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Inspection on 25/11/08 for Strathmore House

Also see our care home review for Strathmore House for more information

This inspection was carried out on 25th 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.

What the care home does well

People wishing to move into the home can be confident that the home can meet their needs and they are invited to visit the home and provided with relevant information before making a decision. People are supported to achieve meaningful lives through personal development and access to leisure, social and recreational activity. The home meets the health and personal care needs of the people using the service People using the service and their supporters can be confident that their views will be listened to and acted upon. People who use the service said, "My keyworker and staff treat me well." "The manager Amanda is great." "I am enouraged to be independent and cook for myself most evenings." Relatives said, "staff are dedicated and supportive," "The care home has a well balanced regime that is caring and supportive for both the carer and residents." "Each student has a range of activities, personal responsibilities, ensuring they have a purpose and meaning to their lives." "Gives the people who live there as much independence as possible." The expert by experience said, "The home was clean and nicely decorated. It was good that the people who lived there had chosen the decor and helped to paint it. It was good that everyone went to work and college and not to daycentres. Everyone uses public transport and travels to work and college independently this is really good." And summarised that, "Overall I think the people at the home were doing lots of activities which is really good but the home is too big. Fourteen people living together is too many. The people we spoke to seemed to be very able and independent, they should consider living independently in their own homes with support rather than a residential home."

What has improved since the last inspection?

The office has been relocated to the ground floor and is more easily accessible to staff and people using the service. Staff vacancies have been filled offering stability to people who use the service. The Manager has been registered with us, the Commission for Social Care Inspection(CSCI) and is reported to have enrolled on Registered Managers Award RMA. A number of environmental improvements have occured since the last key visit including, A new TV purchased for the lounge whihc has also been redecorated and recarpeted. 4 bedrooms have been decorated. The Dining room has been decorated and new flooring put down. Some new furniture has been purchased as well as a new cooker for both the trainnig and main kitchen.Health Action Plans have been implemented and PCCP`s introduced.

What the care home could do better:

The manager could complete the RMA. The service should continue to promote independence and person centred approaches. The expert by experience said, "The home was clean and nicely decorated. It was good that the people who lived there had chosen the decor and helped to paint it. The home was very big. It was confusing when I was walking around because there are lots of corridors and doors that all look the same. It didnt feel very homely because it was so big. It was good that there was a training kitchen but many people dont get to use it because there are 14 people living there. It was good that people are encouraged to cook but again they do not get much opportunity because there are too many people living there." Continue the programme of refurbishment for the service as this will improve the environment for the people who live at the home.. Continue to improve the documentation so that people who use the service can easily understand it, including consideration of pictorial documents, including the menus.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Strathmore House Strathmore House, 27 Queens Park Avenue Stoke-On-Trent Staffs ST3 4AU     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: Wendy Jones     Date: 2 5 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: Strathmore House Strathmore House, 27 Queens Park Avenue Stoke-On-Trent Staffs ST3 4AU 01782596849 Telephone number: Fax number: Email address: Provider web address: strathmore.house@craegmoor.co.uk Name of registered provider(s): Name of registered manager (if applicable) Amanda Johan Lawson Type of registration: Number of places registered: Strathmore Care Services care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD (16) The maximum number of service users who can be accommodated is: 16 Date of last inspection Brief description of the care home Strathmore House provides residential care for up to 16 adults aged 18 to 65 of both genders with learning disabilities. Strathmore House aims to provide a homely environment that will afford people who use the service greater security, choice, independence and a good quality of life. This is achieved by maintaining a relaxed, friendly atmosphere where the staff teams primary objective is to meet individual holistic needs, while maximising the services that the home can offer to the people who live there. Strathmore House aims to offer people who use the service a range of opportunities, both in house and through their activity in the community. All individuals Care Homes for Adults (18-65 years) Page 4 of 31 16 Over 65 0 Brief description of the care home are encouraged to take an active role in life and whilst at Strathmore House, all are encouraged and supported by staff to develop their independent living skills. Strathmore House is owned by the Craegmoor group, which has many other services nationally. It is located in a suburban area close to local amenities and with easy access to the city. The house faces a large park and there is space for car parking. The service user guide does not contain information about the range of fees and charges for the service. The provider should be contacted for this information. Care Homes for Adults (18-65 years) Page 5 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: 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 peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a key inspection site visit of this