Inspection on 10/12/08 for The Byre

This inspection was carried out on 10th December 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Byre 30/03/10

The Byre 17/11/09

The Byre 17/01/08

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Byre Allaston Court Farm The Byre Lydney Gloucester GL15 5SR One Star The quality rating for this care home is: 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: Lynne Bennett Date: 1 0 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: The Byre Allaston Court Farm The Byre Lydney Gloucester GL15 5SR 01594844244 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Footsteps Medical Care Limited 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 4 0 Learning disability Additional conditions: The registerd person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) The maximum number of service users who may be accommodated is 4. Date of last inspection 1 0 1 2 2 0 0 7 A bit about the care home The Byre was registered in July 2007 as a new service for adults with a learning disability. It is located in a residential area on the outskirts of Lydney. The property is a bungalow which has been fully redeveloped in order to meet the relevant National Minimum Standards. All bedrooms have en-suite facilities. There is also a spacious shared bathroom with adaptations, a lounge and a kitchen-dining area. Prospective residents and their representatives are provided with information about the home including the Service Users Guide. Fees levels were reported to range from 1385 pounds to 1864 pounds per week, but are negotiated on an individual basis. 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 Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home This inspection took place in December 2008 and included a visit to the home by one inspector on 10th December. The home did not have a registered manager and was being managed by the deputy manager with the support of a senior carer. The deputy manager and Responsible Individual were spoken with after the visit to the home. The acting manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). Two people were living at the home when this inspection was carried out and time was spent with both people. A relative visited during the visit and gave us (The Commission for Social Care Inspection) some feedback. Before the inspection we were contacted by a relative of a person who had just moved out of the home expressing concerns about staffing levels, support provided to people when they were unwell, quality of meals and the level of activities. These concerns have been commented on throughout the text of the report. Four members of staff were spoken with during the visit. A selection of records were examined which included care plans, medication and financial records, staff files and health and safety records. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the care home does well Purpose built accommodation is provided offering specialist adaptations for people with a physical disability including overhead tracking for hoists in their rooms and the bathroom. Assisted baths are provided. Communal areas are spacious and fixtures and fittings are of a good standard. People are helped to put together a plan which lists their wishes and dreams. What has got better from the last inspection Medication is being given to people safely. When new staff are appointed they are asked for additional details about their employment history if there are any gaps on their application form. What the care home could do better The Statement of Purpose and Service User Guide will need reviewing to reflect changes to the service. People need to have a copy of their terms and conditions providing them with information about any additional costs. Where medication is administered in food clear guidance must be in place having been discussed at a multi disciplinary meeting. Records must be kept of any complaints received and the action taken as a result. Records for new staff must include two satisfactory references and the reason why they left former positions in care. Staff need to develop their skills and knowledge in the areas of sensory awareness, mental capacity act and fire. A quality assurance system needs to be put in place which involves people living in the home. A manager needs to be appointed and registered with us. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Lynne Bennett Colston 33 Bristol BS1 4UA 0117 930 7110 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 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 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 have access to information which needs reviewing to make sure that it is up to date allowing them to make an informed choice about the service provided. An assessment of need must be obtained prior to people moving into the home so that they can assess whether or not their needs can be met. Evidence: The home has a Statement of Purpose and Service User Guide which were displayed in the entrance hall. Further copies were available in the office. These documents will need to be reviewed to reflect changes to our address(The Commission for Social Care Inspection) and also management changes in the home. Information about staff structures also needs to be completed. Two people had been admitted to the home since the last inspection and another person was considering moving into the home. There was evidence that the home had completed their own assessment of need and that people had been visited in their former placements or homes prior to admission. People also visited the home prior to moving in. There was no evidence on their files that the placing authority had supplied an assessment of need and care plan prior to admission. These were in place for one person who had a review of their placement after moving into the home. The Service User Guide includes a copy of a statement of terms and conditions. There was no evidence that this document had been completed for people living in the home. People must have access to information about any additional costs they might have to fund. For instance it appeared that people were paying for meals out several times a week. This document must indicate what will be funded by the home and what they would have to pay for. If the meal out was replacing a meal normally provided by the Evidence: home, such as Sunday Roast (as noted on the receipt) then the home must pay for this out of petty cash. The Responsible Individual stated that contracts between people living in the home, their funding authorities and the home had been mislaid and he was in the process of obtaining new copies. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . A person centred approach to care enables people wishes and needs to be identified. Greater detail in communication plans would aid staff to interpret peoples non verbal behaviour promoting choice and respecting peoples wishes. Evidence: The care of two people was case tracked. This involved meeting them and spending some time with them. Their care plans and other related documents were read and staff were spoken with about the care they provide. Each person had a care plan in place which was person centred and provided clear information about their physical, emotional, social and intellectual needs. Plans made reference to a Health Action Plan at the top of each page but when examining this document it did not appear to have been produced in its entirety. A sample of another Person Centred Plan was also in place but had not been developed for either person living in the home. Staff spoken with had a good understanding of peoples needs and the support they required. People have complex physical, sensory and learning disabilities and plans identified support needed in each of these areas. Communication plans were in place indicating peoples comprehension and expression. These could be developed further to include more information about each persons non verbal behaviour. For instance one plan stated the persons facial expressions indicated how they were feeling. It failed to say what these expressions were and what they meant. It also stated that a person made unhappy and happy noises, but did not specify what these were. One plan referred to using objects of reference but did not state what and another said to use wrist bells to indicate physiotherapy or music therapy. This would appear to lead to some confusion the activities being very Evidence: different. Staff were observed following other guidelines in communication plans such as explaining clearly what you are doing, what is happening and do not make sudden moves. They explained how they supported one person with a sensory disability to develop confidence in their environment, taking them for regular walks around the home and making sure they had access to all areas with their support. There was information in the home about accessing advocacy services although neither person currently had an advocate. Staff said they had to be creative offering choices to people whether this what to drink, eat or how to spend their time. Peoples finances were being managed by staff. Records were being kept with individual receipts being issued by the home or obtained when making purchases. It is advised that when making purchases a receipt is obtained. The home had issued its own receipt for a day out including hydrotherapy and a meal which amounted to 27 pounds. This is not good practice. Risk assessments had been developed from hazards identified in care plans. They were in place for moving and handling, epilepsy, swimming, eating and drinking and health issues. The epilepsy risk assessment concentrated on risks when swimming but should also include reference to how hazards were being minimised when supporting the person during showering or bathing. 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 . Opportunities to participate in social, educational, cultural and recreational activities may be affected by staffing levels. People are supported to maintain contacts with families and friends. People living at the home are offered a range of freshly produced meals giving them choice about their diet. Evidence: Some concerns were expressed by a relative about the lack of activities available to people and whether the staffing ratios were sufficient to support people in their scheduled activities. Activities had been identified for people based on their likes and dislikes. Staff said that people had not been routinely supported to access a range of activities outside of the home but that this was being reviewed and had improved. They said that more creativity was needed when one person attended the day centre to provide external activities to the other person. A local day centre was being attended three days a week by one person who also spent another day out with their parent. The parent said that he was happy with the level of activities provided which also included going to a local social club once a week. Staff confirmed that they had started using a local college for swimming and in the New Year would be exploring day and evening classes for people. Daily records indicated that people were supported to go swimming or to hydrotherapy, trampolining and out and about in their local environment whether shopping or for a walk. Care plans did not indicate peoples spiritual beliefs and whether they wished to be supported to follow these. Evidence: There did appear to be a considerable amount of time spent at home. Staff said that people had access to a room providing some sensory equipment. This room was being developed and staff were fund raising to purchase more equipment. People also enjoyed listening to music or playing musical instruments and listening to the television. One person was said to enjoy watching and participating in baking. Both were involved in shopping for the home. One person liked to spend time in their room and would indicate to staff when they wished to leave communal areas. Part of their daily routine would also be to walk along the corridors in the home to maintain their mobility. Daily notes indicated this was being done. Contact sheets were being kept when relatives and friends called on the telephone or visited. One parent said they were always made to feel welcome and appeared to have positive relationships with the staff. There was information in the home about access to advocacy although neither person had an advocate at the time of the inspection. Staff were observed preparing an evening meal of sausage and mashed potato with fresh vegetables. They said that they offered a mixture of freshly prepared meals and frozen ingredients. One person had recently returned from hospital and they were encouraging them to eat and drink fluids. Monitoring charts were being kept. A dietician had been involved with the home to advise on nutritional diets. A Speech and Language Therapist had also advised where there were risks of choking. Staff were observed following care plans and risk assessments to minimise these risks. Fresh fruit was available in the kitchen. As mentioned people were having a number of meals out and the funding of these needs to be highlighted in their terms and conditions. 