Inspection on 13/01/09 for The Firs

This inspection was carried out on 13th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Firs 16/08/07

The Firs 06/09/06

The Firs 07/02/06

The Firs 05/10/05

The Firs 25/01/05

The Firs 11/05/04

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

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Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

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: The Firs Thorpe Road Kirby Cross Frinton On Sea Essex CO13 0NJ 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: Francesca Halliday Date: 1 3 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. 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 Inspection report CSCI Page 2 of 35 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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 35 Information about the care home Name of care home: Address: The Firs Thorpe Road Kirby Cross Frinton On Sea Essex CO13 0NJ 01255862617 01255860259 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Sheik Kemal Kadar,Mr Ahmad Fareed Kadar Name of registered manager (if applicable) Mrs Susan Ann Law Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 0 1 1 0 care home 8 learning disability physical disability Additional conditions: One person, under the age of 65 years, who requires care by reason of a learning disability and who also has a physical disability, whose name was provided to the Commission in July 2003 One service user, aged 65 years and over, who requires care by reason of a learning disability, whose name was made known to the Commission in July 2004 Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 8 persons) The total number of service users accommodated must not exceed 8 persons Date of last inspection Care Homes for Adults (18-65 years) 1 6 0 8 2 0 0 7 Page 4 of 35 A bit about the care home The Firs is a care home for eight younger adults with learning disabilities. The home is located in a rural setting in a large country house between the villages of Kirby Cross and Thorpe-leSoken. Local shops, post offices and schools are found in these villages. The Firs has a large garden and off-road parking to the front. There is a day centre attached to the home. The centre has a spa pool, ball pool and a sensory room. In addition there is a small farm with sheep, goats, chickens and rabbits. People living in the home can use these facilities. Care Homes for Adults (18-65 years) Page 5 of 35 The home charges between £605 and £1399 a week for the service they provide. There are additional charges for personal items such as toiletries, hairdressing, holidays and chiropody. This information was given to the Commission in January 2009. Care Homes for Adults (18-65 years) Page 6 of 35 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 Care Homes for Adults (18-65 years) Page 7 of 35 How we did our inspection: This is what the inspector did when they were at the care home We looked at lots of different evidence for this report. We looked at paperwork like care plans, staff files and menus. The manager sent us information called an annual quality assurance assessment or AQAA. This gave us information about how they run the home. We visited the home on 13th January 2009. We looked around the home. Care Homes for Adults (18-65 years) Page 8 of 35 We talked to people living in the home and staff. We looked to see if people were happy with what goes on in the home. What the care home does well Care Homes for Adults (18-65 years) Page 9 of 35 Listens to people and helps them to do the things they want to do. Cares for people well and looks after their health. Helps people keep in touch with their family and friends. What has got better from the last inspection Care Homes for Adults (18-65 years) Page 10 of 35 The new manager has started making things better for people in the home. What the care home could do better Where drugs are stored could be better. Care Homes for Adults (18-65 years) Page 11 of 35 Some parts of the home need painting. 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 Francesca Halliday CPC1 Capital Park Fulbourn Cambridge CB21 5XE Tel: 01223 771300 Care Homes for Adults (18-65 years) Page 12 of 35 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 13 of 35 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 14 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People choosing to live at The Firs can be confident that their needs will be assessed before admission to the home. Evidence: Information about the home was available in the form of a statement of purpose and service user guide, although the service user guide was not in an easy read format that would be accessible to people with learning disabilities. The home was full and had not had an admission in over two years. Pre-admission assessment and risk assessment documentation was available and the manager confirmed that a full assessment was carried out prior to a place in the home being offered. Input from relatives, carers and advocates provided key information to assist in the decision making process. Assessments from social services and mental health professionals also provided information during the pre-admission stage. The manager said that people were encouraged to visit the home, have a meal and stay overnight. Emergency admissions were only accepted in exceptional cases and full assessments were carried out on their admission. A trial period of three months was offered to ensure that the placement was suitable and peoples needs could be met, also that their relatives and advocates and other people in the home were happy with the admission. Care Homes for Adults (18-65 years) Page 15 of 35 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 in the home are supported to make decisions and to take responsible risks. The current lack of detail in care plans does not encourage consistency of care practises. Evidence: The manager and the directors were aware that the care documentation was not sufficiently detailed concerning peoples wishes, abilities, preferred routines and activities and were not being fully updated following changes in peoples condition. The manager said that the care documentation was due to be changed and that staff training had been arranged. Daily care records were not being completed so that there was not always evidence that peoples care needs were being regularly monitored. The manager told us that in future a record would be made on each shift. There was evidence that people in the home were being given information and assistance to make choices in