Inspection on 15/01/09 for 11 Tarragon Gardens

This inspection was carried out on 15th January 2009.

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

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

Other inspections for this house

11 Tarragon Gardens 17/01/08

11 Tarragon Gardens 31/08/06

11 Tarragon Gardens 16/03/06

11 Tarragon Gardens 28/09/05

11 Tarragon Gardens 02/02/05

11 Tarragon Gardens 07/07/04

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Bryndale Avenue, 41 Flats 13, 14 & 18

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Tarragon Gardens, 11 Tarragon Gardens, 11 Frankley Birmingham West Midlands B31 5HU     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: Gerard Hammond     Date: 1 5 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 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: Tarragon Gardens, 11 Tarragon Gardens, 11 Frankley Birmingham West Midlands B31 5HU 01214112133 01214112133 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): RNID Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 4 Number of places (if applicable): Under 65 Over 65 0 0 mental disorder, excluding learning disability or dementia sensory impairment Additional conditions: Residents must be aged under 65 years 4 4 The primary care needs of all service users will be that of Sensory Impairment. Date of last inspection Brief description of the care home 11 Tarragon Gardens is registered to provide accommodation, care and support for four people with sensory impairment. The service is run by the Royal National Institute for the Deaf and the premises owned by Nehemiah Housing Association. The house is in a modern terrace, with the main accommodation on the ground floor. Above this are two flats, accessed independently via separate front doors either side of the main entrance to number 11. One flat is occupied by a person using the service, and the other houses the managers office and is also used for staff sleep-in accommodation Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home In the main house there are three single bedrooms with en-suite shower facilities, an open plan living / dining area, a separate kitchen and also a separate shower room / w.c. The residents flat has a bedroom, living room, kitchen (with washer / drier) and bathroom. At the rear of the property is a secure private garden. There is car parking space at the front of the house. The Home is situated in the Frankley area of Birmingham, close to Northfield shopping area. Local amenities such as cinema, bowling alley, gym and restaurants can also be easily accessed at nearby Rubery Great Park. The area is well served by public transport. Information about current fees should be obtained directly from the service provider. 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: 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: This is the homes key inspection for the current year 2008-9. We gathered information from a number of places to inform the judgements made in this report. The Manager completed an Annual Quality Assurance Assessment (AQAA) and sent it back to us.This is a self assessment that focuses on the outcomes for people who use the service and provides us with some numerical information about it. We visited the home and met with residents, the Manager and other members of the staff team. Records including previous inspection reports, policies and procedures, personal files of people using the service, care plans, staff files and other documents were also looked at. Direct observation of care and support, and feedback to questionnaires about service quality provided further evidence for judgements made. Thanks are due to the residents, the Manager and staff for their co-operation and Care Homes for Adults (18-65 years) Page 6 of 31 support throughout the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: The Statement of Purpose and Service Users Guide need to be updated and made available, so that important information about what the service provides is readily accessible. Work on peoples care plans needs to be completed. Better use should be made of person-centred approaches, and each resident should be being supported to work towards clear goals. This is so that they can get the support they need to achieve the things that are important to them. Record keeping about peoples daily support and activities needs significant improvement. This is to ensure that proper information is available to help evaluate progress in meeting goals, and plan for the future. Health action plans need developing. It is also recommended that written protocols for PRN (as required) medication be placed on the medication file, as previously. This will help to ensure that staff have ready access to clear guidance about when to give this medicine. Doing these things will help residents to keep healthy and well. The main living area of the home needs refurbishment and redecoration. This is so that residents continue to enjoy living in a homely and comfortable environment. Quality assurance surveys should be collated, and the information gained used to show how residents views underpin the review and development of the service. A number of issues relating to the staff team need attention. The service is still too Care Homes for Adults (18-65 years) Page 8 of 31 dependent on staff from external agencies, though it is hoped that recent recruitment will address this. All vacant posts should be filled so that residents can enjoy continuity of care. Action is needed to improve the numbers of staff holding qualifications at NVQ level 2 or above. Also (particularly bearing in mind the specialist nature of this service) to ensure that all staff have training in sign language. Arrangements for supervision are in need of improvement too. Addressing these issues will help to ensure that staff have the knowledge, skills and support they need to do their jobs well. The arrangements for regular testing of important equipment are in need of review. Staff need to be clear about who is responsible for carrying out tests, and when. This needs to be monitored to make sure that jobs get done at the right times, and on a regular basis. This is so that all people living and working in the home can stay safe and well. