Inspection on 15/12/08 for The Gables

This inspection was carried out on 15th December 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Gables 19/12/07

The Gables 09/01/07

The Gables 05/09/05

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Gables 22 Beacon Close Crowborough East Sussex TN6 1DX     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: Sally Gill     Date: 1 5 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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 35 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 35 Information about the care home Name of care home: Address: The Gables 22 Beacon Close Crowborough East Sussex TN6 1DX 01892655260 01892660154 peter.langley@eastsussex.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Peter Langley Type of registration: Number of places registered: East Sussex County Council care home 5 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 5 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home is within the following category: Learning disability (LD) Date of last inspection Brief description of the care home The Gables is registered to provide accommodation for up to five adults with a learning disability and admits people with low to medium dependencies. The home is part of services provided by East Sussex Social Services. The registered manager is Peter Langley who has day-to-day control of the home. The premises is a large bungalow situated in a small residential cul-de-sac. There are five bedrooms all with a wash hand basin. People have access to two bathrooms one of which is assissted and also has a walk in shower and a large lounge/diner. There is also a laundry and kitchen accessed with staff support. The home is non-smoking. To the rear and sides there are garden areas one of which has a level paved area with table, chairs, garden swing and raised Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 5 Brief description of the care home flower tubs. Some areas of the garden are not maintained. The home is suitable for wheelchair access. There is limited parking on the drive and additional on street parking in cul-de-sac. The home is situated approximately 10 minutes walk from the centre of Crowborough and its town centre amenities. Approximately 250 metres from the nearest bus stop, which could take you into Uckfield or Tonbridge. The staff compliment consists of the team leader (registered manager), senior care officers and care officers. Care staff work a rota 7am - 9.30pm with a minimum of two staff on duty during the day. One wake night member of staff and further staff on call at another establishment. Fees are based on a financial assessment and people make a contribution although this does not reflect the cost of care. Details of the unit cost per person are available from the registered manager. Previous inspection reports are available from the home or can be viewed and downloaded from www.csci.org.uk Care Homes for Adults (18-65 years) Page 5 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 peterchart Poor Adequate Good Excellent How we did our inspection: The previous inspection took place on 19th December 2007. This inspection was carried out over a period of time and concluded with an unannounced visit to the home between 09.08am and 5.08pm. The manager and staff assisted during the visit. People that live in the home, the manager, staff and the resource officer were spoken to. Observations were made throughout the day. Five people were living at the home on the day of the visit. Surveys were sent to the home for the manager to distribute to service users, staff and health and social care professionals. Five were returned from service users (completed with the help of staff). These were positive. Two were returned from staff members Care Homes for Adults (18-65 years) Page 6 of 35 which were positive. The care of two people was tracked to help gain evidence as to what its like to live at The Gables. Various records were viewed during the inspection and a tour of the home undertaken. The home sent their annual quality assurance assessment (AQAA) to the Commission within the required timescale. The AQAA is a self-assessment picture of how the manager thinks they are doing against the National Minimum Standards. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 8 of 35 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 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 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives do not have the information needed to choose a home which will meet their assessed needs. People are not protected by robust written agreements with the home. Evidence: People do not have access to the full information needed so that they can make an informed decision on whether this home is right for them. Information is also not available in a format suitable for people using the service. The home has a statement of purpose in place. This was dated June 2007 and needs review. A service user guide could not be found on the day of the visit. However in discussion the document terms and conditions of residency may double as the service user guide. If this is the case it does not contain all the information required by the regulations and National Minimum Standards (NMS). An example is complaints procedure, which meets regulation 22. A requirement is made to have a statement of purpose and service user guide in place, which meets the regulations and NMS. As previously advised it would be good practice that the service user guide is in a user-friendly format. Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: People needs are assessed before moving into the home. There has been one new admission since the last inspection. An assessment of needs was undertaken by their social worker. A copy was obtained and is held on file. In addition a copy the care plan, which included a risk assessment was also obtained. The speech and language team were also involved and worked with the person to put together a folder of notes and photographs my life story. The manager advised that he also assesses the persons suitability on a visit to their current environment. However this is not recorded which would be good practice. A copy of the previous homes care plan was obtained prior to the move to inform staff. At the time of the move the care plan transferred with the person. People moving in have the opportunity to test drive the home. The new admission transferred from another home run by East Sussex County Council. The admission was well planned. The person confirmed that they had visited The Gables prior to moving in and had stayed for meals. They said they were happy here. The social worker had also visited. They have also visited since the move to ensure the person has settled. Two people surveyed confirmed they had been asked if they wanted to move here and one said they had also visited prior to moving in. People are not protected by individual written contracts or terms and conditions with the home. Two files for terms and conditions of residency were examined. One person who moved in during October 2008 still does not have an agreement in place. The other agreement was viewed. The manager agreed to send the Commission a copy of the document. The agreement must be between the person using the service and the home not an individual member of staff. The person or their representative had not signed it and there is no place for a signature. It did not contain the full information. An example is fees. It must contain all the information as per the regulations and NMS. There was a previous requirement that the document must be expanded to include additional information about insurance and about the discharge process including rights of both individual residents and the homes responsibilities. This has not been met as the manager advised the document has not changed. The requirement has been reworded to be more specific as to what is required before further action is taken. The manager advised that the statement of purpose, service user guide and terms and conditions are under review by the organisation. Care Homes for Adults (18-65 years) Page 12 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. Peoples up to date individual needs, wishes and preferences are not always reflected in their care plans. People feel they are able to make decisions about their day-to-day lives. Evidence: Peoples up to date individual needs, wishes and preferences are not always reflected in their care plans. All care plans were viewed to some extent and two in detail. Folders are well structured and information is easy to find. Staff surveyed felt they are always given up to date information. Information in care plans is detailed although in some folders better than others. Examples of this are peoples own skills in relation to their personal hygiene routines and domestic tasks they are able to undertake. A key worker and a co key worker system are in place. Reviews are held every six months, which include key people including the person using the service. However two care plan reviews were not within recommended timescales. In addition some individual documents had not been reviewed six monthly including risk assessments and Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: medication information. No care plans had been signed or had a place for a signature. It was agreed some people would be able to sign their care plan, which is good practice. One care plan had been updated in handwriting but these entries were not dated or signed which would be good practice. One care plan, which had transferred from the previous home for the person who moved in during October 2008, had not been reviewed. This contained various information, which was no longer up to date. Changes agreed in a review held in November 2008 had not been followed through into the care plan and review documents were not stored with care plans. An example is it had been agreed a person would have a personal shopping day each week but this was not reflected on their care plan programme. It was agreed to diarize every fortnight a meeting with friend but this was not recorded in the diary on checking. One person had attended a health appointment and the appointment and action had not been followed through into the care plan. Daily notes made by staff contained good detailed information. However some of this should have triggered changes in the care plan and had not meaning the care plan was not up to date. Examples include a change in routine following a flare up of a skin complaint but the care plan still showed the old routine. Details of the skin complaint, which as advised by the manager is not new, is not reflected in the care plan. A medication had been stopped and another prescribed but this was not evident on the care plan. Another person had had a change in medication one had been stopped, another prescribed and another reduced none were reflected in the care plan. Another person had been prescribed a meal supplement drink and again this was not reflected in the care plan. Requirements were previously made in relation to care plans and risk assessments being up to date which has not been met therefore a statutory requirement notice will be served. People feel they are able to make decisions about their day-to-day lives. People surveyed said they are always or sometimes able to make decisions about what they do each day. The manager advised that residents meetings had again been tried recently but were not successful. One to one meetings with key workers are held but they are not recorded which would be good practice. The manager advised that people do have advocates. Advocate information was seen displayed and an IMCA report was also held on file. Any restrictions are detailed in care plan such as a wheelchair harness and foot huggers. Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: People are supported to take appropriate risks. A variety of risk assessments were in place. See earlier comments about a lack of reviews. A risk assessment had been completed following the last inspection regarding one persons visual impairment. Care Homes for Adults (18-65 years) Page 15 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel they are able to make choices about their life style. Opportunities for social, educational and recreational activities can be limited. Evidence: People are able to take part in appropriate activities but opportunities are limited. Each person has a programme in place of activities, which are recorded in their care plan and on a wipe broad. However these did not appear to be up to date and had limited activities recorded. One person had only two activities recorded for each week. Although the manager advised further sessions at the day centre were being arranged and it is hoped these will start in January 2009. Another had a walk recorded each day but the manager advised these did not necessarily happen. Daily records made by staff could be better to evidence varied activities take place. For example there are lots of entries of drive out or drive out lunch or coffee. One person had only 15 activities Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: recorded for the previous month. Staff advised that two people have a regular day out each week. People have the opportunity for a massage usually fortnightly. A music entertainer visits the home once a fortnight. Evidence of other activities recorded or discussed included walk out, theatre trip, church, cinema, coffee out, Ashdown Forest, Tunbridge Wells for lunch, drive out, lunch with a friend, lunch out and drive out get magazine. There is little evidence of in house activities. Records and discussions included made Xmas cards, massage, write letter to relative and craft session. On the day of the visit people went out for a walk and a coffee into Crowborough. In the afternoon one person had a massage and another made a cake. Others watched television or sat in the lounge. People were able to spend time alone in their room, as they liked. People surveyed felt they are able to do what they want during the day, evening and weekend. One person surveyed said they play the harmonica and go out on a Monday. Another said I go out sometimes. One spoken to said they had been to the pantomime in Eastbourne and they dont get bored because they do the carrots and potatoes. Another said we went out for coffee and doughnuts today. The AQAA stated that at times swimming opportunities could be curtailed due to a lack of male staff and/or changing facilities. Also a lack of core staff over recent months had meant it had been difficult to meet everyones needs. Staff also advised that some staff are concerned about driving the homes vehicle to take people out which has also curtailed the variety of activity opportunities. The resource officer present at the inspection advised a new vehicle is on trial between three homes and it is hopeful this home will have a new vehicle by March 2009. Staff and observations felt staffing levels in the afternoon would not allow for people to go out. Therefore good practice would be to have a programme of in house activities for this time which at present there is not. One person is a member of a local club but their membership has expired. The manager advised this should be renewed when annual subscriptions next become due. The manager also advised a previous requirement to assess a person activities had been carried out and discussed at staff meetings. The manager advised that two people are involved in household tasks such as hovering, dusting, room tidy, laundry, laying and wiping tables, cooking and vegetable preparation. Although this is not always recorded in their care plan and not planned into their programme. Staff interactions were kind and caring. One person was observed to open his own post. Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: People are supported to maintain contact with families and friends. One person spoke of their friend and meeting up for lunch with them. They also talked about meeting up with a relative. Staff confirmed one person goes home regularly each weekend. The manager advised that currently the home is working with one family to encourage further independence within the home. People enjoy the meals provided. Breakfast is cereals and toast. Lunch is a light meal with main meal in evening except Sundays. The menu is a six-week rolling menu. The manager advised this is based on known likes and dislikes. One person was heard to say they did not want curry which was for tea and he was offered an alternative. Special diets are catered for and weight monitored where there is a concern. Staff advised new guidance means they are no longer catered for at meal times unless they pay for their meals. They are usually getting theirs when people eat so longer all sit down together. People spoken to say the food is nice you get here and the food is alright you can have what you want. Care Homes for Adults (18-65 years) Page 18 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. The health and personal care that people receive is based on their individual needs. Medication systems need improvement to fully protect people. The principles of dignity, respect and privacy are put into practice. Evidence: People receive support in a way they prefer. A key worker and co key worker system is in place. People are aware who their key workers are and what their role is. People spoken to said staff are kind and caring when providing personal care. People surveyed confirmed that staff always treat them well and listen and act on what they say. In discussion people spoke of choosing and buying their own clothes and going to have their haircut. Peoples health needs are met. Health action plans are in place for each person. Records and discussion confirmed that people have access to their GP and practice nurse, dietician, optician, dentist, chiropodist, podiatrist, clinical psychologist and speech and language therapist. Records are kept of appointments, check ups and tests. Records confirmed