Inspection on 01/10/08 for Tarry Hill

This inspection was carried out on 1st October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tarry Hill 04/10/06

Tarry Hill 20/02/06

Tarry Hill 29/09/05

Tarry Hill 09/03/05

Tarry Hill 06/10/04

Tarry Hill 17/03/04

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Tarry Hill 1 - 7 Cale Road New Mills High Peak Derbyshire SK22 4LW     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: Susan Richards     Date: 0 1 1 0 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 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Tarry Hill 1 - 7 Cale Road New Mills High Peak Derbyshire SK22 4LW 01663746440 01663744915 tarryhill@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Sarah Marie Pemberton Type of registration: Number of places registered: Active Care Partnerships Ltd care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 26. The registered provider may provide categories of service only: Care Home only - PC To service users of the following gender: Either Whose primary care needs on admission to the home fall within the following categories: Learning Disability - LD Date of last inspection Brief description of the care home Tarry Hill provides personal care and support for up to 26 younger adults with learning disabilities. The recently redeveloped site provides a range of accommodation, comprising of three four bedroom town houses, being Kinder House, Cale House and Peak Vale and a four bedroom bungalow, all having individual en suite facilities. Also no 10 Cale Road, which has eight bedrooms, some providing en suite facilities, along with a separate self contained two bedroom flat. The home lies on the northeast outskirts of New Mills in the High Peak close to a main bus route and within easy access of local shops and amenities. Each house has its own dedicated lounge and Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 26 Brief description of the care home dining space for service users and with communal bathroom and toilet facilities. There are also garden areas along with a car parking facility. Staff sleep-in facilities are provided, although there is no dedicated staff room. The registered manager has the support of a team of care and hotel services staff and also receives external management support via Active care Partnerships Ltd. Activities are organised for service users in accordance with their individually assessed educational, social and occupational activity needs. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. For the purposes of this inspection we have taken account of all the information we hold about this service. This includes our annual quality assurance assessment questionnaire (AQAA), which we ask the home to complete on an annual basis in order to provide us with key information about the service. We also received survey returns from four people who use the service out of a total of ten that we sent out. At this inspection there were twenty people accommodated and two people receiving day care. We used case tracking in our methodology, where we looked more closely at Care Homes for Adults (18-65 years) Page 6 of 32 the care and services that two people receive. We did this by talking with them as able, observation of staff interactions with them, looking at their written care plans and associated health and personal care records and by looking at their private and communal accommodation. We spoke with staff about the arrangements for their recruitment, induction, training, deployment and supervision and we examined related records. We also spoke with the deputy manager and administrator in the absence of the registered manager who was not available on the day of our inspection visit, about the arrangements for the management and administration of the home and we examined associated records. All of the above was undertaken with consideration to any diversity in need for people who live at the home. As at the date of this inspection, the range of fees charged per week is: 1,100 pounds to 3,042.50 pounds. Fees charged and what they cover is in accordance with individuals assessed needs and may include for those eligible a funding contribution from their placing authority. What the care home does well: What has improved since the last inspection? What they could do better: The manager has told us about improvements they aim to make over the coming months, which include, Developing their methods of communicating with people, including about their care plans. developing their arrangements for staff induction and training and to achieve full staff training competency. Also to recruit additional staff and to better promote their service information for people. We have made a number of requirements and recommendations at this inspection, which relate to, Providing key service information that is suitable for people who use the service and ensuring that the information provided is regularly reviewed and up to date. Care Homes for Adults (18-65 years) Page 8 of 32 Explore methods of communicating with people with a view to improving consultation with them about their care plans. Develop individuals care planning records to demonstrate individuals capacities with regard to making decisions about their lives and the care and support they receive in accordance with the Mental Capacity Act 2005. Ensure that staff receive the training they need in accordance with recognised workforce standards and targets, so as to consistently underpin good care and practise and to best promote peoples health and welfare. 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 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well supported during their admission to the home and their needs suitably accounted for, although the service guide format does not promote equality of access to information for people who use the service. Evidence: At our last key inspection of this service we judged that peoples individual aspirations and needs were effectively asssessed and accounted for. In our annual quality assurance questionnaire completed by the home, they told us that they ensure a thorough and individually tailored admissions and assessment process for each person. They also told us about some of the improvement they have over the last twelve months and improvements they aim to make over the coming months. This tells us that they seek to promote peoples inclusion in determining their needs and also know what improvements they need to make. At this inspection, people as able, told us that they were asked if they wanted to move Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: into the home and that they were given enough information before they did. We looked at the service guide, which was available in standard format only. Key service information is provided there, although it is not available in alternative formats, which may assist people. Changes in management and staffing and the range of fees had not been revised over the last twelve months and require updating. There are comprehensive needs assessment records in place for people and those that we looked at were reasonably well recorded and in a person centred manner, although the home feel that they can improve their record keeping and are currently reviewing the format of recording. