Inspection on 02/12/08 for The Old Vicarage

This inspection was carried out on 2nd December 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Old Vicarage 04/12/07

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

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 Vicarage 48 Church Lane Stallingborough Lincolnshire DN41 8AA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Wilma Crawford     Date: 0 8 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: The Old Vicarage 48 Church Lane Stallingborough Lincolnshire DN41 8AA 01472882891 01472882891 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) : Home From Home Care Limited care home 13 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 13 The maximum number of service users who can be accommodated is: 13 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either; whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD, maximum number of places, 13 Date of last inspection Brief description of the care home The Old Vicarage is one of a group of homes owned by Home From Home Care Limited. The home is registered to provide care for 13 adults aged 18-65 who have a learning disability. It is a large country house situated in its own grounds at the end of a gravel driveway. The home is situated in the village of Stallingborough, next to the church and within walking distance of local shops and amenities. It has a large private garden with generous parking facilities to the front and rear of the building. The home has 10 single bedrooms all with en suite bathroom facilities. There is a range of communal rooms and facilities including a lounge, activity room, and dining room with a quiet sitting area, sensory room, and spacious kitchen. Three flats have been built to the rear of the buiding to provide more independent living opportunities for people. Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager or staff on the home. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The qulaity rating for this home is 1 star. This means that people who use this service experience adequate quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at risk of harm. In future, if a requirement is repeated , it is likely that enforcement action will be taken. The site visit was was unannounced and took place over two days December 2nd 2008 and December 8th 2008. Four people living in the home and three staff were spoken with during the visit. The manager was available to assist throughout both visits made. The main method of inspection used was called case tracking which involved selecting Care Homes for Adults (18-65 years) Page 6 of 32 tree people living in the home and tracking the care they receive through the checking of their records, discusion with them, the care staff and observation of care practices.The premises were looked at and the records of three people living in the home and three staff were examined. An Annual Quality Assurance Assessment (AQAA) document asking for information was sent out before the visit and information from this was included as part of the inspection process. Seven completed surveys were returned from staff, people living in the home, relatives and professionals. The comments from these and from discussion during the site visit are included in this report. The range of fees charged at the time of the site visit on December 8th 2009 was 1500 pounds and additional costs of 1;1 support where this had been identified or was needed. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking 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 8 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good outcomes in this area. A full assessment of needs is carried out and people are given enough information about the home and its facilities before admission, for them to be confident that their needs can be met by the service. The judgement has been made using available evidence including a visit to the home. Evidence: The home has a statement of purpose and this details all of the information required by this standard and Schedule 1 of the Care Homes Regulations 2001 for adults 18-65 years. A service user guide is available and this contains all the information required by National Minimum Standard 1.2. These documents are currently available in written format, the home has now made these available in a pictorial, large print format. The Annual Quality assurance assessment submitted prior to the site visit states that each individual is assessed prior to moving into the home. The assessment includes the identified needs to be met and both the individual and their families are involved in this process. Other information is collated from other sources, such as the family, Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: social care teams and professional bodies e.g. psychologist. The care files of three people living in the home were examined. Each contained a range of assessments carried out by a variety of professionals who hade been involved in the care of the service user in previous care settings. The staff team had more than enough information on the assessed needs of the service user and this enabled them to provide an individually tailored service to meet the service users complex needs and ensure their emotional stability. Written information, discussion with people living in the home and staff members evidenced that people living in the home had been offered and had taken up the opportunity of visits and overnight stays prior to making a choice about living at the home. In addition to this there was evidence that the other people in the house had been consulted about the new person moving in and had agreed to it. People have been introduced to the home gradually and the staff numbers increased as each new person has been admitted to the home. This has made it easier for the people living in the home to accept the changes and cause the least disruption possible. Care Homes for Adults (18-65 years) Page 11 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service experience good quality outcomes in this area. People using the service are able to make decisions and everyday choices as part of an independent lifestle. The judgement has been made using available evidence including a visit to the service. Evidence: Four care files were examined as part of the inspection process. Each file contained an index page which gave details of each part of the care plan and include: personal details, current care plan, risk assessments, daily support plan, daily records, contact records, health information, report forms analysis information and financial records. The profile of each individual gives details of their medication, its use, the persons likes and dislikes, aspects of their behaviour and an explanation of how this manifests itself and the reasons behind this. One careplan contained very little information about the individual or guidance for staff. The person concerned had been involved in three safeguarding situations, but despite this there had been no new risk assessments Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: completed or more