people have had flu jabs. One appointment had been Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: attended but the outcome was not recorded. Any concerns are referred appropriately and guidance implemented although not always recorded. See earlier comments under care plans. Where there are concerns people are weighed regularly and this is recorded. People are not fully protected by the medication systems. The manager advised that the medication policy has been updated. A local chemist supplies medication mostly in a monitored dosage system. To ensure secure storage notices should not draw attention to the medication storage. Internal and external medication should be stored separately. Medication is usually logged into the home on the Medication Administration Record (MAR) chart but this was not the case for all medications. A meds 2 chart is used by the home to stock check non blister pack medication. However as staff record at different times of the day this is making tracking stock difficult. The manager advised he is addressing this with staff. Handwritten entries on the MAR charts were not dated, signed or witnessed. Stock paracetamol must not be held for staff use. The home has purchased paracetamol for people although this medication is already prescribed and it is recorded on the MAR chart as a prescribed medication. Medication to be returned to the chemist was stored securely although not yet recorded. A letter is usually sent to the chemist although these could not be found. An alternative system where medication can be recorded when awaiting return and therefore more secure was discussed. One medication error was recorded recently where a person was not administered a medicine as prescribed. The manager advised all core staff have received medication training during their induction. For some this is some considerable time ago. Only the manager has received refresher training. The manager advised it is policy to update medication training 3 yearly. This means one member of staff and the manager has in date medication training. A requirement is made to address the above shortfalls. Care Homes for Adults (18-65 years) Page 20 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. Opportunities for people to air their views and concerns could be enhanced and they must have access to a robust complaints procedure. People could be better protected from abuse. Evidence: Opportunities for people to air their views and concerns could be enhanced. The AQAA stated that no complaints have been received in the last twelve months. Residents meetings are not held as the home feel they do not work. One to one sessions take place but these are not recorded. The complaints procedure was examined which is displayed. This is a social services general complaints procedure not specific to the home, does not meet regulation requirements and is not really a user friendly format. A requirement is made. People confirmed that they would speak to staff and felt they would resolve any issues. People surveyed said they knew how to make a complaint. One said I speak to X (member of staff). People could be better protected from abuse. Staff spoken to were clear on how to report abuse within the home but were unclear of the proper route outside of the home. The AQAA stated that policies and procedures are in place to safeguard people living in the home. The manager advised that staff would have had safeguarding training during their induction. It would then be refreshed every two years. Records indicated that four people out of ten staff have not had any refresher training in the Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: last two years some not for some considerable time. A requirement was made at the last two inspections for staff to undertake safeguarding training. A statutory requirement notice will now be served. Care Homes for Adults (18-65 years) Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home, which is homely, clean, comfortable and generally wellmaintained. Evidence: People live in a home, which is homely, clean and comfortable. A tour of the home was undertaken. The home is spacious and generally well maintained and in good decorative order. Since the last inspection improvements have been made. A carpet cleaner has been purchased to help keep the house clean and hygienic. A redecoration timetable has been drawn up. Risk assessments have been developed to ensure the home is safe. A new monitoring form has been implemented to track reported maintenance problems. A tour of the home was undertaken and the following areas discussed. Two bedrooms appeared colder than others and the manager advised that there were ongoing problems with the boiler. A portable heater is used in one room. This needs to be added to the risk assessment. Supplementary heating may need to be considered in the other bedroom. A blind or curtain should enhance the bathroom. Pictures could enhance communal areas. The room through the laundry is not really useable it is visually damp and cold. The manager advised this is only use by staff normally in the Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: summer. One area of the garden is maintained and accessible to people. Other areas are not really and there are two large piles of tree cuttings, which could attract vermin and should be removed. People confirmed they are happy with their rooms. Bedrooms are individual, homely and in good decorative order. Sensory equipment was apparent in two rooms. One person survey said I like my room. Those spoken to agreed. People benefit from a clean, tidy and hygienic home. On the day of the visit the home clean and tidy throughout. People surveyed felt the home is always or sometimes clean and fresh. One said nice and clean. Care Homes for Adults (18-65 years) Page 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers of staff trained, the management of training and supervision does not enhance peoples support. Recruitment records could better evidence a robust process is followed to