Inspection on 19/10/08 for The Grange

This inspection was carried out on 19th October 2008.

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

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

Other inspections for this house

The Grange 19/09/07

The Grange 23/10/06

The Grange 18/03/06

The Grange 08/07/05

The Grange 24/01/05

The Grange 03/08/04

The Grange 24/02/04

Similar services:

The Vicarage

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Stepping Stones

Cornerstones

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Grange 2 Mount Road Parkstone Poole Dorset BH14 0QW     The quality rating for this care home is:   two star good 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: Tracey Cockburn     Date: 2 0 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. that people have said are important to them: They reflect the things 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 29 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 29 Information about the care home Name of care home: Address: The Grange 2 Mount Road Parkstone Poole Dorset BH14 0QW 01202715914 01202743557 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Leonard Cheshire Disability care home 27 Number of places (if applicable): Under 65 Over 65 0 physical disability Additional conditions: 27 The maximum number of service users who can be accommodated is 27. The registered person may provide the following category of service only: Care home only (Code PC) to service users of either gender whose primary care needs on admission to the home are within the following category: Physical disability - Code PD Date of last inspection Brief description of the care home The Grange is a home owned by the Leonard Cheshire Disability a national charity, and accommodates up to twenty-seven adults who have a physical disability. There are four apartments on the ground floor of the home providing accommodation for a total of twenty people and a respite unit on the first floor providing further accommodation for people either on a temporary or permanent basis. Each unit has a kitchen,dining room and two bathrooms, and people have their own bedroom. A communal area in the centre of the building comprises a seated coffee area, with a fishpond, where guests and visitors can also sit. There is a large paved courtyard for use in the summer. The Grange offers adapted living facilities to accommodate people who use wheelchairs. There are adapted baths, beds, a lift, automatic doors and manual and electric hoists. People who use the service have access to some adapted vehicles Care Homes for Adults (18-65 years) Page 4 of 29 Brief description of the care home available to provide transport. The Grange is situated in a residential area of Parkstone, close to local shops and amenities. A bus route is located nearby. The fees for people living at The Grange range from 589 pounds to 907 pounds per week based on assessment of individual needs. This information was accurate as of 20th October 2008. This fee excludes certain items such as hairdressing, chiropody, personal toiletries, activities, magazines, newspapers and holidays. Further information on fair terms of contracts and care home fees can be found on the Office of Fair Tradings website: www.oft.gov.uk. Care Homes for Adults (18-65 years) Page 5 of 29 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: two star good 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: This was a key inspection which started on a Sunday afternoon and continued the following day. The inspection was not announced. A total of nine hours was spent in the service. During the Sunday afternoon, people who live in the home spoke to us about life in the home. We also spoke to people who work in the home. During the second day the registered manager was present and the care supervisor. Care files were seen as well as recruitment documents, staff files, training records and health and safety records. We spoke to twelve people who use the service. We spoke to four staff. Survey forms were returned from ten staff, nine people who use the service and two health care professionals. We also used the annual quality assurance assessment sent by the home as part of the planning of the visit. Care Homes for Adults (18-65 years) Page 6 of 29 Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 8 of 29 At the end of this inspection there is one requirement and two recommendations. We found that the recording of medical intervention in one care plan was not as detailed as it should be to ensure that staff knew what to do and why, to meet the physical needs of one person. We found that some people who use the service were confused about how holidays were funded. Improving the quality of this information in the service user guide would reduce any confusion. It is important that peoples personal preferences are recorded in their care and support plans particularly when professional advice has been sought and individuals choose to either ignore it or the advice changes. This would ensure continuity of care. 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 29 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 29 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. Some people who use the service do not have clear information or understanding of how holidays are funded. This information should be clear in the service user guide to avoid any confusion for individuals. People who are considering using the service have their needs assessed before a decision is made. This means that everyone is clear about whether the service is right for them or not. Evidence: We wanted to understand what peoples experience of moving into the home was like and if they had their needs assessed before making a decision. We received ten survey forms from people who use the service. All ten surveys said that people had the information they needed before they made a decision to move into the home. One person told us that it was not clear in the information they received how holidays were paid for. This person thought that the service user guide should say how the costs were broken down and who is responsible for paying the carer who accompanies them on holiday. Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: In two individual care files that we looked at they both contained detailed assessments from the funding authority. Their care plans were based on this assessment information and people told us they were involved and knew the content of those plans. Care Homes for Adults (18-65 years) Page 12 of 29 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. People who use the service have individual plans which detail their assessed and changing needs. This provides the staff with the information they need to ensure that each person receives the care and support they need and want. People are supported to make decisions and take risks about their own lives so they can lead the life they want to. Evidence: People tell us that they have support plans and they know what information is in them. The manager told us that they have continued to develop goal setting. People who use the service tell us they can decide where they want to keep their personal information and some people told us they choose to keep the file in their room. One person said that their goals are reviewed each week with her and that her support plan is updated with any changes or progress. We looked at care and support plans and could see the written evidence that the goals were reviewed. The support plans also detailed how each person needs and prefers to be supported. One person said that the staff are Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: very good and supportive although they also thought there was not enough on duty sometimes to enable them to be spontaneous. One person said that over the past few months there have been some staff leaving and there has been sickness and this has put the staff on duty under pressure. The support plan for one person we looked at has nine sections which cover daily records, personal profile, skills and interests, goal plan record, record of unmet need, general care, personal support plan summary, risk assessments, medication, management of finances and care plan from the funding authority. The goals for this person included enrolling on a computer course, taking dirty clothes to the laundry. This person also had a record of progress and reviews every two weeks. People told us that since the introduction of an individual charge for transport they have been going out more on their own and making use of their free bus passes. Risk assessments are in place for people who choose to be independent in the community. People told us they are still unhappy about the charge but have tried to make it work for them by going out in small groups of friends and sharing the cost of transport. A recommendation at the last inspection regarding goal setting and monitoring has been addressed. Risk assessments are reviewed and meet peoples changing needs. People who use the service are involved in writing a personal profile in their plans which gives some useful information about who they are, the things they enjoy and what is important to them. Individual routines are clearly documented. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are part of the community, see family and friends as they wish and their rights and responsibilities are respected in their daily lives. Evidence: People who use the service told us that they go to college, enroll on a variety of courses and are able to do the things they want to. One person is taking part in a computer course and is being supported with this goal. One person told us that he is able to do what he wants and live the life he wants to. He says that staff help him when he asks for it and another person said that they find out lots of information on the Internet. At the time of the inspection the board which contains information about what is on locally had been taken down as the walls were being painted. People tell us that there is information available on activities which are happening in town. One person told us that they make cards and sell them. People told us they are able to vote Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: if they want to. An increase in staffing of one person on each shift means that there is some flexibility, however people tell us that it is not flexible enough and there are still times that they would like to go out but cant because there are not enough staff on duty. People have their own televisions, computers and games consoles and can pursue their own hobbies. However there is a wide age range of people living in the home and one person said that they get very lonely. People are supported to maintain their friendships and relationships. Staff were observed only entering individual rooms after knocking. Staff were observed talking to people who use the service and only observed talking to each other when they were deciding what tasks needed doing next. One member of staff said that the shift goes very quickly because there is a lot to do. People tell us they have access to all the communal areas of the home. Meal time was observed and staff were supporting some people to eat this was done in a very low key way at the pace of the individual. Lunch was also observed as a very social time with lots of talk and laughter. People who use the service told us about how they were involved with the local bus company in trying out their new buses which are wheelchair accessible. In the ten survey forms returned people told us that they are able to make decisions about their daily lives. One person told us that sometimes not having enough staff on means they cannot be spontaneous in their choices. One person told us about his birthday and the surprise provided by his friends, which he said he thoroughly enjoyed. Survey forms were returned by two health care professionals one person said I think at times their staffing levels whether due to sickness , can impact on their service. Each apartment is responsible for purchasing their own groceries. People living in each apartment told us they are able to say what meals they would like and that their choices are respected by staff. Recording of all meals is individual and entries are clear. If people use specific aids when eating this is recorded in their individual plans. Care Homes for Adults (18-65 years) Page 16 of 29 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. People who use the service are supported the way they prefer and have their emotional and physical needs met which ensures that their assessed needs and wishes are understood and enables individuals to lead the life they want to. However the recording health care needs has to be clear and specific to ensure that everyone working in the home understands how an individual needs to be supported and to keep the individual safe. The policy and procedure in the home for managing medication ensures that people are able to retain control if they wish. It also ensures that people are protected. Evidence: One support plan we looked at does not mention how skin in vulnerable pressure areas will be monitored, it is evident from the recording that the district nurse is visiting and there is evidence in the room of the district nurses visits and equipment such as dressings. The daily records states that the person is turned during the night but