Inspection on 26/02/09 for The Old Forge

This inspection was carried out on 26th February 2009.

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 Old Forge 19/03/07

The Old Forge 28/02/06

The Old Forge 25/08/04

The Old Forge 06/04/04

The Old Forge 06/08/03

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Old Forge Mill Road Slapton Buckinghamshire LU7 9BT     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: Maureen Richards     Date: 2 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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 33 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 33 Information about the care home Name of care home: Address: The Old Forge Mill Road Slapton Buckinghamshire LU7 9BT 01525221506 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Turnstone Support Ltd Name of registered manager (if applicable) Yok Lin Chong Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 4 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 are within the following category: Learning disability - LD Date of last inspection Brief description of the care home The Old Forge is a small care home that is registered to provide care and accommodation to four service users with learning disabilities. The home is managed by Turnstone Support Housing Association.The Old Forge is situated in the village of Slapton, close to the border of Bedfordshire. The home is centrally situated in the village, close to the local amenities. The nearby towns of Leighton Buzzard, Aylesbury and Milton Keynes provide the service users with a wide range of amenities. Access to the towns is via the home’s own transport.The Old Forge is a single storey building, which has been sympathetically refurbished to meet the needs of service users. There Care Homes for Adults (18-65 years) Page 4 of 33 care home 4 Over 65 0 4 Brief description of the care home is a car park at the front of the property with spaces for approximately four or five vehicles. At the rear of the property there are enclosed communal gardens. Care Homes for Adults (18-65 years) Page 5 of 33 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: The last key inspection of this service took place on the 19th March 2007. This unannounced key inspection was conducted over the course of one day and covered all of the key National Minimum Standards for younger adults. A detailed selfassessment document known as the Annual Quality Assurance questionnaire was completed in June 2008 and was referred to for this inspection. Comment cards were sent to a selection of people living at the home, staff and visiting professionals. Any replies that were received have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into account. Care Homes for Adults (18-65 years) Page 6 of 33 The inspection consisted of discussions with the registered manager, individual discussions with two staff, introduction to the service users, observation of practice, a tour of the environment and examining records required for Regulation. The manager, staff and people who use the service are thanked for their co-operation and hospitality during this unannounced visit. What the care home does well: What has improved since the last inspection? Care Homes for Adults (18-65 years) Page 8 of 33 Areas of the home have been decorated. Person centred plans have been developed and are accessible to service users and staff. What they could do better: 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 33 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 33 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. Service users are provided with the key information on the service with systems in place to ensure that prospective service users are assessed prior to admission to enable the service to meet their identified needs. Evidence: All service users are provided with a pictorial statement of purpose and licence agreement. Records are maintained to evidence that the statement of purpose has been explained to individuals on a yearly basis. The statement of purpose needs to be updated to reflect change of staff. The home has had no new admissions since it opened. The Annual Quality Assurance document confirms that the Organisation has a referral, assessment, and start of service policy in place which makes reference to the procedure on initial visits, advocacy, refusals, appeals , visits to the service and transition, offer of service and support, start of service and review of the placement. The admission policy on file is Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: dated August 2007. The criteria for admission is outlined in the statement of purpose. Completed surveys received from service users confirm that they had a choice in the move to the home and was given enough information about the home prior to the move. Care Homes for Adults (18-65 years) Page 12 of 33 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. Detailed and specific care plans and risk assessments are in place which are kept up to date and reviewed and ensure that staff offer a consistent plan of care to promote service users safety. Service users are supported to make choices and decisions to enable them to feel valued with records maintained to evidence this. Evidence: All four service user care plans were viewed. Service users have two files with those files in the process of being reorganised at the time of the inspection. Service user plans included a photograph and a personal details information sheet which outlined ethnicity, religion, what the individual likes to be known and next of kin details. All of the service user care plans viewed included detailed, informative and very specific details on the support required by individuals in relation to all aspects of their personal care needs in the morning and at night, life skills and involvement in household tasks, Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: activities and religious