protect people. Evidence: A team who have undertaken a qualification support people. The manager advised that five staff have obtained a National Vocational Qualification (NVQ) level 2 or above. This is 50 as recommended for good practice. There is a team of nine care staff in addition to the manager. The manager advised that staffing levels are three or four staff on duty in the morning and two in the afternoon. At weekends this reduces to three in the morning and two in the afternoon. The manager advised that weekends staffing levels have been increased since the last inspection. The team is male and female. Staff surveyed felt there is usually or always enough staff on duty. Previous staff shortages have meant a high use of relief staff although the manager advised this is no longer needed, as there are now no vacancies. People surveyed said they (staff) treat me well all the time, I like it. Improved recruitment records could better protect people. The manager advised there Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: has been no recruitment at the home for some considerable years. The home does not hold staff recruitment files but completes annex 4 forms with recruitment information. Two were examined. One did not contain a photograph. One form stated that references were not available, as the person had worked for East Sussex Social Services since 1990. The Criminal Records Bureau (CRB) information did not indicate if a Protection of Vulnerable Adults (POVA) check had been completed as well on either form. On one form the number and date of the CRB had not been recorded. Two sections on the form had a dash recorded but the manager was not aware what this meant. Both forms had been completed and signed by the manager. Forms must be completed fully and appropriate records must be maintained. A team who is not fully trained support people. The manager advised that when a new member of staff is recruited they would undertake an induction which to Skills for Care specification. One person surveyed felt their induction had mostly covered what they needed to know. The manager advised of training statistics. There is nine care staff excluding the manager. All staff would have had an induction when they started with the organisation. Since induction one member of staff has attended fire (fire officer) training (updates are annually meaning one person has up to date training). Eight staff has attended food hygiene (updates are three yearly meaning seven people have up to date training). Seven staff has attended first aid training (updates are three yearly meaning one person has up to date training). Four staff has attended safeguarding training (updates are two yearly meaning four people have up to date training). One member of staff has attended medication training (updated three yearly meaning one person has up to date training). One person has attended moving and handling (updated three yearly meaning one person has up to date training). No one has attended infection control training (updated three yearly) although two are booked to attend in December 2008. The manager advised that the fire refresher would entail watching a DVD but that this had been mislaid. He also advised that he had spoken to a moving and handling trainer to obtain dates for training although this is not yet booked. At the last inspection a requirement was made in relation to training appropriate to staff role. In addition a requirement was made to train a member of staff in visual impairment and cascade this training to all staff. The manager advised this has not been met. As three requirements in relation to staff training have not been met and statutory notices will now be served. People do not benefit from a team who receive regular supervision. Staff surveyed felt they regularly or often met with their manager for support and discussions. A record of supervision is maintained and a copy obtained. This showed that all staff had received a supervision session in November or December 2008. However the amount of sessions ranged between two and five in a twelve-month period. A previous requirement was made to have regular supervision this has not been met. The Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: requirement has been reworded to be more specific before further action is taken. Care Homes for Adults (18-65 years) Page 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has considerable experience in managing the home. Quality assurance systems are not effective in highlighting and addressing shortfalls. The health, safety and welfare of people could be better protected and promoted which could put them at risk. Evidence: The manager is unable to fulfill their responsibilities fully. The manager advised that eight hours per week are allocated for management tasks, which at present and given the findings of the inspection does not appear adequate. He also advised that the hours are often needed to cover the rota and deal with the needs of people that live in the home. It would be good practice to review the management arrangements of the home to ensure it is able to meet the NMS and legislative requirements. The manager has considerable experience in managing the home. He has acquired his Registered Managers Award (RMA) but is still to complete his NVQ level 4 in care. He has undertaken some mandatory training but needs to update fire, first aid moving and handling. The manager has received three formal supervision sessions in the last Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: twelve months. Staff said of the manager he is approachable and you can talk through any issues. Quality assurance systems are not effective in highlighting and addressing shortfalls. The Commission has received a completed AQAA from the manager. Information was brief and could have better reflected all the NMS. Reports in relation to visits to the home required under legislation by the organisation were examined. A recent visit had taken place but the report not yet received. Prior to this