Inspection on 30/03/09 for The Old Rectory

This inspection was carried out on 30th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Old Rectory 10/05/07

The Old Rectory 15/12/05

The Old Rectory 20/07/05

The Old Rectory 21/02/05

The Old Rectory 12/07/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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 Rectory Cromer Road Hevingham Norwich Norfolk NR10 5QU     The quality rating for this care home is:   three star excellent 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: Judith Last     Date: 3 0 0 3 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 36 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: The Old Rectory Cromer Road Hevingham Norwich Norfolk NR10 5QU 01603279238 F/P01603279238 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) : Mr Richard Jarvis,Mrs Susan Jarvis care home 9 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 9 A maximum number of nine (9) services users with learning disabilities may be accommodated. Date of last inspection Brief description of the care home The Old Rectory is a care home providing personal care and accommodation for 9 younger adults with learning disabilities. Mr Richard Jarvis and Mrs Susan Jarvis own the home. Susan Jarvis has the responsibility for the management of the home. The Old Rectory is a Grade II listed Georgian building located on the outskirts of the village of Hevingham, some 8 miles from the City of Norwich. Most people need staff support to go out and use local facilities, but the home is within easy driving distance of the City of Norwich and the market town of Aylsham. The home has been made bigger and more comfortable for people living there. There are nine bedrooms, eight on the first floor and one on the ground floor. No one has to share a room. The home has various areas people can share, with different sitting Care Homes for Adults (18-65 years) Page 4 of 36 Brief description of the care home areas. Outside there is a big garden that includes a pond and a wooded area. Next to the house there is an enclosed garden for people to use who might need extra support to keep them safe. It costs from £3088 to £3094.20 a month to live at the home. It costs extra for private chiropody, hairdressing, toiletries and personal spending, some day care activities and contributions towards transport and the cost of outings. There is also a charge to people for having their accounts independently audited where the manager handles their money. People living at the home will need Mrs Jarvis or the staff to explain inspection reports to them. Care Homes for Adults (18-65 years) Page 5 of 36 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: three star excellent 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: Before we visited the home we looked at all the information we had about it. This included the form the manager filled in for us, things we found out at our previous visits and the things the manager had told us about. Three people living at the home completed surveys for us. We also had comments from two relatives and three staff, telling us what they thought about the home. We gave the manager short notice that we were going to come and visit. This is because the first time we went there was no one at home. After we looked at the outside to make sure it was in good condition, we went back and spent about 7 hours there. We spoke to two staff members, the manager and two people living in the home. Some others found it difficult to talk to us so we spent some time seeing what Care Homes for Adults (18-65 years) Page 6 of 36 was going on and listening to how staff were working with them. While we were at the home the main method of inspection we used was called case tracking. We use this to see what records say about peoples needs and then try to find out from looking, listening and talking to people, how well their needs are being met. We used all the information we got and the rules we have, to see how what outcomes there were for people in their daily lives. What the care home does well: What has improved since the last inspection? What they could do better: Mrs Jarvis needs to make sure that information about the home shows how much people might have to pay to live there. The information also needs to show how people can contact us if they need to find out more about the home or tell us about something they are concerned about. Where the doctor has said someone needs cream or lotion put on their skin, staff must make sure they always sign when they have done this. This is to make sure all the records are complete and that people have what the doctor says they need to keep their skin healthy. There are some other things that Mrs Jarvis could think about that would improve things even more. She can tell you about these and they are included in our full report. Care Homes for Adults (18-65 years) Page 8 of 36 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 36 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 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People (or their representatives) would have access to most of the information to decide if the home will meet their assessed needs. Evidence: We looked at the statement of purpose and the guide to the home that can be given to people or their representatives. These contain information needed about the service the home provides and is very clear about peoples rights and principles of dignity. However, the guide is not clear about fees and the information about how to contact us is now out of date. People would however, have a clear idea about the philosophy of the service and how it will try to uphold their rights. The guide for prospective service users now incorporates comments from people who already live at the home so that people thinking about moving in would know what others already think about it and what their experiences have been like. There are no vacancies at present and the last admission