needs, communication and specific behaviour needs. The service user plans indicated that it was discussed with the service user but was unable to be signed by them. The majority of support plans viewed were up to date and reviewed with some being identified as being due for review. Service user plans included a pictorial support plan in relation to a specific task which the service user was being supported to develop their skills in for example shopping. Three of the four service users plans viewed were disorganised with duplicate information included and out of date information filed in with the current information. This should be reorganised and made more accessible. Three of the four service users had a pictorial person centred plan on a notice board in their bedrooms. This outlined in pictures what the individual liked and disliked, things and people that are important to them, activities they like to do and enjoy, staff who work at the home and support needed in keeping the individual safe. The manager advised that they were in the process of putting a person centred plan in place for the fourth service user in a format, which is accessible to them. Service users plans evidences service users being supported to make choices in every aspect of their life with objects of reference being used to aid those choices. Records are maintained to evidence service users responses to a specific activity, food, keyworkers and decoration of their bedrooms and purchase of furniture for the home. Service users have monthly house meetings and the records of meetings evidences that service users are consulted in all aspects of their life at the home with the minutes of the meeting in a pictorial format to enable the majority of the service users to understand them. The home has an advocate who has recently become involved with the home and it is planned that she will attend future monthly service user meetings. All of the service user plans included a serious of individual and generic risk assessments in relation to risks posed to individuals. These were found to be up to date and reviewed. All of the service user plans included a moving and handling risk assessment. This was found to be detailed and specific in relation to all aspects of moving and handling and included the height and weight of the individual with details of the equipment used, servicing details of the equipment and a moving and handling plan. One of the moving and handling plan indicates that a transfer required 1 to 2 staff. This should be more specific as to whether 1 or 2 staff so that all staff carry out the transfer safely to promote the service users safety. Completed surveys received from service users confirm that they are supported to make decisions and can do what they want during the day and at weekends. Care Homes for Adults (18-65 years) Page 14 of 33 Care Homes for Adults (18-65 years) Page 15 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported to develop their independence and are supported with a lifestyle, which reflects their choices and interests, provides them with nourishing meals and allows them to have contact with family, friends and the community. Evidence: None of the current service users are involved in work placements. All of the service users attend Gateway club weekly with service users having the option to attend a day centre once a week. The local college set up a weekly cookery and art and craft session at the home. The college staff have not been assisting with this session recently but staff at the home have continued to facilitate it. Service users plans include a record of response to activities which evidences service Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: users being supported to make choices and enable staff to assess if service users enjoy a particular activity. Service user plans included a weekly outline of activities that individuals take part in with a record maintained on individual files of activities that individuals have actually particapted in. The records indicate that service users are offered a range of in house activities with limited community activities which include shopping, bowling, trip to the garden centre. The manager confirmed that this will increase as the weather improves to enable them to offer service users a more varied range of outdoor activities. During the inspection one service user went shopping and in the afternoon all service users were involved in a food tasting session with some individual activities. Service users are supported to maintain contact with families and service users plans outline important people in service users lives. Family and friends are invited to the home for special occasions for example birthdays and visitors can see their relative in private in their bedrooms or in communal areas of the home. Service users plans indicates that service users are being encouraged and supported to promote their independence and be involved in housekeeping tasks. Staff do not enter service users bedrooms without their permission and this was evident during the inspection. Service users are supported to open the front door to visitors and they are made aware of who is visiting the home. A risk assessment is in place to indicate the risks associated with individuals having a key to the front door. Service user plans outline service users preferred form of address and the support required by individual in managing their post. Staff were observed engaging with service users in a gentle and respectful way. Service users can choose when to be alone or in company and when not to join an activity. The daily records support this. Service users have access to all areas of the home. Service users are provided with three meals a day with snacks and drinks available throughout the day. Service users have a choice of cereals, toast and juices for breakfast with a choice of meals for lunch and dinner. Objects of reference are used to enable