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 health and wellbeing are being monitored and they have access to a range of healthcare professionals to support them with their healthcare needs. There are some improvements in the administration of medication that need to be implemented to safeguard people from the risk of error or possible harm. Evidence: Peoples care plans indicated the way in which they would like to be supported with their personal care. Their likes and dislikes were identified and staff spoken with had a good understanding of these. Times for getting up and going to bed were flexible. One person liked to stay up late and night staff recorded different times in the daily notes confirming support for them to do this. Both people needed a range of adaptations and equipment to support them in their day to day lives. These had been provided with support and advice from a range of healthcare professionals with evidence of ongoing monitoring of their needs. There was evidence that equipment was being serviced regularly. One person needed bedsides on their bed and although this was noted in a risk assessment there was no evidence that consent had been obtained for the use of these. This must be recorded. A nebuliser was also in use for one person, there was clear guidance in place describing how to use and care for this and evidence that staff had received the appropriate training. Healthcare records were in place providing a record of appointments with a range of healthcare professionals and the outcome of each appointment. Part of a Health Action Evidence: Plan had been put in place for each person providing information to be taken to hospital. At the time of the visit one person had just returned from hospital and staff were closely monitoring their health and wellbeing. Concerns had been raised by a parent that the home were not managing the health of their sibling who had since left the home. At the time of the inspection the home appeared to be responding appropriately to the health needs of people living there contacting the local Doctor for advice when needed and calling for paramedics as health needs escalated. Procedures were in place for people who had epilepsy and the use of emergency medication. There was evidence that staff had received the appropriate training and that those spoken with were knowledgeable about what they should do. The home was working closely with the local Community Learning Disability Team (CLDT) with evidence that they were implementing advice given to them from the team. A person had been admitted to hospital as an emergency referral and we had not been informed of this. Under Regulation 37 we must be notified of any incidents affecting the well being of people living in the home. Systems for the administration of medication were examined and found to be mostly satisfactory. Staff had completed training in the safe handling of medication. The home had also put in place a competency audit and their own training course. Although both of these need to be formalised. The senior carer stated that it was planned for staff to also complete a more comprehensive medication open learning course. Protocols were in place for the use of as necessary medication including guidelines from the local CLDT. Handwritten entries had been correctly signed on medication administration records. It is advised that these are countersigned. Any gaps in the record were being explored with the staff on duty. A copy of the British National Formula for 2006 was in place this now needs updating. Medication information leaflets were not in place for all medication. Care plans indicated that medication for one person was being administered covertly in their food. Clear guidelines need to be in place providing the rationale for this and consent for this to be administered in this way recorded. Where people may lack capacity to consent consideration must be given to the provisions of the Mental Capacity Act 2005 in respect of medication administration. This must be done in a multi disciplinary forum and include the relatives or advocate of the person concerned. Evidence that the Pharmacist or Doctor have confirmed that medication can be administered in food needs to be provided. This should be reviewed at regular intervals. 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 . The complaints procedure needs to be followed more robustly to make sure that complaints are responded to within the appropriate timescale and evidence is provided that prompt action has been taken as a result. Systems are in place that should safeguard people from possible harm or abuse. Evidence: The AQAA confirmed that the home had a complaints policy and procedure in place and that staff had received training in this. Relatives confirmed that they were aware of this procedure. One said they had no concerns but were confident speaking to the management team, the other had expressed that their concerns were not responded to as quickly as they would have liked. The acting manager said that she had a record of the complaint from one relative in her diary but had not yet recorded this formally. There was no evidence in the home of a complaints folder, how it had been responded to or whether this was within 28 days. We were approached as part of this complaint when the relative was not happy with the outcome. Their concerns were taken into consideration when conducting this inspection. Staff confirmed that they had attended training in safeguarding of adults and those spoken with were aware of local procedures. The home had worked with the local adult protection team when they had concerns about a person living in the home. Training in the Mental Capacity Act will need to be accessed by the new management team and cascaded to staff. Care plans for people indicated that at times they may present with challenging behaviour and guidelines were in place. These clearly indicated that staff would not use physical intervention with anyone living in the home. There was no evidence that skills and knowledge of staff were being developed in response to how to support people when anxious or challenging. Peoples personal finances were being managed by the home. Records were being kept Evidence: for all personal expenditure but as mentioned staff were producing receipts internally for some expenditure. This is not good practice. Wherever possible receipts should be obtained with purchases. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People live in a home that is safe, clean and well maintained which recognises their diverse needs creating an environment that matches their personal requirements. Specialist equipment is provided to those people who need it. Evidence: At the time of the inspection the home was clean and tidy. The Byre provides purpose built accommodation for people with a physical disability. Individual rooms were spacious with overhead tracking and an en-suite of either an assisted bath or a shower. These had been personalised to reflect the lifestyles and choices of people living at the home. Communal areas were pleasantly decorated with a good standard of fixtures and fittings. A seat protection cover was placed on one sofa. This does not promote dignity and respect of the individual and does not deal with continence issues with sensitivity. It is recommended that alternative ways are found to protect furniture or provide furniture which can be easily cleaned. One small lounge was being converted into a sensory environment and some equipment had been provided. The homes brochure indicated that a sensory room and swimming pool were to be provided but at the moment this information was misleading. Plans to build a swimming pool had been put on hold, staff said they were able to access pools locally. The laundry provided a range of equipment and protective clothing promoting good infection control. Hazardous products were stored securely and data sheets were in place. 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 . Peoples needs are met by a staff team who have access to a mainly satisfactory training programme that needs to ensure staff have knowledge about the diverse needs of people living at the home. Improvements in recruitment and selection procedures will ensure that people are being safeguarded from possible harm. Evidence: The AQAA stated that we have a staff team who are very committed and of all ages, we have access to training courses and will all be trained at the same level. At the time of the inspection the home was fully staffed. New staff confirmed that during their induction they shadowed other staff and had completed an induction with the home as well as one provided by an external provider. Staff new to care were completing mandatory training such as moving and handling, food hygiene and first aid. Staff indicated that they were not having access to the Learning Disability Qualification. One member of staff said that they were being registered to start a National Vocational Qualification (NVQ) in Health and Social Care. The DataSet provided with the AQAA stated that 3 staff of a team of 11 had a NVQ qualification. The recruitment and selection files for 6 members of staff appointed since the last inspection were examined and 3 others files sampled. Staff were completing an application form and there was evidence that where a full employment history had not been provided they were being asked to supply this additional information. There was no evidence on staff files of the dates on which they had started work. The senior carer said that they had asked the homes accountant to supply them with this information so that it could be recorded. The management team confirmed that staff were not being appointed without two references and either a povafirst or a Criminal Records Bureau check (CRB). They said that they were still chasing one reference for one member of staff and had made repeated telephone requests for this, although this information had not been recorded. One other staff file only had one reference in Evidence: place. There was evidence that not all references were being obtained directly from previous positions in care but from the personal address of staff or being supplied on unheaded notepaper. This not good practice. The senior carer said they had started using a reference request which needed to be filled in, this would minimise the risk of the latter happening. Where staff had been appointed with a povafirst check staff described what was in place to make sure people were safeguarded including shadowing staff, not supporting people with personal care or going out unsupervised with people. No risk assessments to this effect were in place, these should be drawn up. No training matrix was in place. Staff files contained copies of certificates and information about training attended. Some training had been arranged for later in the year and other specialist training had been identified such as sensory training. Where people had worked previously in care the home were not routinely obtaining confirmation from these employers why they had left. Evidence of identification and a current photograph were in place. In order to comply with the Data Protection Act photocopies of birth certificates and CRB checks should not be kept. 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 . People living at the home will benefit from a manager who has a dynamic and creative approach, and who will provide clear direction and leadership. Effective quality assurance systems must be put in place involving people. Health and safety systems should protect people from harm. Evidence: The registered manager had resigned from the home a few weeks prior to our inspection. The deputy manager was acting up and managing the home with the support of a senior carer. The acting manager had supplied the AQAA prior to the inspection. She and the senior carer said they had been addressing requirements and recommendations issued at the previous inspection. They must make sure that they address concerns about recruitment and selection of new staff. They must also inform us of any events affecting the health and wellbeing of people living in the home under Regulation 37. The home did not have a formalised quality assurance system in place at the time of the inspection. Weekly and monthly audits for medication, health and safety and monitoring care planning and finances were in place. The Responsible Individual had conducted two Regulation 26 visits to the home in February and March 2008 providing us with a checklist of what was examined. These visits need to take place each month and involve people living in the home and their representatives. A