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Up to date information about what the service provides should be available, to help people decide if the service is right for them. Peoples needs are assessed, so that their care and support can be properly planned. Evidence: A Statement of Purpose and Service Users Guide were in place at the time of the last inspection. These were not available on the day of the fieldwork visit to the home: the Manager said that she is in the process of updating these documents. It is recommended that the revised documents make clear statements about what the service provides, and includes all of the information required under the Care Homes Regulations (2001) (see Regulations 4 and 5, and Schedule 1) and National Minimum Standards (see Care Homes for Adults 18-65, Standard 1.2). This is so that people have all the information they need to help them decide if the service is right for them. There has been one admission to the home since the last inspection, so there are currently no vacancies. Previous reports show that residents needs have been Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: assessed. Sampling of the new residents personal file showed that detailed assessments are in place as required. However, it was noted that some difficulties were encountered in arranging the placement, as the person did not want to move away from his area of origin. The file showed previous involvement of an Independent Mental Capacity Advocate in best interest decisions, as his choice of suitable options was said to be very limited. The Manager reported that, after some initial difficulties, he appears to have settled in to his new home. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are needed to care planning and management, to make sure that people get the support they need in ways that suit them best. This will also ensure that they are helped to achieve the things that are important to them. Evidence: At the time of the last inspection it was reported that some progress had been made with developing residents care plans. A new manager has been appointed since then and she is in the process of reviewing care management within the home. She was able to produce evidence of the work she has done to date, but this is very much a work in progress. Sampling of residents personal files showed that care plans are in place. These contain much information about peoples care needs and how they like to be supported. Evidence was also seen that plans have been kept under review, as required. Plans included risk assessments, though it was noted that on one of the sampled files, the risk assessment index did not correlate fully with the documents held on file. The Manager said that risk assessing is also under review, as part of the Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: work that she is currently doing on care management. Available evidence shows that care management within the home continues to need development, and this was discussed with the Manager. Previous reports have recommended the expansion of person-centred approaches: this remains the case. It is recommended that specific training be given to all staff. This is so that everyone can understand how using such approaches can improve their practice and benefit the people in their care. The new Manager is making clear efforts to develop care plans to include residents goals, and to make them measurable. This is is to be commended: it is essential that all staff understand the importance of doing this. This is to ensure that the support they give to people in their care actually helps them to achieve the things they really want. The last report shows that key workers write a summary report each month for each resident. As previously suggested, this provides an ideal opportunity to keep plans under constant review, and to ensure that people are getting the support they want in the ways that suit them best. This will only work if staff understand what they are doing and why they are doing it. If completing the monthly report is merely a paper exercise, then it will have little value. It is suggested that key staff meet with the resident before writing the report. This meeting can be used to plan activities for the coming weeks and to review the goals that were set on the previous occasion. Doing this will help to identify if goals set are realistic and achievable, and provide some clear evidence on progress made. It should also help residents to recognise their responsibilities and the actions they need to take, in order to achieve the things they say they want. Putting these recommendations into practice would help to make peoples care management more systematic. The benefit of this should be seen in everyone being clearer about what they need to do. At the present time it is difficult to see from available records how people are involved in making decisions about the important things in their lives. However,during the fieldwork visit staff were directly observed asking residents about what they wanted to do, making choices about going out, and what they wanted for lunch and evening meals. Following the recommendations made above, and making sure that appropriate records are kept, could improve this situation significantly (see next section Lifestyle also). It should be acknowledged that the Manager is working hard to put systems in place to address these issues but that she is having to do this work without the support of a Deputy Manager, as originally intended (see section below Conduct and Management). 