service users to make a meal choice with records maintained as to their responses to support their choice. Service user plans outline the support required by individuals at mealtimes. Records of menus are maintained which indicate service users are offered varied meals with healthy options being made available. Care Homes for Adults (18-65 years) Page 17 of 33 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. The health and personal care needs of people living at the home are met with records in place to evidence this which promote service users well being. Evidence: Service users plans clearly outline the support required by individuals in meeting their personal care needs. Moving and handling risks assessments and a moving and handling plan outline how individuals are to be guided, moved and transferred. Times for getting up and going to bed are flexible and individual daily records evidences this. Service users are supported and enabled to make choices in relation to their appearance. Service users have a choice of staff on duty who work with them and were involved in choosing their keyworkers. Service users have access to additional specialist support with reports on file from the relevant professionals to evidence this. Service user plans outline their likes and dislikes and communication profiles with records maintained on what is being communicated when a certain behaviour is displayed or response is given. All of the service users are registered with a local General Practitioner and have access to community general nursing and specialist Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: psychiatric services. Service users have access to community dentists, opticians and podiatrist but records were not maintained to evidence the frequency of those appointments. Service users have a health passport which is separate from the service user plans. The one viewed was not fully completed and the registered manager felt that this could be used to record and evidence that service users have access to dentists, chiropodists and opticians. Service user plans outline the support required by individuals to attend health appointments and records are maintained to record the outcome of appointments, which mainly included General Practitioner and Psychiatrist appointments. Service user plans included a weight chart. One of the support plans viewed indicated that the individual was to be weighted four monthly but the weight recording chart indicted this individual was not been weighed four monthly. The other three service user plans viewed did not indicate the frequency of weighing and where there was a decrease in weight there was no indication of any action being taken. This should be addressed to ensure that any changes in services users well being is identified and actioned. None of the service users are self-medicating. However service users medication is kept in their bedrooms in individualised locked cabinets and their medication is administered from there. Service users plans outline the support required by individuals in relation to their medication. The home uses the local pharmacy attached to the general practice to supply their medication. Pre printed medication administration records are provided. Service users have an individual medication file which includes a pictorial agreement for staff to administer their medication which is signed by the General Practitioner with the option for service users to sign. A note was made to indicate that the services users were unable to sign. The file included a medication risk assessment and a copy of the support plan to outline the support required with medication. Service user medication file included a description of individual seizures and outlined the protocol on the use of as required medication and the emergency procedure in response to seizures which was agreed and signed by the General Practitioner One service users health appointment record indicates that as required Diazepam is to be administered in response to seizures. However as required Diazepam was not prescribed for this individual and the emergency protocol indicated that an ambulance was to be called. This should be discussed with the relevant professional to ensure that they are clear on what action staff will take in response to a seizure. The home do not use any homely remedies. The home keeps a record of medication ordered, received and disposed of with stock checks carried out on non blistered and as required medication. All of the medication administration records were viewed and showed no gaps in the administration of medication All staff involved in medication administration are assessed and deemed competent Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: prior to being expected to administer medication with annual reassessments of competency carried out to promote good practice. Two staff are involved in the administration of medication. Training records confirm that staff have training in safe handling of medication with a medication policy in place to support practice. The manager confirmed that a new medication policy was immenient. Medication is well managed and promotes the service users well being and health. Care Homes for Adults (18-65 years) Page 20 of 33 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. Systems are in place to enable service user to raise concerns and complaints and to protect them from potential abuse. Evidence: Service users have an individual copy of the complaints procedure, which is in a pictorial format with evidence of it being explained to them. The Annual Quality Assurance Assessment document confirms that the home has received no complaints in the previous twelve months and none have been received since the Annual Quality Assurance Assessment document was completed in June 2008. A complaints log is in place to record complaints made and action taken. Completed surveys received from service users