no detailed record is kept of when and how. The daily records also show that the person has to lie on their side for one hour in the morning. The support plan does not record that the health care professional has asked for this to be done and it gives no clear Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: instruction to staff. During the inspection we noticed that two people who use wheelchairs were sitting on their slings which are used when they are hoisted. One person was asked if it was their choice and they said yes it made life easier and did not cause a problem. Another person said they were concerned as they had a pressure sore and were worried that it could cause a problem. This was brought to the attention of the manager, who also expressed concern about this practice and he said he would investigate. He contacted us after the inspection. One person has the sling in place as it was found that removing was causing more damage but they are taking advice from the district nurse. The other person has the sling left in situ as agreed by the occupational therapist. The manager also said that there are another two people living in the home who have chosen to leave their slings in situ even after they have been advised it is not necessary. It is important that this information is recorded in each persons support plan. Support plans now contain information on medication and how people like and need to be supported when taking it. Medication is stored in each persons bedroom in a lockable cabinet attached to the wall. Medication is in blister packs which are colour coded to the medication administration record. Medication is supplied by a pharmacy and medication administration records are printed by the pharmacy. People who use the service tell us they are comfortable with staff, one person who responded said I feel comfortable with most of the staff some people commented when staff are busy I sometimes feel rushed In response to the question, do staff treat you well, one person said there is one person who can be a bit awkward sometimes another person said we are treated very well. The team leader told us that staff have received training from the district nurse on how to support one person who lives in the home. People were not complaining at this inspection about the length of time it took to respond if they rang the call bell. They were complaining about the new call system which is not working properly. If someone rings the bell in one apartment it can be heard in all the apartments and this was not what the system was supposed to do. The manager said that they are addressing the problem with the company that fitted the system. People told us that there are some times when the staff do not respond straight away but usually they come quickly. Moving and handling care plans were in place as well as plans from local authority occupational therapists. One person who had recently moved into the service said that the toilet was too high and they are in the process of getting a shorter one. She felt this could have been done before she moved in. Care Homes for Adults (18-65 years) Page 18 of 29 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. People using the service feel their concerns are listened to and acted on which means they feel valued. There is safeguarding training in place for staff which means that they should know how to ensure that people using the service are protected. Evidence: People tell us they have a response to any concerns they raise. Everyone who responded to the survey said they were able to raise concerns they had either with the carers, manager or via their parents. One person said that, nine times out of ten carers listen and act on what we say. One person said I dont feel intimidated about speaking my mind. People also told us they have a leaflet telling them how to complain. All the care staff who responded to the surveys said they knew what to do if someone was unhappy or concerned about the home. One person said that this information was covered in induction and updated through team meetings. The home sent us an annual quality assurance assessment and told us they have a policy and procedure on safeguarding and that staff receive training. Care Homes for Adults (18-65 years) Page 19 of 29 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 who use the service live in a comfortable environment which is in the process of being refurbished with their involvement. The home is clean and staff receive training in infection control which means that they should understand how to maintain a hygienic environment. Evidence: The home is looking dated both in decor and in style. The kitchens are being replaced as part of a large refurbishment programme. One kitchen as already been completed and another one was just starting. The new kitchen was very modern and people living in that apartment were very happy with the changes. They also told us that they were involved in choosing the tiles and flooring and the colour on the walls. There are also plans to update the street which is the main traffic way to the apartments. This is where a lot of people spend time socialising and on a cold autumn afternoon and evening it is not a very inviting place. People who live in the home use wheelchairs There is no comfortable seating. One person said that this would be changing and they were going to have a cafe style area and some comfortable seating. People told us that in the summer it is more inviting and relaxing as the doors are open to the garden and courtyard. The building is purpose built and so is not like others in the street however it is in a Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: quiet road and there are other brick building in the street so it does not look out of place. People tell us that they have access to facilities in the community and are able to go out as they wish. The building is accessible. There is a planned maintenance and renewal programme. The home was clean and free from odours on both visits. There is an infection control policy in place and staff receive training in infection control. The laundry room is well away from where food is stored and has equipment able to deal with soiled clothing. A person who lives in the home told us that the roof in the central atrium had been replaced. They also told us that carpets were being replaced and the annual quality assurance assessment also said this. At the last inspection the issue of security was raised as the door was always open. On the visit on Sunday 19th at 3pm the door was not open and someone who lives in the home opened the door. This was the same the following day. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported by staff who are competent and qualified. Recruitment practice ensures that people living in the home are protected. The effectiveness of the staff team is put under pressure when there is a shortage of staff. Staff received the training they need to do the job well. Evidence: Since the last key inspection training has improved and there is a clear system in place for ensuring that staff receive refresher training when necessary. Ten staff returned survey forms and there are a number of comments about training, support and communication. One person said that they need to employ more staff to ease the work load of the small number of staff on duty. Another person said that the staffing at the Grange is usually very good but that at the time of the inspection they were experiencing problems with staff sickness levels and staff leaving. Another member of staff said in the survey form that they needed increased staffing levels and another said that there should be enough staff at all times. One member of staff also said that management should say thank you more. Several staff commented in the survey forms that the training and induction was excellent. The manager said that they have increased staffing to include one member of staff who floats around the four apartments on each shift. When we visited on the sunday Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: afternoon there were only four staff on duty. It is important that if someone does not turn up a replacement is found. However at the time of the inspection there were three people away from the home which meant there were less people needing support on that day. Staff have undertaken disability equality training. The files of four members of staff were reviewed as part of the inspection we found that all the files contained proof of identity. They all had two written references. One person had an up to date work permit. No agency staff were seen during the inspection. One person who lives in the service told us that she is involved in interviewing new staff, on the day of the inspection someone was due to turn up for an interview but they did not show. A requirement was made at the last inspection regarding staffing. The requirement has been addressed by the service. Staff told us that it had been working well up until about two months ago when a few people left and some staff are off sick. The manager said that they have recruited new staff but are either waiting for the checks to come back or they have only started their induction. Another requirement was made regarding standard 34 and the service not completing all the necessary checks on new staff. This requirement has been met. Some staff told us that they think the manager is too remote and does not give them praise and say thank you. The manager told us that the staff do a very good job. Staff said that the care supervisor is good at saying thank you to staff if they have worked extra hours. A recommendation at the last inspection around communication with staff has been addressed. One health care professional said I feel I have an excellent relationship with all the staff at the Grange and we all work hard to maintain that for the benefit of the clients Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the interests of the people living there and a quality assurance process means that they feel listened to and involved in the development of the service. Safe working practice and training ensures that the health, welfare and safety of the people living in the home is maintained. Evidence: There is a clear management structure in place, people tell us they know who to talk to about issues concerning the running of the home. Since the last inspection the manager has improved staffing structures and has another person on duty on each shift. They also have five bank staff who they can call on rather than using agency workers. This has given more continuity of cover however the improvements the management have put in place have suffered in recent months with staff leaving and there has been additional pressure. It is important that there is enough flexibility in the system in place to cope with times of additional pressure. Staff tell us that they are more pressured at the moment. The home has a quality assurance system in place, which involves the people living in Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: the service as well as other people who may have an interest. Each year they send out surveys and collate the results into a report. There are also both local and regional quality groups and a focus group so that peoples views can be shared more widely within the organisation. At the time of the inspection the annual report and not been completed. A recommendation at the last inspection regarding fire drills and practice evacuations has been addressed. Evidence seen that drills take place at different times. Staff receive training in mandatory safe working practices such as moving and handling, fire safety, first aid, food hygiene and infection control. Equipment is serviced and a record is kept of this and any action taken. Care Homes for Adults (18-65 years) Page 25 of 29 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 26 of 29 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 19 17 The registered person shall 01/12/2008 maintain in respect of each service user a record which includes the information documents and other records specified in schedule 3. specifically item 3 k a record of any nursing provided to the service user, including a record of his condition and any treatment. The registered provider must ensure that support plans clearly document and health care intervention such as the treatment of a pressure area. The support plan must also clearly advise of action that staff must take such as turning an individual to relieve pressure. This information must be accurately documented to ensure that staff understand the action Care Homes for Adults (18-65 years) Page 27 of 29 they must take and why and to protect the individual. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The registered provider should make it clear in the service user guide how holidays are funded and what costs the provider will cover and what costs are expected to be covered by the individual. The registered provider should make sure that where people are hoisted, the support plan makes it clear about whether the sling is removed completely or left in place. The support plan should also say if the reason is either through personal choice or a health care professional has made a recommendation. 2 18 Care Homes for Adults (18-65 years) Page 28 of 29 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. 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