to the home was four years Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: ago. However, the manager is aware of the importance of gathering information about peoples needs so that she can be sure these will be met. Assessment information is also gathered from other sources, for example from speech and language therapists and care managers. Mrs Jarvis is clear in information sent to us that people can visit and spend time at the home and this is encouraged. One person told us I came to look round before I came here. My mum came too. Visits will be built up to include an overnight stop and weekend stay before any trial period begins and that this will all be at the pace of the person concerned, so that they can see if they want to move in. She says compatibility with other people already living in the home is also considered. This means that people have the opportunity to test drive the home and for all concerned to see whether it is suitable and the person wants to live there. Care Homes for Adults (18-65 years) Page 12 of 36 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 are involved in decisions about their care, so far as possible given present communication difficulties. Evidence: Everyone at the home has an individual plan setting out their needs and abilities and how staff are to support them effectively. Plans set out particular difficulties people might have - for example with behaviour - and how staff should respond to these. Staff say they always have up to date information about peoples needs. They say things about care plans like it is always there at hand as well for us to read or refer to at any time, and that care plans are regularly updated. Staff are informed of this both verbally and in the communication book. This means that staff should always be clear about the support people require to meet their needs properly. Records show individual plans are reviewed regularly although reviews do not always break down progress towards individual goals so that people (and staff) can see what Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: progress is being made and whether staff support is being successful in helping people achieve what they want or need. We made recommendations about this in our last report but cannot see how these have been implemented to improve the system. Daily records and our observation during our visit show that the support people require is delivered (in one case this involves assistance to maintain mobility). Records also show that where people require additional monitoring (e.g. with eating, drinking and monitoring weight) that this is given. However, they do not always record information clearly about what staff have observed. For example, one persons records where we were case tracking showed that the person spent the evening in their usual manner. We know that the staff team is generally stable and the manager is present regularly, so most staff would understand what this meant. However, it means that sometimes daily notes are not clear and objective about how staff have supported the person during the shift and the way people spend their time. Not all records are signed or initialled by the staff completing them. Mrs Jarvis says that staff have had some training in alternative communication methods to help support people who have communication difficulties, in making decisions and understanding information. After our visit Mrs Jarvis told us a staff member now has a place to train as a total communication coordinator and this will help improve the way staff are able to communicate with people even more. Mrs Jarvis also recognises that the home could do better in continuing to explore opportunities for advocacy which would help in decision making. She has also attended training in the Deprivation of Liberty Safeguards, which looks at restrictions that might be imposed upon someone to keep them safe. She says she is looking at how this can be incorporated into support plans to make sure people are not subjected to unnecessary or unreasonable restrictions in their daily lives. Support plans contain risk assessments. Case tracking and observation showed that staff were aware of the risk of one persons behaviour escalating and that they responded to persistent comments consistently and in line with what was set out in their support plan. Some risks, for example with swimming, could be more clearly documented for each individual as risks to each person is different according to their abilities in the pool and health conditions (e.g. epilepsy) or mobility. Staff told us about how they minimised the risks of accident with activities such as swimming and spoke of supervision, staff ratios and using a pool with a lifeguard. This shows that although underpinning records may not always be clear and specific, staff have discussed and are aware of how to keep people safe. Care Homes for Adults (18-65 years) Page 14 of 36 Care Homes for Adults (18-65 years) Page 15 of 36 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 services are able to make choices about their life style and the manager has plans to improve this further. People have fulfilling lifestyles although improvements could be made in showing their wishes and preferences are responded to. Evidence: Records show people are involved in activities inside and out of the home. One person who previously was not engaging in day care and activities is now doing this and has been introduced to things gradually over time. This has helped provide a more fulfilling lifestyle for the person concerned. One person is confirmed and goes to church showing that people can have their spiritual needs met. People tell us they can choose what they want to do each day. One person says they Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: have lots of things to do. Records show what they enjoy and what opportunities they have to do things. One person told us Im going swimming later. Its good for my heart. Financial records