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have opportunities to do things they want, but recording about their activities is in need of significant improvement. This is so that important information is available to plan peoples support to help them achieve their goals. Residents are able to keep in touch with people who are important to them. They enjoy a varied diet of their choosing. Evidence: Previous reports have shown that records relating to peoples activities were in need of improvement. This continues to be the case. Sampled files included some examples of activity programmes, but (as previously) it was difficult to make an informed judgement about what people are actually doing. This is because the quality of recording in this area is generally well below standard. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: Peoples activity opportunities are a prime indicator of their quality of life. Supporting people to choose and take part in activities presents the clearest opportunities for them to achieve their stated goals. That is why it is important that there are clear links between what people get to do and their agreed goals. Activities should be purposeful and make a clear contribution to helping each individual achieve the things he or she says they want to do. Staff need to be proactive about how these things are agreed with residents. It has to be acknowledged that residents may agree to follow a particular course of action, and then decline when opportunities are actually presented. However, it is important that doing nothing does not become a soft option, because it is easier than dealing with the root causes of why residents may say one thing then do another. All parties have responsibilities in making this work. Accurate record keeping is important because it provides the information necessary to plan effectively, and then to make judgements about what works and what might need to be done differently. Staff already have appropriate tools at their disposal to keep required records. Sampling of these records during the fieldwork visit showed that these are not being used properly. This was discussed with the Manager, and action needs to be taken to ensure that staff are clear about what they should record and how to use the tools effectively. Staff record keeping should be monitored and evaluated through regular supervision: persistent failure to keep records appropriately should be a disciplinary matter. Available records showed that residents go out to local shops, use local pubs, cafes and restaurants, and attend social clubs and events. One resident goes to college three days in the week, learning independence skills,cooking and literacy. People get the support they need to keep in touch with their families and are able to maintain friendships and relationships outside the home. One person recently returned from spending a few days away with his family, and residents have been supported to go away on holiday during the past year. They were also actively involved in choosing the new vehicle recently purchased for the home. The Manager has introduced a rolling menu programme, to further encourage healthier eating. Records provided evidence of variety and choice: food stocks were examined -these were ample and included fresh produce. The small size of the home means that alternatives to the planned menu can always be catered for. One resident was observed negotiating with staff about what he wanted for his evening meal. Another resident has a specific medical condition that requires careful dietary management. Information about this was displayed on the kitchen notice board, and he has a designated cupboard for storing his food in. A new American stylefridge has been installed in the kitchen: packages of food were labelled with the date of opening. It was noted that the record of tests of fridge and freezer temperatures had not been completed every day, in accordance with accepted good practice. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are generally well supported to stay healthy and well. The support they receive could be improved by increasing the number of staff working in the home who can communicate by signing, and developing residents health action plans. This would help to ensure they get the support they need in ways that suit them best, and that their health and wellbeing is promoted proactively. Evidence: Interactions between residents and staff were directly observed during the fieldwork visit. They have a good rapport and to get on well together, and appear relaxed and at ease in each others company. People were dressed in clean clothing of good quality that was age and gender appropriate. Residents generally tend to their own personal care needs, with staff providing prompts or supervision as necessary. Staff were observed supporting communication with signing. However, staff training information provided by the Manager shows that action needs to be taken to improve the number of staff working in the home who are able to do this. The Manager said that this situation should improve in the near future when newly appointed staff are able to take up their posts. This is a service specialising in caring for people with hearing Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: impairment. Clearly, it