their daily lives and that advocates were involved when they did not have relatives to act on their behalf. From discussions with staff and feedback from relatives/advocates it was clear that people in the home were supported to take risks and be as independent as possible. The manager was aware that the documentation for restrictions or infringements of rights and some of the risk assessments needed to Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: be developed. One relative/advocate told us they have some very good carers in the home. Im really pleased with the care. Staff meetings were used to communicate care and health issues about people in the home and to encourage staff to be consistent in care practises. The manager was aware that detailed and up to date care plans would also encourage more consistent standards of care. Three relatives and advocates told us that people in the home were always supported to live the life they chose and two relatives and advocates told us that staff usually supported and encouraged peoples choices. One of the relatives/advocates who responded usually told us that this had improved since the new manager took over the home. Care Homes for Adults (18-65 years) Page 17 of 35 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 benefit from a range of activities both at the home and in the community and are given assistance to maintain relationships with family and friends. A healthy and balanced diet is provided. Evidence: People in the home had access to a wide range of activities in the local community. One person attended college twice a week, one went horse riding, one occasionally attended football matches and three attended a local club that was held two evenings a week. A number of people in the home went swimming, bowling and ice skating on occasions. The beach, local farms, cafes, pubs and garden centres were also visited. Trips to the circus and pantomime had also been arranged. Five people in the home had been on holiday in the past year and the other three had been on a long weekend away. One relative/advocate told us that the person they visited had recently been on a holiday for the first time and said they had a lovely time, I was so pleased, it was brilliant. The home had purchased a new minibus so that there was more flexibility in Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: the transport available and people were able to go out more regularly. People in the home had access to all the facilities in the day care centre in the grounds of the home. These included a spa and a ball pool, an arts and crafts room, musical instruments and a sensory room. People who were interested assisted staff to look after the animals on site, these included birds in an aviary, some guinea pigs and small farm with chickens, goats and a sheep. One person who liked to earn money collected the eggs to sell to the home and also sometimes washed staff cars. Staff were going to help one person to make a bird table as they enjoyed watching the birds. One relative/advocate told us that they had noticed more activities and outings taking place since the new manager took over. A relative/advocate who completed our survey told us that staff Look after the welfare of people in the home very well, take them on days out and look into courses that will improve skills to help them. An relative/advocate who responded to our survey told us that the home provided a warm, friendly environment where the advocate is always welcomed. Three relatives/advocates who completed our survey told us that staff always helped people in the home to keep in touch with them and two relatives/advocates told us that staff usually helped them to keep in touch. Staff were helping one person to keep in touch with a friend outside the home. One relative/advocate told us that communication with them had improved since the new manager took over. Key workers took all people in the home out to buy what they wanted for Christmas. They involved relatives and advocates in discussions about any of the more expensive purchases. All people in the home had their own rooms and the rooms that we saw had been very well personalised to their individual tastes and interests. Their bedrooms had a door key and they all had a lockable facility within the room. The food served looked nutritious, the menu was varied and was changed with the season. Staff told us that they tried to use produce and herbs from their own garden when possible. The manager told us that the menus had recently been revised in consultation with people in the home. A choice was available at each meal time. Main meals were served with seasonal vegetables and fruit was available. Staff were aware of the benefit of encouraging people to eat five fruit and vegetables a day. Diets were catered for and alternatives were available if people did not want what was on the menu. The home had a list of foods that people disliked and were aware of their nutritional needs. Staff said that they tried as far as possible to offer a choice at the time of the meal. Snacks and drinks were available at all times. One person had been finding it difficult to eat unaided following a change in their condition. The occupational therapy department had been consulted and had loaned them different cutlery, a beaker and a plate guard to try out and this had enabled the person to maintain their independence. Care Homes for Adults (18-65 years) Page 19 of 35 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 care needs are met but improvements in medicines management are needed to ensure their safety. Evidence: A relative/advocate who completed our survey said I feel that ... is well cared for and has a good quality of life. An relative/advocate responding to the question about what the home does well said that The Firs supports people with complex needs and complex behaviour very well. Another relative/advocate responding to the same question said Very impressed. The staff are excellent, facilities are brilliant, cannot fault the care home, ... always seems happy and well looked after. The care they receive at The Firs is superb. The majority of relatives or advocates who responded to our survey told us that people in the home always received the care and support they needed and that they were always informed about important issues such as an accident or admission to hospital. One relative/advocate told us that staff at the home always keep us aware of the persons wellbeing. We spoke to the one person who told us that the person they visited usually received the care and support they needed