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are reasonably well supported to make decisions about their daily lives and their risk assessed, changing needs are fairly well reflected in their written care plans. Although active consideration of the implications of the Mental Capacity Act 2005 may further benefit people who use the service. Evidence: At our last key inspection of this service we judged that the homes risk management strategies ensured that people were effectively supported and empowered to make decisions about their lives. In our annual quality assurance questionnaire completed by the home they told us that they always strive to encourage, support and assist people to make decisions about their lives. They also told us about improvements they have made and aim to make. These focus on the development of peoples written care plans, consultation with them about these and training for staff in person centred care planning. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: At this inspection most people told us that they sometimes make some decisions about what they do each day. One person told us about these and we observed staff engaging with people in this process with people, which was undertaken in a supportive and encouraging manner. However, one person told us that staff do not always stick to agreed arrangements in respect of their daily living routines The written care plans that we looked at included fairly comprehensive daily living plans incorporating many aspects of peoples known daily living routines and lifestyles and also care plans formulated in accordance with individuals risk assessed needs. All had regularly recorded reviews. Although discussions with staff and examination of written care plans showed that the principles of the Mental Capacity Act 2005 have not been actively considered in respect of determining peoples capacity to make decisions, which are not fully accounted for within their care records. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are reasonably well supported to engage in educational, occupational and social activities, to be part of the local community and maintain links with their families and friends. Evidence: At our last key inspection of this service we judged that people were enabled to engage in social, occupational and educational activities, which were developing well and that sufficient nutrition was provided for people. In our annual quality assurance questionnaire completed by the home, they told us that people are well supported via a key worker system to take part in activities, education and healthy living projects, both within and outside the home and to plan for the future, which may include employment in the local community. They also told us Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: about improvements they have made which include improved access to activities within and outside the home and established holiday arrangements. They feel they could improve opportunities for people via awareness raising and links within the local community. Also by researching access to more community groups and by reviewing how they assist people to make life choices and to progress these in respect of peoples life skills and work. At this inspection we spoke with people about the arrangements to enable them to access educational and occupation opportunities. Also as to how people are supported to establish and maintain community links, to engage in social activities both within and outside the home and to maintain contacts with their families and friends. People told us about some of the educational, occupational and social activities that they engage in and told us that they can usually do what they want during the day and at weekends. Although one person case tracked told us that they used to visit a day centre before they move into the home and would like to do something similar. This person was very recently admitted and this was not considered within their needs assessment and initial care plan. We discussed this with the deputy manager, who advised that they aim to use their key worker system to assist people in devising their activities programmes with a number of people accessing mainstream colleges, day centres and adult education facilities. (See also section two of this report, where we have made a recommendation relating to communicating with and assisting people in the decisions they make about their lives). People can access community transport and the homes own large vehicles, with some individuals using their own transport via individual motability arrangements. People also told us that residents meetings are held regularly in each house and that residents have recently suggested holding open days/fun days open to public invite to assist inforging links and raising awareness in the local community. One person that we case tracked told us that he was involved in menu planning and was assisting in the food shop on the afternoon of our visit. People who wish and are able are involved in weekly menu planning via contributing to the shopping list and menus recorded in each house show that varied and nutritious food is provided. People also told us that they usually like the food at the home. Care Homes for Adults (18-65 years) Page 16 of 32 Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and health care needs reasonably well met, although the existing staff training status does not consistently underpin best practise or peoples best interests. Evidence: At our last key inspection of this service we judged that peoples personal and healthcare support needs were met in accordance with their personal preferences and risk assessed needs. We made two requirements relating to medicines recording practises. These are met at this inspection. In our annual quality assurance questionnaire completed by the home they told us that they ensure peoples personal and health care needs are met. They also told us about improvements they aim to make over the coming months, including engaging outside healthcare professionals to assist in developing their methods of communication with people in respect of their personal and health care in order to optimise choice and independence. They also gave us general information that we asked for about the needs of their client group as a whole. This tells us that there are eleven people Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: accommodated with specialist communication needs. At this inspection most people told us that staff usually treat them well and mostly listen and act on what they say with key workers for each person. Although one person felt that improvements could be made by staff not using their mobile phones for private calls whilst at work and sticking to previously agreed routines. Examination of the minutes of recent staff meetings indicate these issues. The written care plans and associated health care records of those people we case tracked were reasonably well recorded in accordance with peoples risk assessed needs and accounted for