the last visit had been July 2008. The manager advised that visits are now unannounced. Visits are required monthly and a requirement to undertake visits as per the regulations is made. The manager advised that people have recently completed a survey called choice and control. They also completed a have a good day survey in February 2008. These were then sent off to resource officers but no feedback has been received to date. Relatives attend reviews but do not have the opportunity to feedback anonymously. Other stakeholders are not canvassed for their views. A previous requirement in relation to relatives and other stakeholders views and feedback has not been met. This requirement has been reworded before further action is taken. The health, safety and welfare of people could be better protected and promoted. The fire safety logbook was examined. All tests and servicing was within recommended timescales except visual checks on extinguisher which must be in place and recorded. The periodical electrical wiring certificate is out of date. A valid certificate must be in place. A requirement is made. Risk assessments are in place to ensure safety although as previously mention the portable heater needs adding. Reporting required by regulation 37 was discussed. The manager advised that previous events have been reported although not recorded by the Commission. The accident/incident book was examined. An incident occurred on 23/11/08 and the report was still awaiting a management signature. Because of this the incident had still not been reported to the Commission. Events must be reported without delay and this does not meet required imescales. A requirement is made. Fridge and freezer temperatures are checked each day and a record kept. See earlier comments regarding mandatory training. Care Homes for Adults (18-65 years) Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 5 5(1)(bb) & (bc) The Terms and Conditions of 29/02/2008 residence/licence agreement must be expanded to include additional information about insurance and about the discharge process including rights of both individual residents and the homes responsibilities. All care plans must be up to 29/02/2008 date, showing detailed information about how needs are to be met. Service users individual risk assessments must be updated as soon as possible to reflect the current risks. 31/01/2008 2 6 15(1) 3 9 13(4)(c) 4 23 13(6) Staff must undergo training 29/02/2008 in adult protection and a record of attendance must be maintained. [This was a requirement of the previous inspection timescale given was 30/04/07]. 5 35 18(1) That staff are appropriately trained to undertake their roles. [This was a requirement of the previous inspection timescale given 31/03/2008 Care Homes for Adults (18-65 years) Page 30 of 35 was 30/05/07 this includes training on the administration of medication, first aid, moving and handling, infection control and fire safety]. 6 35 18(1) At least one member of staff 31/03/2008 must receive training on working with people with a visual impairment and this training must then be cascaded to all staff. All staff must receive regular 31/01/2008 formal supervision. As part of the homes quality 29/02/2008 assurance system the views of relatives and other stakeholders must be sought about the quality of the service provided. In relation to residents satisfaction questionnaires, a revised system must be found that will the seek views of the residents in such a way as to inform practice. 7 36 18(2) 8 39 24(1) 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 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 1 5 The registered person shall have a service user guide in place in accordance with the regulations and National Minimum Standards To ensure people and their representatives have access to comprehensive information 28/02/2009 2 1 4 The registered person shall 28/02/2009 have a statement of purpose in place in accordance with the regulations, schedule 1 and the National Minimum Standards To ensure people and their representatives have access to comprehensive information 3 5 5 The registered person shall have written contract of terms and conditions in place in accordance with the regulations and National Minimum Standards with each service user 28/02/2009 Care Homes for Adults (18-65 years) Page 32 of 35 To ensure people and their representatives have access to comprehensive information and are protect by this information 4 20 13 The registered person shall 26/01/2009 make suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home To ensure that systems for medication are safe to protect service users 5 22 22 The registered person shall have written complaints procedure in accordance with the regulations To ensure service users have a clear and effective complaints procedure 6 36 18 The registered person shall 28/02/2009 ensure that persons working in the care home are appropriately supervised To ensure service users benefit from a supported and supervised staff team 7 39 24 The registered person shall 28/02/2009 establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home in accordance with regulation 24 To ensure service users, 28/02/2009 Care Homes for Adults (18-65 years) Page 33 of 35 relatives and other stakeholders views underpin the monitoring and development by the home 8 39 26 The registered person shall undertake visits in accordance with regulation 26 To monitor, review and improve the quality of care delivered 9 42 37 The registered person shall report events in accordance with regulation 37 To ensure service users are protected 10 42 13 The registered person shall ensure that all parts of the home are free from hazards to peoples safety. In particular have a valid electrical wiring certificate To ensure peoples health and safety 15/01/2009 15/01/2009 15/01/2009 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 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. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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