and that they sometimes were informed about health concerns or accidents. They told us that the overall Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: standards had improved since the new manager took over the home and that communication with them had improved considerably. The manager said that she had put considerable stress on the need to improve communication in the home. She had been holding monthly staff meetings and ensuring that staff had two monthly supervision and an annual appraisal. Issues such as staff confidentiality were stressed at staff meetings. The manager tried to ensure that people were cared for by staff of the same sex wherever possible. One relative/advocate said that they had never heard staff talk about different people in front of others in the home. They also told us that staff were good at protecting privacy and dignity of people in the home. There was evidence that people in the home had good access to local NHS services. Staff in the home were acting as advocates and liaising with NHS staff to ensure that any operation or procedure was carried out in a way that minimised distress and disruption to their daily routines. An independent Mental Capacity Advocate had attended meetings and appointments when discussions were held about one persons planned operation. Staff were also accessing NHS services to gain additional support to enable people to remain in the home, following changes in their condition and increase in their dependency levels. Relatives/advocates told us that they were always involved in decisions if there were any health concerns. One told us that staff were quick to call the GP and let me know if theres anything wrong. Peoples weight was being monitored and there was evidence of action taken when one resident lost weight. A chiropodist and an optician visited the home and people attended a local dentist for regular checkups. Two GP practises provided services for people in the home. The manager said that the majority of people were with one GP and said that the GPs were very supportive. Medicines were being stored in a separate locked room. The home was not using any controlled drugs. The medicine administration records (MAR) we looked at were generally well completed but staff who made changes to the MAR were not always signing and dating these entries. Staff were not monitoring the temperature of the room on a daily basis and on the day of inspection it was found to be 27.5c. This was above the safe storage temperature for the majority of medicines, which is 25c. This could result in people being given medicines that were not fit for use. The manager told us that she was investigating alternative methods of storage for the medicines in consultation with the directors. Medicines with a limited shelf life when opened were not being dated on first opening. This also could result in medicines being given beyond a time when they were fit to be used. The manager told us that they had a small fridge that could be used if they had any medicines that needed to stored in a fridge. The homely remedies were not being recorded in such a way as to keep a record of stock balance but the manager said that this would be done following the inspection. The manager told us that none of the people administered their own medicines. The manager told us that they had made considerable efforts to get the GPs to prescribe buccal midazolam (which was more expensive than diazepam) for the treatment of epileptic fits. The new treatment was not invasive and it would be much easier to protect peoples dignity than giving rectal diazepam. Training was being given Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: to staff before they administered the midazolam. One person was having some swallowing problems and staff, in consultation with the GP, tried different forms of the medicine before finding a method that enabled them to continue taking their medicines safely. These both demonstrated that staff were advocating strongly on peoples behalf to enable them to receive the most appropriate and effective treatment. Staff told us that they always ensured that medicines were labelled on the actual container and not just the outer carton and returned them to the pharmacist if this did not occur. Training had been given to staff prior to them giving oxygen to one person when they had a seizure. Two staff who administered medicines had not received any training or updates in the administration and management of medicines since 2003 and 2004. The manager said that there was no record of whether staff who administered medicines had received an assessment of competence. However, she told us that training and updates had been booked, in early February 2009, for all staff who administered medicines. The medicines policy and procedure needed to be amended to include covert administration and the procedure for administering medicines outside the home, including the limits on secondary dispensing. The manager said that this would be done following the inspection. Care Homes for Adults (18-65 years) Page 22 of 35 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 and their relatives or advocates can be assured that their complaints will be addressed but lack of safeguarding training means that people cannot be confident that they will be protected from abuse. Evidence: The home had a complaints procedure that was included in the statement of purpose and user guide. The procedure needed to be updated to reflect the CSCI role in monitoring complaints. Four relatives and advocates who responded to our survey told us that they knew how to make a complaint and that staff always responded appropriately if they or the person using the service raised concerns about their care. One relative or advocate told us that they did not know how to make a complaint and felt that staff usually responded appropriately to complaints. The manager told us that they had an open door policy and there was evidence that staff were reminded of this in the staff meeting minutes. One relative/advocate told us that they had not had to raise any concerns since the new manager took over. The home has a safeguarding vulnerable adults and prevention of abuse policy and a policy on disclosure of abuse and bad practice (whistle blowing). A number of staff needed safeguarding training or updates and the manager said that this was booked for February 2009. However, there was also evidence that the manager and one of the directors discussed issues of good and poor practice regularly at staff meetings and in staff supervisions. The home used the