is important that appropriately trained staff are available to ensure that peoples communication is supported effectively at all times. People are able to choose what time they get up and go to bed, and routines in the home are flexible according to individuals preferences. As suggested above, the management of peoples support could be improved by developing the use of personcentred approaches and more effective goal-setting and monitoring. This would help to ensure that people are getting the support they need in all the areas that that are important to them, so as to achieve their goals. Sampling of personal records showed that residents are supported to access services from other health professionals on a regular basis. These included appointments with GPs, Consultant Psychiatrists, Psychologists, local Mental Health teams and Community Nurses, Physiotherapists, Dietician, Optician and Dentist. A particular issue was noted by staff on the day of the fieldwork visit. The member of staff was observed taking positive action to ensure that the person concerned was seen by their doctor, without delay. She accompanied him to the surgery to ensure that he was appropriately supported. As previously reported, it is recommended that Health Action Plans are developed. Setting clear goals and devising appropriate strategies to actively promote individuals health and wellbeing should guide this process. This is to ensure that peoples healthcare needs are met in a proactive manner,rather than reactively. Medication in the home is now administered using the Boots Monitored Dosage System (MDS). Staff interviewed said they liked this better than the previous one, and that they had received training in using it. Two staff sign for medication each time it is given, to help prevent errors. The record includes a list of specimen signatures. The Medication Administration Record was examined and had been completed appropriately. Records showed that (separate) medication audits had been carried out by the Manager and the Pharmacist. It was recommended that written protocols for PRN (as required) medication be placed on the file with the administration record, in keeping with previously observed good practice. The medication store was clean, tidy and secure. 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 know that their concerns are listened to, taken seriously and acted upon. Action is taken to protect residents from abuse, neglect or self-harm. Evidence: The service has appropriate policies and procedures in place covering complaints and safeguarding (adult protection). The Complaints record was examined. This, and the annual Quality Assurance Assessment (AQAA) shows that no complaints have been received since the last inspection. We have not received any complaints in respect of this service. Previous inspection reports show that residents know their rights to complain, and are able to do this. The Manager said that she is currently seeking to develop links with local advocacy services, so that residents can have access to independent support if they wish. This has been made available to them in the past. Staff information shows that most of the current team have done training in the protection of vulnerable adults from abuse. New staff are scheduled to attend the next available training session. Staff on duty were able to identify the different forms that abuse can take, and say what action they should take in the event of witnessing or suspecting that abuse has taken place. A recent incident provided clear evidence that procedures are understood, and that appropriate action is taken when required. 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. Residents live in a house that is homely, comfortable and safe. Some improvements are needed to the main living areas, and shared spaces are inadequate. The home is kept clean and tidy, and satisfactory standards of hygiene maintained. Evidence: A tour of the home was carried out in the company of the Manager. The registered premises are part of a modern terrace. The main house is all on the ground floor, and there are two separate flats (accessed via different front doors) on the first floor above this. Three male residents occupy the three single bedrooms in the main house, and a female resident occupies one of the first floor flats. The single rooms all have en-suite toilet and shower facilities. One resident has had his en-suite refitted since the last inspection. The new resident has expressed a preference for a bath rather than a shower. The Manager advised that she is currently obtaining quotations for the work necessary to carry out this conversion. Previous reports have shown that the only bath available for residents to use is situated in the other upstairs flat. Accessing this involves going outside, so this is not a satisfactory option. The resident occupying the other flat enjoys sole use of her own bathroom. She said that that she has been much happier since she moved out of the main house, when the flat became vacant. Peoples bedrooms are all individual, with personal possessions and effects in evidence. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: The living room / dining area is in need of refurbishment. The Manager showed that she is making efforts to involve the residents directly in choosing new furniture and colour schemes. She advised that she is in the process of arranging for the room to be redecorated. Communal space in the main house is limited. Bedroom access is immediately off the living area. As previously reported, there are no other rooms in this part of the house to receive visitors or have private meetings / conversations, other than in the office or individuals bedrooms. Previous reports have also shown that the other upstairs flat is technically available for residents use. However, it is currently being used as the Managers office and staff sleep-in room. There is an enclosed private garden to the rear of the house. This was landscaped over twelve months ago, to improve facilities and access for the residents benefit. Staff reported that the poor summer last year limited its use somewhat. In spite of the shortcomings reported above, staff continue to do what they can to ensure that the house is kept clean, comfortable and homely for the residents. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are needed to staff training and development, and arrangements for supervision. This is to ensure that residents are looked after by a qualified and well supported staff team. Evidence: Recuitment of staff is processed centrally within RNID. Sampling of staff files showed that required documents were in place. Records included completed applications and work histories, two written references, proof of identity and evidence of checks with the Criminal Records Bureau. The Manager was able to show work done in developing staff files, so that these are better organised and contain appropriate documentation. It is recommended that files are indexed, to make location of information easier. However, available records provide evidence that every effort is made to ensure that staff employed are fit for the job. Staff training is also organised centrally, on the basis of information provided by each establishment. The Manager provided a copy of the current staff training plan. It is recommended that the plan be developed to show specifically when training has been completed (with dates) and dates when refreshers are due. Available information shows that the numbers of staff holding qualifications at NVQ level 2 or above continue Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: to be below the target minimum of 50 . This was identified as an issue at the last key inspection, though it should be acknowledged that there have been changes in personnel working in the home since then. Given the specialist nature of the service, the number of staff holding qualifications in British Sign Language (or equivalent) is also a cause for some concern. The Manager indicated that this should improve when new staff take up their posts. Though this may be the case, the ability of staff to communicate effectively with residents has to be a clear priority. It is recommended that early action be taken to provide support for all staff working in the home to be trained in signing. The Manager said that a new Deputy has been appointed, and is due to commence work shortly, subject to required clearance. She reported that five new members of staff have been recruited, and it is hoped that these will also be able to take up their posts in the near future. She advised that vacancies are currently being covered by existing team members and agency staff. Though efforts are being made to use regular agency staff that residents are familiar with, it is clearly desirable to fill permanent vacancies without delay, so as to promote continuity of care. Sampling of staff records showed that formal supervision of staff is not yet up to standard (minimum of six times in any twelve month period, pro rata for part-time staff). It was also noted that minutes of staff meetings showed that recent attendance is poor. These issues were discussed with the Manager. It has to be acknowledged that the vacant deputy post has placed additional pressure on the Manager, and she was able to show that efforts have been made to schedule supervision appointments appropriately. Staff must recognise their responsibilities to attend individual supervision and staff group meetings, if these are to have any value. It is recommended that a timetable be drawn up well in advance so that all parties can plan for these meetings appropriately. Similarly the organisation must make appropriate arrangements to ensure that staff are able to attend group meetings regularly. It is also recommended that a supervision contract be established so that all parties are clear about their responsibilities. Staff must also recognise that supervision and staff meetings can only be worthwhile experiences if they make clear commitments and positive contributions to the process. 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. The Manager is working hard to develop the service, but a number of improvements are required to make sure that the home is well run. Regular checks on important equipment must be carried out effectively, to ensure the health, safety and welfare of people living and working in the home. Evidence: A new Manager has been appointed to run the home since the last key inspection. She is qualified to NVQ level 4 and holds the Registered Managers Award (RMA). She reported that she is in the process of completing her application to become registered with us, the commission. A new Deputy Manager was also appointed at the same time: unfortunately this person left having only been in post for a short while. It should be acknowledged that this has inevitably placed additional pressures on the new Manager at a time when she is trying to establish herself, develop the existing staff team and the systems to manage the home. A significant proportion of her time has also had to be devoted to recruiting staff to fill vacancies. A balance needs to be struck between the time she spends working in the office upstairs and being able to have a visible Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: presence in the main house, with the residents and members of the staff team. However, it should