quality assurance system needs to be put in place which produces an annual report reflecting the outcomes of the system and any plans for the future. Systems for the monitoring of health and safety in the home were inspected. Staff Evidence: were monitoring fridges and freezers and hot temperatures of food. Fire records had not been completed since the manager left. Prior to this they had been done regularly. A fire risk assessment was in place and environmental risk assessments had been completed for all rooms in the home. There was no evidence that staff were completing fire training on a regular basis. Legionella testing had taken place in 2008 and staff said that water temperatures were regularly tested although the file could not be found. Discussions with staff and the Responsible Individual indicated that there may be concerns about the financial viability of the home. Meetings were being arranged with funding authorities to discuss the future of the home and new admissions were being followed up. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 1 39 26 Unannounced visits by an 24/06/2008 appropriate person as defined by Regulation 26 must take place at least once a month. A report on the conduct of the home needs to be written and a copy supplied to the manager and CSCI. This standard was not assessed at this inspection. The timescale for action was 29/02/08. Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 1 6 The registered person must review the Statement of Purpose and Service User Guide. 30/01/2009 This is to make sure that people have access to up to date information. 2 2 14 The registered person must obtain an assessment of need from the placing authority prior to the persons admission to the home. 30/01/2009 This is to make sure that the home is able to meet their needs. 3 5 5 Each person must have a statement of terms and conditions in place which provides information about any additional costs which are to be paid. 30/01/2009 This is to make sure that people have access to information about the costs of the service they are to receive. 4 18 13 The registered person must 16/01/2009 ensure that where bedsides are used the rationale for this is clearly recorded along with the consent for their use. This is to make sure that any forms of restraint are used appropriately and people are safeguarded from possible abuse. 5 19 37 The registered person must inform the Commission of any incidents affecting the well being of people living in the home. This is in respect of an emergency admission to hospital. 16/01/2009 This is to make sure that we can monitor the support people are receiving. 6 20 13 The registered person must 16/01/2009 make sure that where medication is administered in food, clear protocols are in place and consent is recorded. This is to make sure that medication is administered safely and people are not at risk of possible harm. 7 22 22 The registered person must provide evidence that complaints are fully investigated and responded 16/01/2009 to within 28 days. This is to make sure that the home processes complaints in line with its policies and procedures. 8 34 19 The registered person must obtain written confirmation from the employer of prospective staff s reason for leaving former positions in care. 16/01/2009 This is to safeguard people from possible abuse. 9 37 8 The registered provider must 27/02/2009 appoint a manager who must apply to become registered with us. This is to make sure that the home is managed in line with current legislation. 10 39 26 The registered person must conduct unannounced regulation 26 visits to the home and produce a written report. 16/01/2009 This is to make sure that the organisation is monitoring the service being provided. 11 39 24 The registered person must put a quality assurance system in place to evaluate the service provided. 16/01/2009 This is so that the quality of the service provided can be monitored and reviewed. 12 42 18 The registered person must make sure that staff complete fire training on a regular basis. 16/01/2009 This is to make sure that staff had the skills to safeguard people from harm. 13 43 39 The registered person must inform us of any changes to the care home as soon as is practicable. 16/01/2009 This is to make sure that we are aware of the current registration status of the home. 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 7 Communication plans should provide clear guidelines about how people use non verbal behaviour to express their feelings. Receipts should be obtained for all purchases. Risk assessments for epilepsy should record how hazards are minimised when supporting people with their personal care, showering or bathing. Peoples spiritual beliefs should be identified and care plans indicate how they are supported to follow these. Continue to explore opportunities for people to be involved in frequent meaningful activities. Medication information leaflets should be in place for all medication used. Handwritten entries should be countersigned by two people. A recent copy of the British National Formula should be in place. 2 3 7 9 4 5 6 7 8 11 14 20 20 20 9 10 11 12 20 22 23 30 Medication audits should be recorded along with any training provided in the home. A complaints folder should be kept to store any concerns or complaints and record the outcomes of this. Management and staff should access information/training about the Mental Capacity Act. Seat protection covers should not be used in communal areas. Alternative furniture should be provided which can be kept clean and odour free. Copies of birth certificates and CRB checks should not be taken or kept on file. Where staff are employed on a povafirst check a risk assessment should be in place outlining the duties they are allowed to perform. Where telephone references are received these should be recorded and then backed up with a written reference. Any contact made to obtain references should be recorded. References should be obtained from previous employers and not from personal addresses. References should be on headed notepaper. 13 14 34 34 15 34 16 17 18 35 35 42 Staff should have access to the Learning Disability Qualification. Staff should increase their skills and knowledge in sensory awareness. Fire checks on equipment and systems should be completed regularly. 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). 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. 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