjoyed it. People living at Station House are not being provided with an annual holiday. The Statement of Purpose suggests that people living at Station House would not beable to cope with changes to routine that a holiday would create. Discussion about the individuals however indicates that two people out of the four living there may benefit from and enjoy a well planned holiday. The manager agreed to look at this as it is important that such decisions are made on an individual basis. People living at Station House originate from other parts of the country and consequently their families live at a distance. We could see that staff try to help people keep in touch by sending letters home updating family members about activities and progress. Since the last inspection a system has been developed to demonstrate how residents specific cultural dietary requirements are being respected. We could easily see at this inspection that people who do not eat pork are provided with suitable alternatives. Also, one person has been supported to lose and maintain a considerable amount of weight loss. We were invited to eat lunch with staff and residents. We could see that lunch was freshly made and was well presented. The mealtime was pleasant and relaxed. People were able to indicate their choices by pointing to what they wanted. We saw people had a choice of three drinks and we saw someone pour their own tea. One resident verbally made requests which were met. Staff explained how pleased they are that the resident now has the confidence to do this. After lunch we asked the manager to reflect on the practice of prompting adults to say please and thank you in their own home. This will ensure people are not treated like children will promote an awareness of power differentials and will remove the risks of behaviours arising from such requests. Care Homes for Adults (18-65 years) Page 15 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are not sufficiently in place to evidence regular health care. Further improvements are required to enable the home to demonstrate that medication is always administered as prescribed to support peoples health and welfare Evidence: We looked in detail at the care provided to two of the four people living at the home. We could see that people are well groomed and that their appearances reflect their personal styles and preferences. From talking to staff it seems that some health care is being provided and medical advice is sought when peoples health changes. There are few health records however, so although appointments are logged in the communal office diary it is difficult for the service to show that appointments have always been kept. This also means that outcomes of appointments are not recorded and this makes it difficult for the home to plan for and evidence how it has acted upon medical advice given. The manager readily accepted this feedback and at the time of writing has informed us how health recording systems have been improved since feedback at inspection. Where medical Consultants have copied to the home letters sent to the GP we can see that medical reviews have taken place. Dental, optical and foot care could Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: not be evidenced. The manager agreed to review record keeping to ensure health services can be evidenced and to ensure greater accountability. One person has experienced a significant change in health over the past year. Staff who identified the changes quickly reported to the GP and unsure what to do next raised their concerns with us at inspection. This person is not able to consent to medical treatment and does not cooperate with medics. A chronological record of letters on file between a number of health professionals show that the home has supported the person to attend scans and has advocated to try to ensure that the medical issues are properly assessed and treated. However there has not been any further progress and no more has been heard since April 2008. Discussion with the manager staff and sight of these letters shows there is concern about the impact the health condition may be having on the persons comfort and behaviour as he is not able to communicate pain or discomfort. The funding authority has not been involved in a review of this persons care since 2003. It is vital now that the manager organises a multi agency Best Interest meeting under the Mental Capacity Act to ensure that appropriate health screening diagnosis and treatment is obtained. Failing this with little further delay the manager should consider referring the matter to Telford and Wrekin under Safeguarding procedures. Since inspection, the registered manager has confirmed to us that changes to this persons health have been reported to the funding authority to try to secure their support. The manager has taken some steps to better account for medication being stored on the premises. Now a form is completed to record any medication received into the home mid cycle and based on advice from a Consultant Psychiatrist who prescribes the medication guidance is in place for medications given as required for agitation. The manager said she checks the medication records daily and there have been no errors. We looked at medication records for two people. We could see that medication records tally with the plans of care and we could also see from checking stocks of medication that all medications were available as prescribed. We could also see that there are no gaps in medication records indicating that people are receiving their medication in accordance with medical direction. We then looked closer by auditing some medication records and comparing them against the numbers of tablets held in stock. This did not tally. Twenty eight diazepam tablets had been dispensed and nineteen remained in stock indicating nine had been administered. Records show thirteen rather than nine tablets had been administered to the person. This casts doubt on the integrity of the records and the administration of the tablets. We feel that the integrity is compromised by not carrying forward in records the number of tablets that remain on the premises at the time that more Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: tablets are obtained. We explained to the manager how she could do this. The Manager had told us that she is now checking medication records daily to meet our requirement for improvement from the last inspection. These