Inspection on 30/09/08 for The Firs

This inspection was carried out on 30th September 2008.

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

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

Other inspections for this house

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Firs 2 Hiltop Drive Rye East Sussex TN31 7HT     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: Caroline Johnson     Date: 0 3 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (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 32 Information about the care home Name of care home: Address: The Firs 2 Hiltop Drive Rye East Sussex TN31 7HT 01797225780 01424751641 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Leigh Darren Hills Type of registration: Number of places registered: Hastings and Rother Primary Care Trust care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 6. The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home The Firs is a two-storey home situated in a residential area on the outskirts of Rye. The town centre, with its shops and access to bus and rail routes is approximately one mile away. The home is registered to accommodate six adults with a learning disability. Resident accommodation consists of six single bedrooms. Bathing and toilet facilities are provided by way of three bathrooms, one of which provides an adapted bath facility. Communal areas comprise of a large lounge and separate dining room. A large and well-maintained garden is situated to the side and rear of the property. Parking is Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 6 Brief description of the care home available at the front of the home. In April 2008 Hastings and Rother PCT became the registered providers for this service taking over from the Kent & Medway NHS and Social Care Partnership Trust. The Trust manages nine other homes within the Hastings, St Leonards and Rother area. Details of the fees charged can be seen in the summary section of this report. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: For the purpose of this report the people living at the Firs will be referred to as residents. As part of the inspection process a site visit was carried out on 30 September 2008 and it lasted from 11.30 until 2.20pm. A second visit was carried out on 3 October and this visit lasted from 09.40 until 3.30pm. The registered manager facilitated the inspection. Over the course of the inspection there was an opportunity to meet with and to spend time with all of the residents. In addition time was spent with two members of the staff in private. A full tour of the home was undertaken. Two care plans were examined in detail. In addition records seen included; staff rotas, training, medication, menus, health and safety, quality assurance and leisure activities. Care Homes for Adults (18-65 years) Page 6 of 32 In advance of the site visit surveys were sent to the home for distribution to residents and visiting professionals. The manager responded advising that due to the residents complex learning disabilities they would be unable to complete the surveys. Two surveys were returned from visiting professionals. Both were very positive. A comment from one in relation to how the home could improve was, I think the carers are already doing an excellent job. For a number of years there has been an expectation that the Firs would close. Following the take over of the organisation earlier this year a decision was made to keep the home open and to put in place a full programme for the refurbishment of the building. The fees for the service range from 1,331 to 1,366 pounds per week. Prior to finalising this report the home submitted a list of actions that they would be taking over the coming months to address issues raised in this report. In addition an improvement plan was also provided. What the care home does well: What has improved since the last inspection? What they could do better: Having made a decision to keep the home open for the foreseeable future the PCT Care Homes for Adults (18-65 years) Page 8 of 32 must now advise the Commission of the timescales for the proposed refurbishment of the property to improve the quality of the accommodation provided. A decision must also be made about how to address the issues raised in the recent compatibility assessment. The arrangements in place for formal day care need to be reviewed to ensure that residents receive a regular and consistent day care package. The arrangements in place for the management of residents DLA (disability living allowances) need to be clarified with their relatives and/or representatives. Monthly visits carried out by the senior management team need to be more detailed, need to identify shortfalls observed, how they are being managed and any impact the shortfalls have on the quality of care received by the residents. The home needs to keep a record of all correspondence entered into or received on behalf of residents. Some of the issues raised in this report are organisational issues. The registered provider must support the manager to ensure that the requirements can be met. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Work is underway to ensure that prospective residents receive information about the services on offer in a format that can be easily understood. Residents would benefit from living in a permanent placement with people with whom they are compatible. Evidence: For a number of years there has been an expectation that the Firs would close. The six residents placed at the home had only ever been placed as a temporary measure and were not seen as compatible. Following the take over of the organisation a decision was made to keep the home open and to put in place a full programme for the refurbishment of the building. The manager advised that he has completed a compatibility assessment for the residents and that this is currently with his line manager. Some of the residents have over the course of the last couple of years become friends and it is considered appropriate that they remain together. For others it is still considered an inappropriate placement and it remains essential that action be taken to address the needs of the Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: residents. The organisation has produced a generic statement of purpose that will be amended further by the manager to include specific information about the Firs. A service user guide was seen and this had been produced using a pictorial format. The manager advised that further work was going to be carried out in an attempt to make it more user friendly. It is envisaged that this will be achieved by using a DVD. It was reported that the staff team will be facilitated with appropriate training on the use of computer software to use a widget system and this may also be used to assist in providing clearer information for the residents. It is also hoped that the local advocacy service will be part of the process of assisting staff to explain the document to the residents. Service user guides are stored in individual residents bedrooms. The organisation is continuing to work on the production of a new terms and conditions of residence and a license agreement with the housing association. There have been no new admissions to the home since 2006. There is information in each of the residents care plans about how they communicate. Where necessary advice and support from the speech and language team is used to assist in this process. At the time of inspection the manager was meeting with the SALT team regarding one of the residents as although they the SALT team had put guidelines together in the past staff wanted more advice as they felt that they could be missing out on some of the ways that this resident was trying to communicate. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Progress has been made with the introduction of person centred planning and the home needs to continue to develop this further. Evidence: Three care plans were examined in detail. Since the last inspection extensive work has been carried out to improve care planning and to use the PCP (person centred planning) approach. Support plans have been compiled using this approach. Some have been completed in full and others still require further work. Each residents needs are clearly identified. There are very detailed guidelines in place advising staff of the action to be taken to ensure that the identified needs are met. Support records are written daily to record the support given to residents but they mainly refer to the activity programmes and how residents responded. Record keeping in relation to this has until recently been very limited. However there was evidence that in the weeks leading up to the inspection record keeping was more detailed, Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: stating what residents actually did and the level of participation in activities. Files seen were bulky and include a wealth of information about each of the residents. However, if the PCP system is to work appropriately then the key information must be separated away from the detailed folders and this would enable both residents and agency staff to fully participate in the process. In each of the care plans seen there were detailed risk assessments in place, which had been reviewed and updated regularly. However, risk assessments have yet to be transferred to PCP system. PCP meetings are held every six months and they are used to review what has happened in the previous six months and to plan ahead for the next six months. The manager advised that placement authorities are invited to reviews but that they prefer to just receive a copy of the minutes. This information is recorded in the diary but not in the individual care plan. Residents are encouraged to make choices and decisions and staff are continuing to build up a bank of photos to assist residents in this process. Staff were observed offering choices over the course of the day. Staff have begun the process of supporting residents to make decisions about the colour schemes for their bedrooms, as they are due to be refurbished in the coming months. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home have introduced more person centred activities but a further review of day care arrangements is required to build upon this. Evidence: MCCH are the day care provider contracted to provide day care for the home. Since the last inspection a review of the day care arrangements were held and although the home would like to see further improvements in the number of activities provided they did however acknowledge that the service has improved since last year. It was reported that a further review of the day care arrangements is to be carried out. One resident is supported to attend a gardening project one day a week and another to attend a cookery session at a local college. MCCH relies on the staff taking the residents in the house car to wherever the session is to be held. This can often take a Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: member of staff out of the home for an hour. However, staff do take residents on public transport, the bus stop is close to the home and two of the residents also enjoy walking into town and will often get the bus or a taxi back. Each of the residents has a weekly planner showing the planned activities for the following week. Generally records showed that the residents are participating in the activities as planned. Where an activity is cancelled the reason is sometimes recorded. It was noted that one resident has a vegetable patch in the garden as they enjoy gardening and their activity plan included regular opportunities to spend time in the garden. An activity for a morning could include preparing a drink. One resident was observed choosing what they wanted to drink, participating in the preparation of the drink, choosing to spend time