confirm that they know who to go to if they are unhappy and they know how to make a complaint. The Annual Quality Assurance Assessment document confirms that the home has had no safeguarding of vulnerable adults referrals or investigations. The home has a whistle blowing policy and a safeguarding of vulnerable adults policy in place. The safeguarding policy was reviewed in June 2007 and was due for review in June 2008. Staff spoken to during the inspection were clear of their role in responding to bad practice and potential abuse situations. The training records viewed indicate that the majority of staff have up to date safeguarding training with this training booked for one staff member and highlighted during the inspection as being due for a further two Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: staff. The home has a copy of the Bucks Interagency Adult protection procedure and the manager is clear of her role to report to the Local Authority. The home has a policy for supporting people who may challenge which was due for review in April 2008. Some staff have training in positive approaches to people who may challenge. Service users plans include guidance on the support required by individuals when things go wrong which outlines how staff manage behaviours that may challenge. Service user plans include guidance on the support required with finances and a money risk assessment and budgeting plan. Service users have an appointee or is under the court of protection and individuals plans outline this. Care Homes for Adults (18-65 years) Page 22 of 33 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. The home is homely and personalised and staff support service users to live in a clean and maintained property, to promote their safety. Evidence: The Old Forge is a single storey building, which has been refurbished and adapted to meet the service users needs. The home has a ramp and handrail to enable the service users to access the building and handrails are situated internally in the toilets, bathrooms and along the corridor. Areas of the home have been redecorated and a protective layer is in place on the bottom walls and doors to prevent them being damaged by wheelchairs. On entering the home it appeared homely, bright and airy. Service users have their own bedrooms, which are nicely furnished, individual and personalised. The home has one bathroom with a toilet, turntable and an assisted bath with an overhead shower. The home has a separate shower room and toilet and a further single toilet. There is a communal lounge and diner, separate kitchen and separate laundry room. On the day of the inspection the home appeared clean and tidy. Completed surveys received from service users confirm that for them the home is Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: always clean and fresh. Care Homes for Adults (18-65 years) Page 24 of 33 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. Permanent staff are suitably recruited with formal inductions, mandatory and specialist training and supervisions taking place to safeguard service users. Evidence of appropriate recruitment of sessional staff must be available to safegaurd service users. Evidence: Staff were observed to be accessible to and comfortable with service users. They appear to have developed a good understanding of service users individual communication needs and service user plans included communication profiles to support this. Some staff have specialist training in positive communication, epilepsy, diversity awareness and autism awareness training. The Annual Quality Assurance Assessment document completed in June 2008 confirms that over 50 per cent of staff have an National Vocational Qualification, however the manager confirmed at the inspection that 6 out of 8 of the permanent staff have an National Vocational Qualification which is now more than the 50 per cent required. The home has developed professional working relationships with other professionals. No feedback was received from other professionals involved with the home prior to this inspection. At the time of the inspection the home had a twenty three hour care staff vacancy with a senior and carer recently appointed and due to start once the pre employment Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: checks were complete and satisfactory. There was a full time staff member on maternity leave and a full time staff member had recently returned from long term sick on a gradual return to work programme. The vacant positions were being covered by the Organisations sessional workers and the occasional use of agency staff. The rota seen indicates that there are two staff on each day time shift with a third staff member being rostered on duty for specific activities. The manager works two shifts per week and is allocated 20 hours for administration tasks. At night there is a waking night staff and a sleep in person. Staff are responsible for the cooking and cleaning and there is an on call manager available to provide back up on call support. Staff confirmed that they have regular team meetings and minutes of meetings confirm that team meetings take place monthly. Two staff files were viewed at this inspection. The staff files seen contained a tick list to confirm that the required pre employment checks had been carried out and were satisfactory. The file contained a photograph of the staff member, a copy of the application form, copies of references and confirmation of CRB clearance. Files contained copies of birth and marriage certificates, copies of passport and driving licence. Files for the sessional workers were requested but were not available at the home. The manager had a e mail on file dated March 2006 to confirm that two of the sessional workers used had the required pre employment checks and included their CRB numbers. There was no confirmation of pre employment checks for all of the sessional workers who work at the