checks, findings and actions arising are not being recorded and from our findings at this inspection are not sufficiently extensive in range. The checks are not accurately identifying whether there have been any medication errors. All staff who administer medication received training in 2007. Systems are not in place to assure their ongoing competency to administer. The manager agreed that this would be a good idea and said she would devise and implement an assessment. Care Homes for Adults (18-65 years) Page 18 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. No complaints have been received and there is a good level of satisfaction amongst all stakeholders about the service provided. On a day to day basis steps are in place to keep people safe. The service did not follow safeguarding procedures in response to injuries identified to one person on one occasion. Evidence: We can see that all staff have received training in safeguarding vulnerable adults and a staff member we talked to could describe the forms abuse takes, who can abuse and her role in reporting this should she have any concerns. She said that she definitely feels people living at the home are safe. In the annual return to us the manager confirms that the client group is protected from all forms of abuse neglect and self harm and is unsure what could be done to enhance this. We looked at accident records which showed reports of largely minor incidents. One gave cause for concern and we followed this up further. Injuries to one person had been identified and were well recorded. Medical attention had not been sought in line with policy to check the persons well being at the time or to check that the injuries were consistent with the explanation provided. The issues were not discussed with Social Services and advice was not sought from ourselves. Discussion with the manager showed she knows how to refer and has good links with local agencies. On the basis of an assumption that it couldnt happen here, she had not considered the Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: matter as a potential safeguarding issue and she was clearly upset about this oversight. The manager has explained that the service knows the people who live there well and that the individual concerned can be self abusive. The manager was keen to explain that any ommissions in following procedure were not as a result of complacency. Whilst this is appreciated, we explained that in such circumstances, it is not within the staff or managers remit to mitigate. All such similar concerns should be reported without prejudice, for partner agencies to investigate. The manager vowed that she would not fall into this trap again. The manager should discuss the matter retrospectively with Social Services. No complaints have been received. The complaints policy has been updated to include details of our new address. The manager said she has circulated copies of this to all families. Surveys completed and returned to the manager by families and professionals provide very positive feedback. This will be outlined in more detail within management national minimum standards 37 to 42. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and domestic style property that currently meets their needs. The need to update decor is being addressed. Evidence: A tour of the environment showed it to be clean and fresh. Robust cleaning schedules are in place to maintain this. We could see that the internal decor and flooring is tired. The manager explained that plans are in place to replace both throughout and later in the day a decorator arrived to leave his quote. The suite in the lounge is also threadbare in several places. Again the manager said there are firm plans to replace it. The conservatory is also being renewed and works were expected imminently. Washing and drying machines are in the conservatory which leads from the kitchen. Two entrances to the conservatory however means that soiled linen does not have to be carried through food areas. Looking round the premises showed it to be tidy too with no evident hazards. It is currently meeting the needs of those who live there in a domestic and homely way. The manager gets frustrated by response times to maintenance issues but confirmed that nothing was outstanding at the time of the inspection. Care Homes for Adults (18-65 years) Page 21 of 31 Care Homes for Adults (18-65 years) Page 22 of 31 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. Staff are provided in sufficient numbers and are motivated, competent well trained and supported. Recruitment checks for new staff are obtained in a timely way to ensure they are suitable to work with vulnerable people. However the manager should improve how referees are identified to enable the most recent care employers to comment on applicants suitability to work with vulnerable people. Evidence: The manager tells us that the core staff team are experienced and motivated have worked together for a long time and know the people who live there well. She states there is an appropriate mix of skills and experiences. We were able to verify this by talking to staff about their job, the people who live there and from looking at training records. A staff member told us she is happy at work and feels very well supported by the manager who is willing to listen to new ideas. She said they do the best they can are always pushing the capabilities of the people who live there who respond well to this and are happy. She said there are good opportunities for training and listed a number of courses she had done recently. She is qualified to the national minimum standard but is now doing the next level up. In a survey sent to us by a staff member no concerns are identified and satisfaction with training and support is reported. Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: We looked at training records which were updated in September 2008. This confirms what we have been told that most staff have undertaken most expected training to equip them to undertake their jobs competently. All staff who administer medication received training in 2007. Nothing is in place to assure their ongoing competency. We advised the manager about this and she agreed that it was a good idea and undertook to devise and carry out such assessments routinely. We looked at supervision records and can see that staff are receiving formal supervision regularly. It is positive that the newest staff member has been provided with supervision that exceeds the minimum frequency required. We looked at how new staff are recruited. Not requesting the applicants employment history at application stage is compromising the services ability to identify and explore any gaps in employment and ensure that references are appropriately obtained from the most recent care employer. Therefore we do not judge the previous requirement to explore gaps in employment history to have been met. Other significant checks including police checks had been obtained prior to the person starting in employment. Similarly we can see that an induction work book is completed by new staff but it doesnt appear to meet all the standards with possibly sections missing. We have advised the manager to double check what is in place now meets the requirements for induction of the Skills for Care Council. As such we do not consider the previous requirement to have been met. Following changes in our guidance however this has been changed to a recommendation. Staffing ratios are organised around peak times and enable activities to be undertaken and peoples needs to be met. Care Homes for Adults (18-65 years) Page 24 of 31 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. On a day to day basis the service is managed well and people who live there are happy, settled and are making progress. The service however is not moving forward at an adequate pace and we have identified some omissions in systems which need to be better, more accountably managed. Evidence: On a day to day level the home is managed well. There are sufficient staff with skills to meet peoples needs. The staff team is happy and motivated. People living there are well stimulated and it is evident that social and emotional progress has been made since the admission of those whose care we looked at. External stakeholders are satisfied with the care provided and have no concerns. One parent has said I could put everything is excellent which it is. My son is well looked after by people with excellent qualifications. Another relative said, all the people are very happy. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: Systems however are not well developed to help the home to progress. Although she feels sufficiently supported, the manager who also works in a care capacity at the home, does not have a large infrastructure available to her to support regular professional updates and to proactively improve the service. Not all requirements have been met and overall the service is not developing. In addition the inability to evidence health care well, combined with some omissions in protection, recruitment, medication systems and a lack of quality assurance all conspire according to our guidelines to reduce the services overall rating. The manager is aware that the Fire Risk Assessment is overdue for review and the decreasing mobility of one resident should be considered as part of this. The manager also agreed to carry out individualised fire evacuation plans for the four people who live at Station House. Care Homes for Adults (18-65 years) Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes R 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 1 20 13(2) The Registered Manager must make arrangements to ensure that all medications received into the home are appropriately checked and recorded in (including any medications received mid medication ordering cycle) The Registered Manager must review systems to ensure that all medication is administered as prescribed and that the integrity of the MAR charts in this respect accurately represent administration practice. The Registered Manager must implement an evidenced system whereby she regularly audits the medication records and acts upon any discrepancies. Requirement made January 2007. Not Met November 2008 and carried forward. 31/01/2007 2 34 19 Sch 2 During the pre employment 31/01/2007 of new staff the Manager must ensure that a satisfactory written explanation of any gaps in employment are obtained. Page 27 of 31 Care Homes for Adults (18-65 years) Requirement January 2007. Not met November 2008. Carried forward. 3 41 37 The registered person shall 31/01/2007 give notice to the Commission without delay of the occurrence of any event in the care home which adversely affects the wellbeing or safety of any service user. (This includes notifications of any restraint employed) Requirement January 2007. Not met November 2008 as potential safeguarding concerns not notified. Carried forward. Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 23 13 Steps must be taken to 31/12/2008 ensure that Local Safeguarding reporting procedures are followed at all times to prevent people being harmed or suffering abuse or being placed at risk of harm or abuse. This will prevent people being harmed or suffering abuse or being placed at risk of harm or abuse. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 14 19 The manager should review individual peoples needs in relation to the provision of an annual holiday. The manager should ensure that adequate records are maintained in respect of each person to demonstrate that all specific and routine health screening and treatment are evidenced. This will enable the service to monitor and review care and treatment provided, ensure consistency of care and demonstrate its duty of care. Care Homes for Adults (18-65 years) Page 29 of 31 New recommendation 20 November 2008. 3 20 Steps should be taken to assess and monitor the ongoing competency of staff to administer medication to ensure risk to people is minimised and their health and welfare promoted. The manager should review current induction training to ensure it complies with The Skills For Care Councils up to date Standards. Where applicants have previously worked in care, steps should be taken to ensure a reference is sought from at least the most recent care employer to determine the suitability of the person to work with vulnerable people. This will include always seeking a written employment history from all applicants. The Registered Person should establish and maintain a system for evaluating the quality of services provided at the care home. Requirement made January 2007. Changed to a recommendation November 2008. 4 32 5 34 6 39 Care Homes for Adults (18-65 years) Page 30 of 31 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). 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