service undertaken on 25 November 2008 and included formal feedback to the manager. In total the visit took approximately 05.30 hours. The purpose of this visit was to assess the services performance and to establish if it provides positive outcomes for the people who live there. The visit included checking that any requirements and recommendations of the previous inspection visit of 28 November 07 have been acted upon; looking at information the service provides for prospective service users, their carers and any professionals; looking at information that the service provides to people who use the service to Care Homes for Adults (18-65 years) Page 6 of 31 ensure that they understand the terms and conditions under which they have agreed to live at the home and the fees they should pay. Other information checked included assessments and care records, health and medication records; activity and records relating to the menus, staff training and recruitment, complaints and compliments, fire safety and health and safety checks. The manager, staff and people who use the service were spoken to during the site visit and a brief tour of the building was undertaken. Before the visit began, the service provided its own assessment of its performance, in the form of an Annual Quality Assurance Assessment (AQAA). Surveys were sent out to people who use the service, relatives, staff and any professional that has involvement in the service. We have received six surveys from people who use the service, six relative, seven staff and one health professional, the main points are included in the following report. We were accompanied by an expert by experience and his mentor during part of this visit. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. What the care home does well: What has improved since the last inspection? The office has been relocated to the ground floor and is more easily accessible to staff and people using the service. Staff vacancies have been filled offering stability to people who use the service. The Manager has been registered with us, the Commission for Social Care Inspection(CSCI) and is reported to have enrolled on Registered Managers Award RMA. A number of environmental improvements have occured since the last key visit including, A new TV purchased for the lounge whihc has also been redecorated and recarpeted. 4 bedrooms have been decorated. The Dining room has been decorated and new flooring put down. Some new furniture has been purchased as well as a new cooker for both the trainnig and main kitchen. Care Homes for Adults (18-65 years) Page 8 of 31 Health Action Plans have been implemented and PCCPs introduced. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 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 10 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. Prospective people are provided with relevant information which enables them to make a decision about moving into the home. They can also be confident that their needs will be assessed and will only be offered a place if their needs can be met. Evidence: The service told us in the AQAA that, The home has a Statement of Purpose which is reviewed and updated as required. There is a Service User Guide which is available in an easy to read pictorial format. A detailed assessment is completed prior to admission. Prospective service users are invited to the home for visits/overnight stays as necessary. The views of people who use the service are taken into consideration before an admission. People are given a contract between themselves and Strathmore House. We saw that the service has a Statement of Purpose that has been updated since the last key visit, additional minor amendments are needed, it should include the fee range and the additonal cost of the service. In surveys four relatives said, I always Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: receive enough information. Two said, I usually receive enough information. One relative said, I am in regular contact with my daughter and the home, they provide me with the information I need. Six people who use the service said in surveys, that they had received information about the service, and all six said that they had had an opportunity to visit the home before deciding to move in. The expert by experience spoke to one of the newer people at the home and reported that, She is very happy at the home because she gets to do lots of activities. She used to live independently but this did not work out. We looked at a sample of three pre admission assessments, and saw very good information about the needs of the indivdual who are assessed, there is evidence that people have been involved in the assessment process and have had the opportunity to visit the home prior to moving in. Care Homes for Adults (18-65 years) Page 12 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. People who use the service are supported to make decisions about their own lives including taking risks and a record is kept within their individual plan. Evidence: The service told us in the AQAA, Each of the people who live here has a Person Centred Care Plan (PCCP) which has been completed with each individual, their families, key worker and other professionals where required. Included in the PCCP are individual care plans and risk assessments. We looked at three care files and saw that people have support plans in place that are based upon their assessed needs, risk assessments have been completed where they are needed and there is evidence of regular reviews and updates of both support plans and risk assessments. We spoke to people who use the service, one person said, Id like to be more independent, staff help me with the things I need to know. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: The expert by experience reported that, One person I spoke to did not know what a care plan was. This is something that needs to be explained as everyone should know what their care plan is and be able to decide what goes into it. We looked at the records of one person who requires some one to one support, and spoke to staff about the type of assistance that is needed. We saw that there is a very detailed action plan in place that gives the staff team clear guidance about how they should engage the person and respond to his needs. One member of staff said, It can be quite intensive sometimes especially if you are expected to provide the one to one support for the whole shift. We have received feedback from a health professional who said, I have raised the issue of person centeredness and feel the service needs to become less group orientated and focus on individualised care. We looked at a sample of peoples financial records and checked that balances were accurately maintained and can confirm that they are. The expert by experience said, I asked one person if he had his own money. He said that he did and that it was in a tin in the office. He said that the money in the tin was for activities that he did during the week. He said that he got his personal allowance on a Saturday to go out and spend on what he wants. Why do people not go to the bank and get their money? We spoke to the manager about this and understand that all people have their own bank accounts, money is withdrawn on a weekly basis, calculated for each individual based upon their known needs, they keep this money in a locked box in their rooms. Any additional money is secured in the office. We saw that financial procedures are robust. Care Homes for Adults (18-65 years) Page 14 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 who use the service can be sure that they will be supported to access a wide range of activities and work experience opportunities and are able to make decisions about their day to day life. Evidence: The service told us in the AQAA,People are supported to access work and college placements. Social and recreational activities are encouraged e.g. swimming, basketball, athletics, drama group, craft sessions, aerobics, kayaking, pub, cinema, meals out, snooker, crown green bowling. All individuals are encouraged to access local community facilities e.g. shops, park, library. People are supported to maintain relationships with family and friends. Relatives said, The service provides outings and a wide range of activities, more than Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: I could organise. My relative has a good social calendar. The expert by experience told us that, One person said that he chooses what time he goes to bed and what time he gets up in the morning. He showed me that they have a training kitchen where the people that live there are taught how to prepare meals and drinks. It is good that they have this. He showed me the cleaning rota on the wall. All the people that live there do cleaning everyday and on a Sunday they help to prepare the Sunday lunch. This is good. It would be good if people could get more involved in cooking their own meals. The expert by experience also commented, I asked one person what activities he does during the week and at the weekend. He seemed to do a lot of activities. He also told me that he takes care of the garden and that they all go over to the park for picnics regularly. It is good that that people have so many activities outside of the home. I was also told that nobody who lives in the home goes to a day centre, they all go to work or to college. This is really good. The expert by experience spoke to another person, and said, A person told me that he works during the week as a labourer and gets paid to do this work. It is really good that he has a paid job. The person also told me that he chooses the activities that he does during the week and at the weekends and cooks for himself every night, this is really good. While talking to people we saw that they are actively involved in food preparation and cooking, there is a rota for this. The expert by experience commented that, People showed me the menu. It was all written and was quite confusing, it would be better if there were some pictures on it. There were two choices on the menu. I was told that the staff asked everyone what they want on the menu and then they go and get the food. It is good that everyone is asked what they want but with 14 people all choosing food does everyone actually get their choice? I was shown a separate menu for people who are vegetarian. This is good. The manager told us that they try to ensure that people living at the home have an opportunity for a holiday if that is what they wish to do. The expert by experience also reported, I asked if people go on holidays and was told that they did. One person told me that they are given three options and they all take a vote. They go to the place with the most votes. I asked if they could have more than three options and was told that they could if they wanted them. It is good that they get to choose their holidays but what happens if they dont want to go to the place that is chosen? Do they have the option to go somewhere different to the others? Care Homes for Adults (18-65 years) Page 16 of 31 Care Homes for Adults (18-65 years) Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that their health needs are monitored and met, and medication is well managed, promoting peoples health and welfare. Evidence: The service told us in the AQAA that, People are supported to attend healthcare appointments/checkups. People have a Health Action Plan. People have a designated Key Worker and are assessed to ascertain their ability to self medicate. Medication is stored and administered as per Company Policy to those people unable to self medicate. People told us that staff treat them with respect, and we observed some good interactions throughout this visit, but a relative commented that her daughter should be better supported with her personal hygiene and a health professional said, There appears to be inconsistencies with some service users. ie clean, well presented and on one occasion less than clean, with dirty nails. Also I have observed some staff speak sharply to some people. We spoke the the manager about some of these comments, she said, that issues had arisen but staff have received guidance through training and Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: supervision and she is confident that these issues no longer occur. We saw that people who use the service are registered with a GP and have regular appointments at the dentist, opticians and with chiropody if needed. Specialist health services are also involved with some people. We saw that the service has introduced Health Action Plans. A Health