show opportunities for sailing, some cookery and trips to shows. A staff member tells us that some summer shows have already been booked for people who want to go. This shows people are able to go out and make use of local facilities. One person has a full time job and one a part time one. The manager says another person is being supported by an outside agency to look at employment opportunities. This means that people who are able to manage this, are supported with appropriate job opportunities. Support plans set out peoples interests and goals for a fulfilling lifestyle. One persons records show that they expressed an interest in football matches, pub visits and activities out of day centre hours. They had been referred to a befriender to help with this but their records do not show the homes staff have followed up these interests with them. They predominantly show that the person spent time in their chair and relaxed or that they relaxed watching T.V. Both relatives who wrote to us felt that people were always supported to live the life they chose. People have opportunities to go on holiday and staff say that duty rosters are flexible to allow for this and for other outings. They told us things like extra staff are always provided to meet any additional needs. For example on outings. There is a vehicle available with hoist so that people are able to access it and get to places they want. Relatives tell us that people are always supported to stay in touch with them and one person says I go home at weekends. The manager tells us she feels that community links have improved since our last visit. The home has also hosted a coffee morning on behalf of the local church,and people have also attended functions at the local school. This shows efforts are made to try and ensure people are part of their local community. Staff say they would take into account peoples reactions to visitors to the home, especially if the person was unable to communicate verbally. This would be used to interpret whether a person was happy with receiving that particular visitor so action could be taken if necessary. It is also clear that staff counsel people to make sure that they respond in a socially acceptable manner to people they do not know well. This shows staff support people with appropriate social interactions. Mrs Jarvis and staff say people are supported to join in some daily living tasks subject to their abilities - such as putting away laundry and changing their beds but Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: opportunities, support and supervision for people in this area does not always show up in their daily notes. The results of the homes own quality audit and survey shows that those surveyed feel the home does well in offering people opportunities. We conclude from the information and from what we saw that either records do not do justice to practice. Some staff have completed training in fitness and healthy eating and efforts are made, in conjunction with the dietitian, to try and ensure people are supported to maintain a healthy weight. We heard people being offered choices of different sorts of drinks at lunchtime and chatting with staff. Two people told us the food is good and one said they were hoping that tomorrows lunch might be cheese and pickle sandwiches. Mealtimes are arranged to suit activities and we saw that people were given plenty of time to eat a light lunch before going swimming in the afternoon. Care Homes for Adults (18-65 years) Page 18 of 36 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 personal and health care people receive is based on their individual needs. Staff respect the privacy and dignity of people concerned. Evidence: People say they like the staff and that staff listen to them and act on what they say. There are some male staff employed by the home so that people could have support with their personal care from someone of the same gender (subject to roster constraints). Risk assessments and individual plans show what support staff should offer people to meet their personal care needs safely. This includes giving advice about dental care and diet where people need this to help them make decisions about a healthy lifestyle. Records show people can decide when they want to go to bed and get up, taking into account commitments for day time activities. They also show that other professionals are involved where appropriate and that their Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: recommendations are responded to - for example around maintaining mobility and responding to difficulties with eating, drinking and swallowing. There is clear guidance about the managers expectation people will be treated in a way that respects their privacy and sets out principles for upholding peoples dignity. We could see during our visit that staff did not talk about people and their problems in front of others and that they were discreet in any reminders to use the toilet before going on the swimming trip. This means that staff are aware of the principles of privacy and dignity and try to uphold these in practice. Health Books have been introduced for everyone, setting out who is involved in keeping them well and what support they need from staff to promote thelr health. Daily records show that someones routine had been adjusted because they had been unwell with a heavy cold. This showed that they had been able to decline activities or stay in bed longer and were encouraged with fluids. Other records show that someone had been supported with an in patient stay in hospital so that they had a familiar face with them and someone who understood their needs well. This shows that staff respond flexibly to health issues and give support (physical and emotional) to people who are unwell. Records show that one person at risk of developing pressure area problems, is provided with equipment to minimise the likelihood of their skin breaking down. This shows that peoples health and welfare is