home. This must be addressed to ensure that confirmation of pre employment checks is available at the home for all sessional workers used at the home prior to them commencing work. The manager is aware to obtain confirmation from agencies of pre employment checks of their staff. The proforma for one agency staff member viewed did not include confirmation that two references had been obtained. This must be addressed with the agency concerned. The training records viewed indicate that the majority of staff have up to date mandatory training with this training overdue but already booked for one staff member. Staff have had some specialist training as outlined under standard 32. All new staff undergo induction training and complete the common induction standards and the organisations induction programme. Completed induction records viewed evidences this. New staff spoken with during the inspection confirmed that they were inducted into the home and supported in getting to know their role and responsibilities. The manager confirmed that she supervises all staff. The senior will be expected to assist in the supervision of care staff once established in post. Supervision records are maintained of supervision sessions. These were found to be disorganised and it was difficult to establish if supervision takes place regularly for all staff. Staff confirmed Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: that they receive regular supervision and feel able to approach the manager with any issues and concerns. Six completed surveys were received from staff who confirmed they were suitably recruited, inducted, given the training to do the job, supported and have access to regular supervision. Completed surveys recived from service users confirm that staff always treat them well and always listen and act to meet their needs. Care Homes for Adults (18-65 years) Page 27 of 33 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 well managed with effective monitoring systems in place to promote good practice and promote service users health and safety. Evidence: The manager confirmed she has obtained a National Vocational Qualification level 4 in management. She is a qualified nurse and has worked at the home as the registered manager since the home opened. The manager attends relevant training which include the Mental Capacity Act training and has up to date mandatory training. The manager has been proactive in promoting service users involvement in the home and has introduced ways of enabling service users to make informed choices and decisions. Staff confirmed that they feel the home is well managed and that manager is approachable, supportive to them and takes on board suggestions to benefit the service users. The Annual Quality Assurance document was completed in June 2008. The document let us know the changes they had made and the improvements required to develop the service. Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: The organisation carry out Regulation 26 visits with detailed and thorough reports including an action plan available to evidence this. A finance audit was carried out in July 2008 and a staff questionnaire was completed in March 2008 with an annual staff observation service report completed. A medication audit was completed in July 2008. The Organisation currently do not seek feedback from relatives or other stakeholders. The majority of staff have up to date mandatory training as outlined under standard 35. A sample of health and safety records were viewed. An up to fire risk assessment was in place. Fire records indicate that weekly fire point tests, fire blanket, door guards and emergency lighting checks take place. A fire drill was carried out on the 31st October 2008. A fire emergency plan and fire audit dated February 2009 is in place. Service user plans include risk assessments in relation to fire. The home has records in place to confirm up to date servicing of fixed lighting, portable appliances, fire and moving and handling equipment. Records are in place to evidence health and safety checks of bedrooms as well as water temperature checks, fridge and freezer temps and food probe checks. A record is maintained of all accidents and incidents, with a copy of the accidents reports relating to service users filed in their individual files. The home has a record of maintenance issues reported and date when acted on or followed up. Care Homes for Adults (18-65 years) Page 29 of 33 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 30 of 33 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 34 19 The manager must obtain confirmation of pre employment checks for sessional workers prior to them commencing work at the home. To safeguard service users 17/04/2009 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 1 6 Service user files should be reorganised and made more accessible. Moving and handling risk assessment should be specific as to whether one or two staff are to assist in a transfer to promote service users and staff safety. The choice, range and particaption in outside actives should be developed on. Records should be maintained to evidence that service users have access to dentists, chiropodist and opticians with an outline of the frequency and an indication as to Page 31 of 33 2 9 3 13 4 19 Care Homes for Adults (18-65 years) whether a service users refuses to attend to further promote their health and well being. 5 19 Service user plans should outline the frequency of weighing and action to be taken in response to a significant loss or increase in a service users weight to promote their health and well being. Staff supervision files should be reorganised with information on frequency of supervisions being made more accessible. Some policies and procedures as outlined within the report are due for review and updating. 6 36 7 40 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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