Action Plan (HAP) is an individual plan, belonging to a particular person, that explains that persons health needs. It also describes what has to happen for those needs to be met. A health professional said in a survey, The service has received specific training to help meet the needs of a person they care for, we are in the process of providing other relevant training. We looked at a sample of medication records(MAR), these are properly maintained. The service records the stock delivery on the MAR, this enables them to carry out an audit of the medication they have in the home. We saw that the medication storage has improved since the last inspection and is now suitable and safe. We noted that two people currently self medicate, there are risk asessments in place. We recomend that the service further promotes people rights to self medicate if they choose to and if it is assessed as safe for them to do so. We saw that where people are prescribed medication as required a protocol or clear instruction for its administration has been agreed and signed by the GP. We have been told that staff who have responsibility for the administration of medication are trained to do so and are assessed as competent. We didnt see these records during this visit. Care Homes for Adults (18-65 years) Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be sure that if they have any concerns they will be listened to and acted upon and can be confident that staff have been trained to recognise and report suspected abuse. Evidence: The service told us in the AQAA that, Staff are aware of and adhere to Company Policy and procedures relating to complaints. The complaints procedure is displayed on the notice board. A pictorial complaints procedure is also available. Staff receive POVA training. Staff are aware of and adhere to Company Policy relating to peoples monies. Information regarding local advocacy groups is available and accessible. We saw that the complaints procedure is on display in the home, we spoke to people who use the service about what they would do if they had any concerns or complaints, and we looked at the record of complaint that the service maintains. We saw two complaints have been recorded and also saw that the service has responded to them within the time frame of the company policy. We havent received a complaint about this service since the last key inspection site visit. People who use the service say in their surveys that they know how to complain and who to go to with any concerns. During the visit people said, Id speak to Amanda the manager because I know she will sort out things. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: A health professional said, The manager has been responsive to queries and concerns. Relatives said, If there are any problems I speak to the staff and resolve the issues. The expert by experience reported, I asked one person if he knew how to complain when he wasnt happy about something, he said that he would go and talk to Amanda the Manager and she would sort it out. I asked what happens if the complaint is about the staff, I was told that he would write it down and then it would go to the Manager to sort out. It is good that the people that live there know how to complain and who they can go too. Is there anyone independent that they can complain too if the complaint is about the Manager? We spoke to the manager about this query, she stated that if necessary she would refer people to the independent advocacy services available. The manager also said that through the Your Voice initiative people have the opportunity to discuss any concerns outside of the home and most have regular contact not only with family and with staff who organise activities outside of the home, but with people they work with if they have a placement. We looked at the staff training records and saw that staff have received training in recognising and reporting abuse. The service has policies and procedures in place in relation to safeguarding people. We are not aware of any saefguarding referrals since the last key inspection visit. We have also looked at recruitment records and found them to be satisfactory. Care Homes for Adults (18-65 years) Page 21 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 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 clean, well-maintained and homely environment that currently meets their needs. Evidence: The service told us in the AQAA that, People are encouraged to personalise their own rooms with personal items and furniture and are involved with choosing decor for individual rooms. The home is kept clean. Staff receive training on infection control. The expert by experience said, Amanda, the Manager told me that there are 14 people who live in the home. They have room for 16 people but that would mean that they have to share bedrooms so they only have 14 and everyone has their own room. It is good that people dont have to share a bedroom. I asked if we could have a look around so Amanda asked one of the people who lives there to show me around. The house is very big and there are a lot of doors and corridors. I felt it was quite confusing to know where you were. Since the last key inspection visit we have been told that some environmental improvements have taken place, we saw that the lounge has been redecorated and refurbished, the ground floor toilet and bathing failities have been improved. The office Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: has moved to the ground floor and is now in a central position for ease of access to people who use the service and the staff team. A new bedroom has been created in the old first floor office space. We saw this bedroom and can confirm that it is meets the minimum standards in terms of the space it provides. The expert by experience reported that, I spoke to one person who showed me around his home. He showed me his bedroom. He told me that he chose the colours in his room and decorated it himself. He also chooses and buys his own bed linen. This is good. He had a play station and a television in his room so that he can go in there and be on his own if he does not like the programmes that the others are watching in the main lounge. He told me that the staff knock on his door and wait for him to tell them they can go in. We saw three people