in the garden and later choosing to listen to music and indicating what music they wanted. Records would only have shown information about the drink preparation and not the other activities that they participated in. Staff support residents to maintain contact with families and friends. A staff member advised one positive change is that one of the residents has started to have their hair cut at the hairdressers rather than at the Firs and she is enjoying this new experience. There is a four-week menu in place and a dietitian has been involved in the compilation of the meals to ensure that they are balanced and varied. The home are in the process of taking photos of all the meals so that they can encourage residents to make more informed decisions about the food they eat. Discussion was had about the need for a four week set menu and it was acknowledged that as residents skills in making choices at meal times improves this could lead to a greater flexibility in the menus. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are protected by the systems in place to manage medication. Evidence: Records seen in relation to the administration of medication were in order. There are appropriate arrangements in place for the storage and handling of medication. Auditing of the medication system is carried out on a daily, weekly and monthly basis. There are clear arrangements in place for the recording of all medication returned to the homes pharmacy and for recording all medication provided for social leave. All new staff complete training on medication as part of their induction to the service and as part of the homes in-house induction there are assessed on at least three occasions administering medication before they are deemed competent to administer medication in the home. Staff also receive annual refresher training on this subject. Each of the residents has a health action plan, which clearly states how their health needs are met. Records showed that residents attend regular dental and opticians appointments. Chiropody, if needed, is arranged via the gp. Individual weights are monitored on a monthly basis. In addition arrangements are made for those residents Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: who require specialist advice and support to receive this. Staff observed in the course of their duties showed patience, allowing plenty of time for residents to carry out tasks. In addition residents were treated with respect and there was a very relaxed atmosphere in the home. The home has yet to carry out an assessment of the wishes and needs of the residents in relation to dying and death. Care Homes for Adults (18-65 years) Page 18 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are procedures in place to ensure that anyone wishing to make a complaint can do so. The management of residents allowances needs further clarification. Evidence: There is a detailed complaints policy and procedure in place. The Manager confirmed that there have been no complaints received about the Firs. There is a simplified version of the complaint procedure in the service user guide. There is a procedure in place on the protection of vulnerable adults. A copy of the Sussex multi-agency guidelines on the protection of vulnerable adults is also available in the office for staff to refer to. Staff spoken with were clear about the action that should be taken should they suspect abuse. There have been no adult protection alerts for some time. The manager confirmed that incidents within the home have significantly reduced and it is thought that this is a result of stability in the staff team and that staff are working more consistently. Residents finances were not examined in detail. However, records seen in relation to daily expenditure were in order. The arrangements in relation to the management of DLA (disability living allowances) monies were unclear and need to be clarified. Care Homes for Adults (18-65 years) Page 19 of 32 Care Homes for Adults (18-65 years) Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Timescales for the refurbishment of the property must be agreed to ensure that a good quality of accommodation is provided for the residents. Evidence: The Firs is a two-storey home situated in a residential area on the outskirts of Rye. Resident accommodation consists of six single bedrooms. Bathing and toilet facilities are provided by way of three bathrooms, one of which has an assisted bath facility. Communal areas comprise of a large lounge and separate dining room. A large and well-maintained garden is situated to the side and rear of the property. Parking is available at the front of the home. At the time of the last inspection it was noted that there was a padlock on the garden gates. The manager confirmed that this has been removed. At the time of the last inspection the future of the property was uncertain and although it was in need of refurbishment it was agreed that this would be on hold until a decision was reached about the future. It has since been decided that the home will remain open for the foreseeable future and as a result a refurbishment programme is Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: currently being put in place. The manager advised that since the last inspection carpets in the communal areas and in the office have been replaced. Loose door handles have been repaired and the external locks on the two upstairs bathrooms have been removed. In addition the washing machine and dishwasher have been replaced. The manager said that they have looked at how the refurbishment programme will be implemented and a planning meeting will be held in early November to discuss the timescales and plans. It is thought that the main part of the work will be done whilst residents are on holiday but they would like to involve some of the residents in some aspects of the refurbishment. The manager advised that they are currently encouraging residents to choose between