services of advocates for people who did not have a family and could not communicate and had also used the services of an Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: independent mental capacity advocate. A small amount of personal money was held for people in the home. Everyone in the home had a separate bank account and receipts were available for all purchases. We looked at the accounts for two people and the balances were correct. The manager confirmed that they always liaised with relatives or advocates before spending money on larger purchases or holidays. Staff were not obtaining a double signature for all transactions or getting people to sign when they received money but the manager said that this would be put in place following the inspection. Internal audits on peoples finances had not been carried out but the director said that this would be done in future. Care Homes for Adults (18-65 years) Page 24 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People live in a clean and safe environment but potential infection control risks have not been eliminated. Evidence: Peoples bedrooms that we looked at were well personalised to their individual tastes and personalities. People who wanted a lock on their door had this installed and the locks seen could easily be opened from the inside of the room. A relative/advocate told us that when they asked if a bedroom could be redecorated this was done. Staff confirmed that people were consulted about the colour scheme and decor when their rooms were redecorated. The directors said that there was a rolling programme of redecoration in the home. Two of the communal rooms had been redecorated and new furniture and curtains were on order. However some areas of the home were in need of painting, particularly corridors and doorways, which had extremely scuffed paintwork. One relative/advocate told us I do feel the home would benefit from decorating. The home had employed a handyman since the last inspection and they had attended a five day decorating course. The first floor shower room had a step up to get into the shower and the management team were aware that people in the home with physical disabilities would benefit from easier access if it was converted into a wet room with no step to negotiate. The manager told us that window restrictors had been installed on all the first floor windows since the last inspection and that they had completed the covering of all radiators to reduce the risk to people in the home. Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: The home had extensive grounds that included a day care centre, a small farm and a greenhouse, all of which people in the home could access. Raised beds, with herbs and plants with interesting textures and scents, had been built to turn an area into a sensory garden for wheelchair users. Staff had also planted one bed with colourful plants for a person who liked a flower in their button hole. The directors said that they were planning to add a conservatory at the rear of the home following the successful application for a grant. The laundry was in a very poor condition, the floor had splits in the lino and the walls had areas where the paint was peeling off so that neither could be kept in a hygienic condition. The two mop buckets seen were extremely dirty. Staff were handling soiled linen as the home did not have washing machines with a sluice cycle or use dissolvable red bags (or equivalent) for handling soiled linen. This put staff at risk and people in the home at potential risk of cross infection. A number of areas where staff carried out personal care, including peoples rooms, did not have a supply of liquid soap and paper hand towels for staff to carry out appropriate infection control procedures when providing personal care. However, these issues were addressed promptly following the inspection and the manager confirmed that the laundry had been completely renovated and a washing machine with a sluice cycle installed. The home was clean on the day of inspection and a relative/advocate confirmed this when they told us The home always looks clean. The manager said that she had introduced the wearing of different coloured protective aprons for use in the kitchen and for use when staff carried out care in order to improve infection control practice. Care Homes for Adults (18-65 years) Page 26 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are supported by well recruited, competent and qualified staff. Evidence: Interactions between staff and people living in the home were friendly, supportive and caring. A relative/advocate told us that there was a good family atmosphere in the home. Staff knew them well and provided support in a way that met their needs and wishes. Three relatives and advocates who responded to our survey told us that staff usually had the right skills and experience to look after people properly and two told us that care staff always had the necessary skills and experience. One relative/advocate who responded to our survey told us that staff were friendly, approachable and informative. The home usually had three support workers on duty during the day and four on duty when they were taking trips out. In addition two of the directors, the manager and the team leader were on duty from Monday to Friday. There were two support workers on at night with one of the management team on call. A cook was available from 08.00 to 14.00 Monday to Friday and an additional support worker cooked the meals at the weekends. Support workers carried out the cleaning and laundry. The home had a mix of male and female staff and took considerable effort to ensure that there were always both male and female staff on duty to reflect the sex of people in the home. Some people had requested care from a carer of the same sex and the Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: manager said that they usually managed to accommodate this. They also tried wherever possible to meet peoples choice in relation to their key worker. One relative we spoke with was concerned at the turnover of staff as they said it took people in the home some time to get used to new staff. The manager considered that the workforce was more stable now and that staff usually tried to cover absence/leave themselves so that they only used agency staff very occasionally. We looked at the records for two members of staff and these demonstrated a sound recruitment procedure. A criminal records bureau and a protection of vulnerable adult list check were carried out. In addition two references were taken up and identification was