some their individual choices and preferences in terms of their personal support routines. However staff had not undertaken person centred care planning training, which they felt may benefit and assist the service to meet with their stated aim in the AQAA, which is to further develop peoples written care plans to promote a more person centred approach. Peoples access to outside healthcare professionals were accounted for, including for the purposes of routine health care screening and specialist advice and treatment, including access to specialist advice concerned with the care of people with autism. Staff had not received any training in this area, although there are a number of people accommodated with this disorder. We looked at the arrangements for the ordering, receipt, storage, adminsitration and disposal of peoples medicines for those people, which again satisfactory. People have lockable fixed metal storage facilities in their own rooms to keep their own medicines and there is additional separate storage in each house for stock and as required medicines. However, peoples capacities were not always clearly recorded in respect of their abilities and long term goals concerned with the management and handling of their medication. This was particularly pertinent for one person we case tracked, who had a longer term goal to achieve more independent living. (See also section 2 of this report and our recommendation made there in respect considering and applying the principles of the Mental Capacity Act 2005). Individual written care plans were in place for people in respect of their medicines and use of as required medication and a revised written protocol was being introduced in respect of these. All staff responsible for the adminstration of peoples medicines have undertaken Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: suitable training. However, there are also significant deficits in other areas of staff training, which are relevant to this outcome section of this report (see also staffing section of this report), including in equality and diversity, nutrition, epilepsy, autism, infection control and the Mental Capacity Act 2005. Discussions with staff confirmed these. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who user the service, are not best informed about how to complain, although there are suitable arrangements in place to promote their protection from harm and abuse Evidence: At our last key inspection of this service we judged that peoples views were listened to and acted on and that people were protected from harm and abuse. In our annual quality assurance questionnaire completed by the home, they told us that they encourage people to raise any concerns they may have. They gave us some statistical information about the number of complaints they have received over the last twelve months and also told us that they aim to continue to effectively manage concerns and complaints they may receive over the coming months. At this inspection most people told us that they sometimes know who to complain to and one person said they always do. The homes complaints procedure was available in standard print format only and within the service guide. This means that it may not be easily accessible to people who use the service. The procedure also was in need of updating as some of the information provided there in respect of contact details was either insufficient or Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: incorrect, including the contact details of the Commission, which we discussed with the deputy manager. The deputy manager, in charge on the day of our visit was unable to locate the complaints record, although provided us with records of two complaints investigated via local joint agency safeguarding procedures. The home had previously notified us about these in writing at the time they occurred. This showed us that the home had followed correct procedures necessary to safeguard people using their service. The homes monthly training statistics audit of September 2008 detailed that ninety eight percent of staff have undertaken recognised training concerned with dealing with violence and aggression from any service users. Although, that only twenty four percent of staff had received safeguarding adults training. Staff that we spoke with, including a senior carer with a training lead responsibility, told us about the arrangements, which had been put into place to rectify the latter by way of a weekly rolling training programme. They also told us they have access to internal policy and procedural guidance that they can follow in the event of any witnessing or suspicion of abuse of any service user and had overall demonstrated reasonable knowledge of these. This tells us that satisfactory action is being taken to ensure staff receive the training they need with regard to safeguarding people from harm and abuse and that this is up to date. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with purpose built accommodation, which is safe and suits their needs. Evidence: At our last key inspection of this service we judged that people lived in a homely and comfortable environment, being totally redeveloped. We made a requirement about ensuring peoples safety during the major redevelopment of the site. Since that inspection the total redevelopment of the site has been satisfactorily undertaken in three phases, with completion in October 2007 resulting in the provision of three four bedroom town houses, one four bedroom bungalow, the main ten bedded house and a two bedroom flat, each having their own separate facilities. In our annual quality assurance questionnaire completed by the home, they told us that they provide people with a safe and homely purpose built environment, although feel that they could improve the garden areas for people. They tell us that they aim to create stimulating garden areas for people to access over the the coming twelve months. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: At this inspection people told us that the home is always or usually fresh and clean and we observed this to be so at our visit. They also told us that they choose colour schemes in their own rooms. During our visit we carried out a general tour of the home, with particular focus on the private and communal accommodation of two of the people we case tracked. All areas seen were clean, safe, well furnished and decorated and suitably equipped. Peoples own rooms were personalised and provide locks to doors, which are accessible in an emergency and also individual lockable storage facilities. People have access to outdoor garden and patio areas, although many felt that these could be improved. We were provided with a copy of the report from the local fire authoritys most recent inspection which detailed that all matters appertaining to fire safety and precaution to be satisfactory. Staff raised the fact that there is no separate staff room facility for breaks, quiet time out or training. Although there is a staff sleep in room with washing and toilet facility and also lockable areas to store personal belongings. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported from staff that is effectively recruited, deployed and supervised, although whose induction and training arrangements do not meet with recognised workforce training targets, which may not be in peoples best interests. . Evidence: At our last key inspection of this service we judged that people were well supported with their needs met by the number and skills of staff caring for them. However, that not always obtaining two references for each staff member on their recruitment compromised otherwise effective recruitment practises. We made a requirement that at least two written references be obtained in respect of each person employed, including one from their most recent employer. This is met at this inspection. In our annual quality assurance questionnaire completed by the home, they told us that staff is always effectively recruited, inducted and deployed. That over the last twelve months they have improved their management of staff rotas in line with new admissions to the home. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: However, they feel they need to improve their training and staffing arrangements and told us here what they intend to do to achieve these. They also gave us some statistical information about staff employed, including that twenty eight staff have achieved at least NVQ level 2 or above. This tells us that they know what they need to do to improve their staffing arrangements and also provides some information as to how they are going to do this. At this inspection we spoke with the deputy manager and training lead about training arrangements and staff training status and were provided with details of the most recent monthly staff training audit figures. We also spoke with four staff, two team leaders and two more recently employed care staff about the arrangements for their recruitment, inducton, training, supervision and deployment and we examined those related records. These told us that staff is effectively recruited and deployed, although further improvements need to be made in the arrangements for their induction and training to ensure that staff consistently receive these in accordance with recognised standards. We could see from some of the information provided that some work has commenced towards this. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the home is reasonably managed and run, although the current status of staff training in safe working practises, may compromise peoples health, safety and welfare. Evidence: At our last key inspection of this service we judged that the home is well managed and run and in people best interests. In our annual quality assurance questionnaire completed by the home, they tell us that they seek continual service improvement by way of quality auditing systems and set clear expectations wtih regard to standards of care and service delivery. They also told us about significant management changes over the last twelve months and that they need to improve their staff training statitstics to ensure full competency of their staff team over the coming months. At this inspection, the registered manager was not present. We were assisted by the Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: deputy manager and administrator. Staff spoken with described satisfactory arrangements for communication and the management of the home, including for their support and supervision, although identified areas of training deficit, which we have referred to in Section 7, Staffing of this report, together with an identified requirement made there. However, all expressed confidence in the registered manager, who they said promotes confidentiality, good staff support arrangements and is working hard to develop the home and its staffing arrangements. We looked at the homes quality assurance and monitoring system, which is a formal and comprehensive system and which includes for consultaton with people who use the service and with staff who work there. Although there were no minutes available of residents meetings and results of the most recent satisfaction survey were not yet colllated. Service users views of the home are also not included in the homes service guide. We spoke with staff about the arrangments for safe working practises, including training, although as detailed under the staffing section of this report core health and safety training is not up to date for staff. This is identified by the manager who had recently undertaken and staff training needs analysis and told us about the action needed to address these. During our tour of the houses, we did not observe any environmental safety concerns and records of maintenance for systems and equipment at the home were mostly up to date, with the exception of one area. Care Homes for Adults (18-65 years) Page 28 of 32 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 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 35 18 At all times there must be 01/01/2009 suitably qualified, competent and experienced persons working at the care home as are appropriate for the health and welfare of service users. Staff must receive induction and training, which accords with sector skills council workforce trainig targets. So that service users needs are consistently met from staff that is effectively inducted and trained. And to ensure staff fulful the aims of the home and are able to meet peoples changing needs. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 22 22 The homes complaints procedure must be appropriate to the needs of service users and must be kept up to date wth regard to contact details, including those of the Commission and the stages to follow. 01/12/2008 Care Homes for Adults (18-65 years) Page 30 of 32 So as to best inform people as to how to complain. 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 users guide and key service information should be available in formats suitable for the people for who the home is intended. And should be reviewed and amended to ensure that changes to staff and fees information is updated and accurate. The implications of the Mental Capacity Act 2005 should be actively considered in order to best account for the determination of peoples individual capacity to make decisions within their care planning records. Methods of communicating with service users should be explored with a view to improving consultation with them about their lives and should include seeking accesss to independant advocacy services for people. Staff training arrangements should ensure consistency and continuity of support for people. Peoples health care records should more clearly demonstrate as to their individual capacities and decisions made with regard to managing their own healthcare, including medicines and as part of their long term goals. Consideration should be given to the possibility of providing a dedicated staff room. Results of satifaction surveys should be collated and published/shared with people who have an interests in the service and service users views of the home should be included in the homes service guide. 2 7 3 7 4 5 18 19 6 7 28 39 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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