promoted. Medication management shows that advice we had given at our last inspection had been taken into account. There is now clear guidance about the use of medication needed for occasional use to control behaviour. This means it is clearer to see that it is being used properly and to promote the wellbeing of the person concerned. However, neither records on the reverse of the administration record nor in the persons notes show that the effects of the medication is always monitored. The guidance Mrs Jarvis has put in place for staff requires that the person should be monitored after administration of the medication and their behaviour recorded. This is not always happening. This is needed so that the effectiveness of the medication is clear and further advice from prescribers can be taken if it is needed. The time of administration is also not recorded on the administration record to make sure medication is given at the appropriate intervals. There are regular checks on medication available in the home and staff sign records properly to show when people have taken tablets or medicine. This helps to make sure Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: medication is not being misused and is being given as prescribed to keep people well. However, staff do not always sign when they have applied lotions or creams that the doctor says they should have to keep their skins healthy. This means records do not show external medication is always applied as it should be. Staff say that they have training in the administration of medicines and are not expected to administer medicines until this is complete. They are also monitored to make sure that they give medicines properly. This shows that the manager takes care to ensure that staff are competent to give people their medicines safely. Care Homes for Adults (18-65 years) Page 21 of 36 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. Peoples concerns (or those of their representatives) would be taken seriously and addressed. There are measures in place to help make sure people are protected from abuse. Evidence: The people who wrote to us and who we spoke to say that they would speak to staff or to Susan (Mrs Jarvis) if they had any complaints or concerns about their care. Two people we spoke to told us that they were happy with their care, get on well with staff and were happy living at the home. Both said they had no complaints. Information about the home explains that people have a right to complain without fear of retribution. One of the two relatives who wrote to us (50 ) say that they know how to complain if they need to. One did not but did say that the home had always responded appropriately if they had raised any concerns. Mrs Jarvis confirms that relatives had a copy of the procedure and that she had also reissued that to make sure everyone knew. This shows she has tried hard to make sure that peoples representatives know how to complain if they need to and could support residents in doing so. Staff say that they know what to do if someone expresses concerns and one says policies.... are available to staff. The content is very clear. The manager recognises that they could do better in making the complaints procedure Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: more accessible to people living in the home and feels that the Total Communication Coordinator, once trained, will be able to help with this. These things show that there are systems in place to ensure that any concerns people or their representatives have, would be dealt with promptly. Staff have training in safeguarding vulnerable people and this is, based on records, delivered soon after they are recruited. It is factored into the annual training plan and is discussed within the home. Staff are clear about their obligations to report any concerns and sign to say they have understood relevant policies such as the safeguarding policy and whistleblowing guidance. Monies managed on behalf of people who are unable to do this for themselves, are clearly recorded and cross-referenced with receipts. Arrangements are made to ensure that they are independently audited every year. These things means that there are systems in place to help safeguard people and to protect them from abuse. Care Homes for Adults (18-65 years) Page 23 of 36 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 safe, comfortable and very clean environment that suits their needs. Evidence: We looked around communal areas of the home, at the kitchen and the laundry - and at records associated with maintenance. These showed that problems are addressed and there is a programme for carrying out redecoration or repair when these are needed. The manager also looks at the quality of the premises as part of her quality assurance processes so she can identify what needs doing and prioritise things to provide a safe and well maintained home for people. There are records showing that fire alarm and detection systems are tested regularly to make sure that they will work and so promote peoples safety in the event a fire breaking out. Although the building is old with a newer extension, efforts have been made to ensure people are able to access it in safety. Floors have been gently ramped where there are changes of level and there is access to a hoist should this be needed for people. There is one ground floor bedroom suitable for someone with mobility problems. Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: These things show that the home is maintained in a manner that promotes safety for people living and working there. The manager provided information that all staff have training in infection control and this was supported by staff files sampled. The home has also completed information about Safer Food Better Business in conjunction with the district councils environmental health department. Records had been completed regularly. There are cleaning schedules for staff to follow to make sure that the home is kept clean and things are not missed out. Areas we saw were clean and there were no unpleasant odours. These things mean that people live in a home that is kept clean and hygienic and that the risk of the spread of any infection is minimised so far as possible. Care Homes for Adults (18-65 years) Page 25 of 36 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 benefit from a competent, consistent and effective staff team that is well supported to understand and respond to their needs. Evidence: The manager gave us information that five out of the nine permanent care staff have National Vocational Qualifications to help them understand their work and roles. We saw certificates for this on file. One person told us they had obtained their qualification before they started work at the home. In order to understand the needs of current clients they say they have completed additional units of training as part of their induction. The home uses induction for new staff that is specifically tailored to working with people with learning disabilities, so that they gain an insight into the particular needs that those they support might have. Staff say that their induction covered very well what they needed to understand their roles. We had comments like I just had to ask if I was unsure of anything, the induction process was thorough and supportive. Once the process ended, information and support were, and still are, available on an ongoing basis. We asked staff about training in our written surveys and when we visited. We had Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: comments like that the training is good, staff feel they are given training that keeps them up to date, helps them understand peoples needs and is relevant to their role. They say things like should I feel there is training in any area that I need, I can also request this, training is an ongoing thing, any relevant courses you are always welcome to attend. There are plans to improve the effectiveness of the staff team in finding alternative ways to communicate with people, now a training place has been secured. This will help improve how staff communicate with people and how people living in the home are able to make more choices and participate more by expressing their views. Staff meeting minutes show that changes or practice issues are discussed as they arise so that staff can be clear about what is expected of them. There is also a training plan for the home to make sure that time limited training such as first aid is kept up to date and to identify what additional training might be beneficial in meeting peoples needs. These things show that staff are competent and trained to meet peoples needs appropriately and that training is ongoing where peoples needs warrant it. The home has a history of low turnover and sickness within the staff team. Staff say there are always enough of them to meet peoples needs and that the duty roster is reorganised if necessary to support people with activities. This indicates that people benefit from consistent staff who they know well, and who are on duty in sufficient numbers to meet their needs. People say I like the staff and I get on well with them. Recruitment files checked contain the information required to ensure they are safe to work with vulnerable people and that full enhanced criminal records bureau checks are in place before they start work. Staff say that they are supernumerary while they are learning about the work. Records confirm there is a probation period and that staff are expected to progress with their induction at a satisfactory pace during this time. This shows that the requirement we made last time has been met and that there is a robust procedure for recruitment that ensures people are safeguarded from staff who should not work with vulnerable people. Staff say that they receive regular supervision and opportunities to meet as a team, and records support this. They say that you can raise things at staff meetings, that you can always ask for support, and that support is always there whenever needed. This shows that people benefit from a staff team that is well supported and Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: well supervised in their work. Care Homes for Adults (18-65 years) Page 28 of 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect. There are effective quality assurance systems developed by a qualified and competent manager. Evidence: We know from our previous visits that the manager has the necessary qualifications and experience to run the home properly. She has 12 years experience of running the home, teaching qualifications and a Masters degree in social work. She participates in regular training updates and since we last visited, has attended training in the Mental Capacity Act, Deprivation of Liberty Safeguards and risk assessment in relation to safeguarding vulnerable people. This shows she keeps her knowledge of relevant issues up to date so, if necessary, she can adapt the way staff support people and the guidance she provides. The manager has a history of responding appropriately to requirements that regulators have made to ensure the service is properly managed and complies with the law. She Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: also shows that policies she expects the staff to follow in peoples best interests are updated in line with latest guidance. For example she has updated the policy on management of finances in line with our best practice guidance published last year to help show people are protected. Staff say that they feel they can raise issues with the manager. We had comments showing they felt well supported and could raise issues (see the staffing section of this report). One person says I have never found the manager unapproachable in any way. When anything needs talking through or a suggestion is made she is always ready to listen. Another comments that the manager is always available to discuss and support issues that may arise as well