who showed us their bedrooms, they all said that they had been able to choose what they had in their rooms and had been involved in choosing the colour scheme and decor. The manager informed us that the service has an on going maintenance and development programme. Care Homes for Adults (18-65 years) Page 23 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. People who use the service can be confident that staff are provided in sufficient in numbers, have been properly recruited, trained and are committed to ensuring needs are met and the promotion of peoples independence. Evidence: The service told us in the AQAA that, New staff complete an induction file during their first 6 months of employment. All staff receive mandatory training which is documented in the homes training file. Regular staff meetings are held and the minutes are made available to all staff. Staff supervisions are carried out every 2 months and staff receive an annual appraisal. Craegmoor has a robust recruitment process which meets CSCI requirements. People said in surveys, My keyworker and staff always treat me well. The staff are nice to us. Five people said, the staff always treat me well. One said, they sometimes treat me well. We spoke to this person and confirmed that he is happy with the service he receives, he knows who is key worker is and confirmed that he meets with them regularly to discuss what he wants to do. We saw that staffing levels for the day of the inspection site visit appear to be Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: satisfactory, the staff roster showed that the staffing levels are typical, but there is some flexibility in the rota to allow for activities. The managers hours are additional to the support team. Staff said in surveys that, Sometimes there are not enough staff to facilitate individual activities although these are promoted by the service. Sometimes staff are hard pressed to meet individual needs. We talked about staffing levels and recommend that they are kept under review to ensure they are adequate at all times, particularly as the service is currently providing one person with 1:1 support while in the home and 2:1 while out of it. We looked at staff recruitment records, they are properly maintained. We looked at the records of staff meetings and can confirm that meetings are held regularly. The service has told us that staff meet on an individual basis with the manager every two months. Four staff said in the surveys that, I meet with the manager regularly, One said, I sometimes meet with my manager, and two said, I often meet with my manager. Care Homes for Adults (18-65 years) Page 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be sure that they live in a service that is properly managed and that continually strives to improve. Evidence: The service told us in the AQAA that, We have a trained Manager in post who has had previous management experience within the learning disability field. The manager has been in post for 15 months and is now fully competent with Craegmoor systems and procedures. Unannounced audits by Craegmoor Clinical Governance Team are carried out. Staff receive Health and Safety training. Manager has completed IOSH training. Craegmoor have up to date policies and procedures that are regularly reviewed. Manager and staff team receive support from and have access to Area Manager and Divisional Managing Director. People who use the service receive an annual questionnaire relating to the service they receive. The Manager is enrolled on the RMA and has been registered and approved by us. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: We saw that the organisation undertakes audits of the service regularly but the records of the most up to date visits were not available in the home as they should be. We saw that the service has a development plan and the manager knows what she needs to do to improve. We spoke to people who use the service about fire safety and what to do in the event of a fire, they gave satisfactory accounts of the evacuation procedures for the service. Records show that fire drills have taken place and staff have received fire training. The service has provided us with an AQAA that provides information in sufficient detail to make a judgement about the type of service that is offered. It also tells us that equipment in the home is serviced regularly, we checked the certificate of insurance and the registration are on display in the home and are up to date. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 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 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 1 The Service User Guide should contain the fee range and the costs of the service. So that people who may use and use the service know what the fees and costs are. The service should continue to improve the way it promotes person centred thinking. To ensure that people who use the service receive individualised support. The service needs to ensure that people who use the service know about their support plans and are involved in there implementation and review. The service should ensure that people can make independent choices about holidays and activities. To ensure that the home is delivering a person centered service. The service should produce menu plans that are user friendly so that we can be sure that people who use the service can make informed choices about their meals. The service should ensure that people who use the service receive the personal care they require. The service should continue to promote peoples independence by supporting and encouraging self medication where safe to do so. 2 6 3 6 4 14 5 17 6 7 18 20 Care Homes for Adults (18-65 years) Page 29 of 31 8 33 The service should keep staffing levels under review to ensure that there are sufficient staff at all times to meet the needs of people who live in the home. The manager should complete the Registered Managers Award. The service should ensure that the monthly reports on the conduct of the service are available in the home. So that people who use the service have access to this information and can see what action the service needs to tkae to continually improve. 9 10 37 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. 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