wallpapers and colour schemes for their rooms. The refurbishment of the property includes plans to fit new bathroom suites in all three bathrooms. In the kitchen there will be replacement work surfaces, a new sink, flooring and kitchen unit doors. In addition new carpet will be fitted in two of the bedrooms and new furnishings will be provided in the lounge area. All areas of the home seen during the inspection were clean. Staff have received training on infection control. Care Homes for Adults (18-65 years) Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are provided with good opportunities to update their knowledge and skills. Arrangements must be made to ensure that all staff receive regular supervision. Evidence: The new format for the staff rota showed that there is now always three staff on duty at all times throughout the day. The rota was clear and very detailed showing all activities (staff training, appointments and trips) planned over the day and how the home is to be staffed. The managers hours are supernumerary although he occasionally works a shift if there is sickness. The home also uses agency staff to cover where necessary and the manager advised that they always try to use staff that are familiar with the home and the residents so that they can maintain consistency for the residents. As a result of a recent fire risk assessment staffing levels at night have also increased and now there is one waking and one sleep in carer on duty each night. The manager advised that he is now much more involved in the recruitment process. The Trust held an open day during the summer months and one of the residents joined the manager in representing the home. The manager advised that he was clear about Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: what he was looking for in staff. Information was provided to prospective staff about the types of activities that they would be expected to undertake. Applicants who were successful in the first stage interview were invited to the home and to meet with all the residents and a record was kept of how well they interacted with the residents. Two staff were appointed as a result of this open day and the manager confirmed that he saw all the recruitment records obtained as part of the recruitment process. A staff training matrix is on display in the home. The matrix is colour coded to show when staff are up to date with training, if it is due to run out within the next three months, if it is over due and when a new course has been booked. The matrix is updated on a monthly basis. In addition to the mandatory training, training that is regarded as essential for all staff working at the Firs includes training on the Mental Capacity Act, Proact Scip, epilepsy and mental health. Records showed that the majority of the staff team were up to date with all training. However, seven staff require training on moving and handling, three on first aid and five on PCP (person centred planning). The manager is a qualified instructor for ProAct Scip. There is a new health and safety course so staff are going on this two at a time and records showed that four staff would receive this training in November. Six of the eleven permanent staff have completed NVQ level two or above and two staff are currently working towards this. Records showed that all staff have had one or two formal supervisions since January. Staff spoken with confirmed that they feel well supported and that they can go to the manager at any time if they need advice or support. Care Homes for Adults (18-65 years) Page 24 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Despite the shortfalls in the environment and the problems with compatibility, the home is well managed and there are some very good systems in place, which have significantly improved the quality of life for the residents. In order to move forward the compatibility issues and the environment must be addressed as soon as possible. Evidence: Since the last inspection of the service the appointed manager has been registered as manager. He is a qualified nurse in learning disabilities (RNLD). He is also a ProactSCIP instructor, an accredited mentor for students and holds a D32 NVQ Assessors Award. Staff described the manager as very thorough and when he does something he does it well. They also stated that he is very approachable and supportive. Team meetings are held every eight weeks and all staff are expected to attend. Minutes were seen of the September meeting. They were very detailed minutes and clearly showed that all staff participated in the discussions and the outcomes reached. The majority of the staff team signed that they had read the minutes. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: There is a good handover system in place between shifts, which shows that the residents monies are checked daily. Staff are advised to read the diary and communication book. As part of the handover a staff member is designated as the keyholder for the day and the format also identifies who is supporting each resident and who has responsibility for meal preparation. In addition household tasks are allocated. A service leader visits the home on a monthly basis unannounced to report on the conduct of the home. Visits generally last about an hour in duration and a wide range of areas are examined in this time. During this time the service leader talks with or observes residents, talks with staff, examines a care plan and discusses any issues relevant to the home. Despite the fact that the visits are only an hour in duration a wide range of issues are reported upon such as maintenance issues, staffing issues and the incompatibility issues. However, discussions with staff about how they are supported are not documented. As stated in section one the manager has completed a compatibility assessment, which is now with his line manager. It is not clear what will happen as a result of the assessment and if there is a timescale