also be acknowledged that establishing and managing these priorities is no easy feat. The absence of a Deputy has been particularly relevant in this regard. She was able to provide evidence of the hard work she has done to develop care management systems. She was also directly observed encouraging a member of staff to take responsibility for reviewing a residents risk assessment. This demonstrates a positive attitude to providing opportunities for staff to learn and develop. As indicated in the previous part of this report (Staffing) there is a good deal of work to be done in developing staff training and supervision. Also, recording of activities and daily support needs to improve. Addressing these issues will play an important part in the overall development of the staff team, with positive benefits for the residents. It is important that the organisation makes sure that the Manager gets all the support she needs, to make sure that the service is well run. The Manager said that visits and reports on behalf of the Registered Provider required under Regulation 26 (Care Homes Regulations 2001) are being done regularly. She was able to show copies of these reports on her computer. She said that surveys / questionnaires have recently been circulated, as part of the homes quality assurance activity. One reply had been received from a social work professional. This gave positive feedback about the support given to one of the residents during a very difficult time in his life. In particular, it gave recognition to the work staff had done to engage positively with him, follow his care plan and keep on trying in spite of difficulties encountered. As previously reported, it is important that this exercise be completed and the opinions of people using the service properly recorded. This is so that their views can be seen to underpin the review and future development of the service. Previous reports have recommended that the development of person-centred approaches and identification of clear agreed goals will make a positive contribution to this. Safety records in the home were sample checked. Testing of the fire alarm and emergency lighting systems has been carried out, but there were a number of gaps in the record. Fire drills have previously been carried out regularly, but the last one recorded was over six months ago. Fire-fighting equipment has been serviced. Staff on duty were not able to say clearly how these checks are managed. There is a health and safety checklist completed each day morning and afternoon: this includes building security and water temperatures. The record of fridge and freezer temperatures showed a number of gaps. Packages of food stored in the fridge had been correctly labelled, showing the date of opening. Portable appliance testing of electrical equipment has been carried out. The number of gaps in the records of tests of essential equipment suggests that practice in this area needs to be reviewed. It is important that such checks are done systematically, to make sure that essential Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: equipment is working properly. 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 6 Develop care plans using person-centred approaches, set goals with measurable outcomes, and evaluate these on a frequent and regular basis. This is to ensure that people get the support they need in ways that suit them best. Ensure that records reflect fully and accurately how people have been supported to make decisions and choices. Doing this will help to ensure that people get the support they need to achieve the things that are important to them. Ensure that full and accurate records are kept of peoples activity opportunities. This will ensure that important information is available to plan effectively, and give people the support they need to achieve their goals. Ensure that all staff working in the home are trained to communicate with residents using sign language. This will help to make sure that people get the support they need in ways that suit them best. Develop health action planning so that residents health and well being are promoted more proactively. File a copy of written protocols for PRN (as required) medication with the Medication Administration Record. This will ensure that staff have clear guidance to hand when Page 29 of 31 2 7 3 12 4 18 5 6 19 20 Care Homes for Adults (18-65 years) considering whether or not such medication should be given. 7 27 Carry out redecoration and refurbishment of the main living area, to ensure that residents continue to enjoy comfortable and homely surroundings. Take action to increase the number of staff qualified at NVQ level 2 or above, to ensure that residents are supported by appropriately qualified workers. Recruit to all vacant posts and decrease dependency on staff from external agencies. This is to ensure that continuity of peoples care is promoted fully. Review arrangements for staff group meetings and formal supervision, to make sure that staff get the support they need to do their jobs well. The Manager should complete and submit her application to the commission, so that she can become properly registered to run the home. Complete quality assurance monitoring and produce a report of the findings. This is so that it can be clearly seen how residents views underpin the development of the service. Review practice with regard to regular testing of essential equipment. Ensure that staff are clear about their responsibilities, and monitor action taken. This is to make sure that people are supported to stay safe and well. 8 32 9 33 10 36 11 37 12 39 13 42 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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