as on a formal basis for supervision and appraisal. They feel that the service is responsive to need and will change when there is need to respond to changes in peoples needs as well as when new developments come along we take them on board. Records from staff meetings show that the manager takes a clear lead in this process. Information from the manager shows that staff have had some training in equality and diversity issues. She recognises the importance of having a staff group from different backgrounds and the issues that can arise as a result of disability. There is clear guidance about peoples rights and staff responsiblities to uphold these - for example combatting loneliness that may arise as the result of disability or communication problems. She says, in information for us, that she is looking to source more training in the area of communication and equality and diversity. This will help staff understand issues more fully. People living at the home see the manager as part of the team that supports them. During our visit it was clear that people felt able to approach her and two people told us if they were worried or concerned they would speak to Susan. This shows that people living in the home find her approachable and are confident she would respond appropriately. The home has a history of filling vacancies quickly showing that other professionals are satisfied with the service it can offer to people who need residential care. These things show that staff and people living in the home benefit from the leadership that the manager gives. The information the manager sent to us was clear and showed that she had taken into account individual standards she needs to comply with. She gave us a range of evidence to support what the service was doing well, but also showed she had plans to improve. She was able to show us small internal audits relating to the outcome groups Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: in this report, and how she had used these to identify areas for improvement. She says that she also uses this information to look at the self assessment she sent us and to keep this up to date with improvements made. As part of her quality monitoring systems she surveys other people about what they think of the service, including family members. We were able to see positive responses from these showing they feel the home is well run. She says improvements have been made to the survey used for people living in the home to help gather more direct feedback and the Total Communication Coordinator would be able to support this process once they are trained. One relative told us that care is well and another says that everything is run very well at the home. There are risk assessments for activities people and staff take part in. We could see from records sampled and matched with information sent to us, that equipment is maintained and tested regularly to make sure it remains safe for use. Staff have training to help them keep people safe - with regular updates of moving and handling, fire safety and emergency first aid. Care Homes for Adults (18-65 years) Page 31 of 36 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 32 of 36 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 4 The information about the home must be clearer about the range of fees payable and what they cover as well as information about how to contact us. This is so people (or their representatives) can take cost into account when selecting a placement and know how to contact us if they need to. Regulation 5 of the Care Homes Regulations 2001 sets out this information needs to be in the service users guide. 29/05/2009 2 20 17 Staff must sign records 05/06/2009 showing that they have applied topical medication as prescribed. This is so the home can show that prescribed treatment is being given. Care Homes for Adults (18-65 years) Page 33 of 36 This is so there are complete records of all medicines administered to people (externally as well as internally). Regulation 17(1)(a) of the Care Homes Regulations 2001 sets out what records are required in respect of service users. Schedule 3, number 3(i) of the regulations says that there must be a record of the date that medications are administered. 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 Individual goals should be separately recorded so that progress towards achieving them can be more effectively reviewed and recorded. Daily records should be initialled or signed by the staff member completing them to show who has been accountable for this. This is so any concerns about them can be easily followed up with the person responsible. Where individual goals remain unchanged for long periods of time, they should be broken down into smaller steps and stages so that progress is more easily identified. This would help show how the home is supporting people with independence, and gaining or maintaining skills. The manager could look at the records of activities for everyone, to make sure that those who are less able are given opportunities and to see whether records could be improved to show what is happening for everyone. Daily records should clearly show that the administration of medication to control behaviour is warranted, rather than simply stating that the person concerned is a little unsettled. This is so records show that the administration is clearly justified on each occasion. Page 34 of 36 2 6 3 6 4 14 5 20 Care Homes for Adults (18-65 years) 6 20 Medication administration records should clearly show the time medication is administered, rather than relying on daily notes to suggest a time that is has been administered. Daily notes should show the effects of administration of medication to control behaviour. This is so any concerns about its effectiveness can be followed up to make sure it remains an appropriate medication for the person concerned. 7 20 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 36 of 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!