obtained before staff were offered employment. Two interviews were carried out for potential staff. One was a general interview to introduce them to the home and type of care provided and the second was a more formal interview focusing on their potential role. The manager told us that newly appointed staff received the GSCC Code of Conduct, an employee handbook, employee safety handbook and the Essex County Council safeguarding booklets. The manager was aware that some staff training was overdue and was taking steps following her appointment to address the shortfalls. Staff now signed a training agreement in order to ensure that they understood their responsibility to attend training that was booked for them. A rolling programme of training had been booked. The majority of staff had completed infection control and basic food hygiene training and the cook had received more advanced food hygiene training. Some staff needed training or refreshers in moving and handling but this was in part due to the fact that the last session had been cancelled by the trainer and was due to be rebooked soon. Training in care planning, fire safety and health and safety was booked for January 2009. The majority of staff had received training in the use of oxygen, as one person needed oxygen when they had a seizure. A number of staff needed training in challenging behaviour and care of people with epilepsy. The majority of staff had completed the National Vocational Training (NVQ) at level 2 and three staff had completed NVQ at level 3. The manager and one of the directors had received some training in deprivation of liberty and the Mental Capacity Act. Care Homes for Adults (18-65 years) Page 28 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People benefit from a well run home that puts their interests first. Evidence: The manager had previously been in charge of the day care centre and had been appointed to manage both the home and the day care centre in June 2008. She was not yet registered with CSCI at the time of this inspection. One of the relatives/advocates told us that the management of the home, communications with relatives and the range of activities and outings for people in the home had really improved since the new manager took over adding shes just what the home needed. Another relative/advocate said that they had also noticed a difference in standards since the new manager had taken over. They said shes a people person. The manager had support from two of the directors who were both in the home on five days a week. The manager and one of the directors had been on a training session about quality assurance and were planning to develop a quality assurance system for the home with a number of audits. Staff were also being more involved in the running of the home and encouraged to come forward with suggestions to improve care or services for Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: people living in the home. One of the directors told us that they would be developing a range of audits to monitor standards in the home. There was evidence in staff meeting minutes that the management team were carrying out informal monitoring of standards and addressing any issues in discussion with staff. There was evidence that equipment was serviced and maintained on a regular basis to ensure that it was safe for people to use. The temperature of water outlets was checked every week and adjusted to ensure that temperatures were kept at the safe level for people in the home. A fire risk assessment had been completed. Accident records had been completed following accidents to people in the home and they showed that they generally had very few accidents. Areas of potential risk to people in the home such as the laundry, kitchen, electrical cupboard and medicines room had a coded entry to restrict access. An external company carried out health and safety audits of the home on an annual basis. Safety had been improved for people in the home by the safer storage of hazardous chemicals, the fixing of window restrictors on the first floor and installation of radiator covers. Care Homes for Adults (18-65 years) Page 30 of 35 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 Care Homes for Adults (18-65 years) Page 31 of 35 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 6 15 The manager must ensure that care plans provide details of peoples wishes, abilities, preferred routines and preferred activities and must be updated following changes in their condition. In order to ensure that people in the home receive a consistent standard of support and care. 23/03/2009 2 9 14 The manager must ensure 23/03/2009 that risks are assessed and that actions taken to manage the risks are recorded. In order that people are supported to take responsible risks as part of an independent lifestyle. 3 20 13 The manager must ensure that staff who handle medicines have regular 23/03/2009 Care Homes for Adults (18-65 years) Page 32 of 35 refresher training on the management of medicines and an assessment of competence. In order to ensure that they have up to date knowledge and understanding of the receipt, administration, recording and disposal of medicines. 4 20 13 The manager must ensure that medicines are stored at the correct temperature and that medicines are dated on first opening. 04/05/2009 In order to reduce the possibility of medicines being given to people when they are not fit to be used. 5 23 13 The manager must ensure that staff receive safeguarding training and regular refresher training. 23/03/2009 In order to ensure that staff are confident to recognise and report any poor practises and can protect people from potential abuse. 6 24 23 The proprietors must ensure 01/06/2009 that the home is kept in good decorative order. In order to maintain a pleasant environment for people in the home. 7 30 13 The manager must ensure that liquid soap and paper hand towels are available in 23/03/2009 Care Homes for Adults (18-65 years) Page 33 of 35 all areas that staff carry out personal care. In order to reduce the potential risk of cross infection to people in the home and to staff. 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 manager should consider producing information about the home in an easy read format that would be accessible to people with learning disabilities. The proprietors should consider converting the step in shower into a walk in wet room in order to make it more accessible to people with physical disabilities. 2 27 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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