for responding to the assessment process. The organisation has introduced a new quality assurance system, which includes obtaining the views of the residents. There are a number of surveys in place, one of which is carried out with one of the residents on a monthly basis. Three different surveys had been completed. The results of the surveys were at the head office so it was not possible to make a judgement about the outcome. Records also showed that surveys had been sent to four of the residents relatives and had been returned and that the results were at the head office. One of the families had raised some concerns regarding the need to upgrade the property and head office had responded to these concerns. A copy of this correspondence was on file in the home. In advance of the inspection surveys were sent to the home for distribution to residents and any visiting professionals. The manager responded advising that due to the residents complex learning disabilities they would be unable to complete the surveys. Two surveys were returned from visiting professionals. Both were very positive. In one the respondent stated in response to a question about how the home could improve, more staff more money. In the second survey, the respondent advised in relation to a question about the home managing health care needs, the care service always alert the primary care team in our surgery in case of the slightest concerns re residents in the house. In relation to the question about how the service could improve, the response was, I think the carers are already doing an excellent job. Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: As previously referred to in the complaints and protection section, the management of residents monies in relation to DLA allowances were unclear and the registered provider must ensure that they are clarified. As stated previously in the environment section there had been plans to close the property in April of this year but this decision was then changed. The home is to remain open for the foreseeable future. As a result of this decision there are now plans to upgrade the entire building. However, there are no clear timescales for the completion of these works. The manager confirmed that a health and safety audit would be carried out in December. A fire risk assessment has recently been carried out and as stated in the previous section, staffing arrangements at night have been increased as a result. Another option being explored is the possibility of installing a fire escape and this was being looked into at the time of inspection. Staff have received fire safety training that was specifically designed for the Firs. This involved looking at the fire evacuation plan in detail. The padlocks referred to on the garden gates at the last inspection have been removed. They had been fitted when a particular resident lived at the home. This resident no longer lives at the home so it was not necessary to keep them. Portable appliance testing was carried out in June 2008. Records showed that weekly check of alarms and monthly light checks were all in order. Fire drills are carried out regularly and records refer to all staff present but dont mention the residents or what happened when the alarms sounded. The manager confirmed that the boiler is old and is due to be replaced. He is hoping that this work will be carried out in the coming months. He confirmed that the heating is working well and that the fire safety officers were happy with the current arrangements as long as the staffing was increased at night. There were certificates in place showing that equipment is serviced regularly. Electric hardwire tests were carried out in June and records showed that the certificate was to follow, but this is not yet in place. Water temperatures are recorded monthly. Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The registered person must ensure that they can meet the needs of the residents both in terms of their individual needs and in terms of their compatibility as a group. Residents must know that their home can meet their needs and aspirations. 28/02/2009 2 10 17 The registered person must 30/01/2009 ensure that a copy be kept of all correspondence entered into and received on behalf of a resident. Residents must know that information about them is handled appropriately. 3 21 12 The registered person must 27/02/2009 ensure that an assessment is carried out in relation to the needs/wishes of residents in relation to dying and death. If necessary relatives and/or Care Homes for Adults (18-65 years) Page 29 of 32 representatives should be consulted on this subject. The ageing, illness and death of residents must be handled as individuals would wish. 4 36 18 The registered person must ensure that all staff receive supervision at regular intervals. Residents benefit from well supported and supervised staff. 5 39 26 The registered person must ensure that more effective monitoring is achieved through Regulation 26 conduct visits of the home. The provider must be kept informed of all shortfalls/improvements in order to gain an informed opinion of the conduct of the home. 6 42 13 The registered person must ensure that there is a clear programme for the refurbishment of the property in place along with timescales for the completion of the refurbishment programme. Residents must live in a homely, comfortable and safe environment. 7 43 17 The registered provider must clarify the arrangements in place for the management of 27/02/2009 27/02/2009 30/01/2009 27/02/2009 Care Homes for Adults (18-65 years) Page 30 of 32 (disability living allowance) payments. Residents must benefit from competent and accountable managemet of the service. 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 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (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. Care Homes for Adults (18-65 years) Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!