information to guide staff, leaving the individual with the potential to be considered at risk. Each person has a pictorial and written booklet called my hospital passport all about me. This give information about the individual, their communication any aids or adaptations they may need, current medical conditions, allergies, what they might do if they were in pain, how they prefer their medicines to be given, how they would tolerate the nursing staff, what they may do if they were upset and any other information which hospital staff may need to ensure that their needs are met during their stay in hospital. Service users also have a health action plan. Care plans overall are comprehensive, very detailed and are based on the individuals assessed needs and give precise information of what support staff need to provide for service users and an element of what skills and ability service users already have in order to build on these and demonstrate progress. This is especially important at The Old Vicarage as the service users that live here have more complex needs and require a high level of staff support. The people living in the home are consulted in the development of their care plan and place their thoughts on the daily record sheet and sign it. Risk assessments and care plans are evaluated and are usually reviewed in line with the individuals changing needs, but some gaps in one persons care plan were identified and need to be acted upon. The risks had been identified, assessed and were being minimised by the production of risk assessments that staff were familiar with and followed and a number of these related to measured risk taking allowing service users to develop and maintain their independence. This was further supported during discussion with people living in the home and staf.. In one of the care files examined there was one monitoring form that had not been fully completed for the previous day. Further checks of this care plan and two others showed that this appeared to be the only occasion that this had occurred, all other areas of the care plans were fully complete and up to date. Care plans also documented areas of specific needs and charted the progress or deterioration in these areas. All of the people living in the home whose files were examined had made considerable progress in identified areas of their behaviour. Minutes of reviews showed that multi agency decisions were made and agreed with the individual and that reviews were held regularly in line with the individuals changing needs. In addition to this the service users had benefited from a person planning book which covered all areas of the individual: their previous life, likes/dislikes, hopes and dreams and an individual action plan on how the person could be supported to fulfil these. These records were documented on a daily basis by the individual and their keyworker. Information about any specific conditions that the person had were also available in the care plan for example epilepsy and Cornelia de Lange syndrome. The inspector observed service users being offered opportunities to participate in the day to day running of their own home; assisting with shopping for the home. There are regular residents meetings which minutes are available for. Staff and service users confidential information was observed to be securely kept. Staff were observed to knock on doors and to ask Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: permission to enter bedrooms. During the visit a staff was observed using inappropriate language about a person living in the home, this was not picked up on or adressed by either the manager or the senior carer who were both within earshot. When this was raised with the manager she said that she had had similar problems with the individual previously and would address it at supervision. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service experience good quality outcomes in this area. People using the service have opportunities to access a range of activities,are supported to maintain relationships and have their nutrtional needs met. Evidence: Each individual has their own time table of planned activities in the home and the community. The timetable is based on vocational, occupational, recreational and educational activities. A sample of a daily programme included cleaning their bedroom, a trip to the seaside, a walk to the post office and then watching a film. During the visit different activities were observed, 0ne person went out with staff to do some shopping at the local supermarket, one person had a head massage from an external therapist, another went out into the village, two people were at a horticultural class one person was at college, while another was involved in cooking. Each activity was Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: identified in each persons time table. In addition to this there are also holidays, day trips, visits to pubs and clubs. People living at the Old Vicarage have significant needs and all require a high level of support from the staff team, therefore none of the service users currently have work placements. Two people have a college placement. The manager and staff promote a healthy eating menu. Breakfast is cereals/porridge and toast. Lunch is either provided at the college or is a choice of pasta bakes, homemade burgers and chips or anything the person may request. people living in the home who were spoken with and feedback from their surveys confirmed that they enjoyed the food and they were involved in both the menu planning and shopping for the home. They also commented that staff would prepare anything that they wanted. One person has a special diet which is provided for and in close consultation with the individual. They were able to explain how they were involved in this and how a record of this was kept. It was felt that the balance was right for people living in the home users and ensures their physical well being and ongoing good health. People living in the home were very excited about the forthcoming birthday party of one of their peers and some were involved in preperations for this. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service experience good quality outcomes in this area. People living in the home receive appropriate health care and personal support. The judgement has been made using available evidence including a visit to this service. Evidence: The health action plans are complete and detailed, providing valuable information about individuals health needs, but also further information about the as individuals and how they would demonstrate that they were ill or in pain and their response to medical treatments and how they could be supported to manage this effectively. This would ensure that symptoms are picked up on quickly and the appropriate support offered, so that the individual does not find the process traumatic in any way. Staff and service users spoken with were aware of this process and able to give clear examples of when it had been used successfully. In addition to this the recording of outcomes to health appointments were detailed on a separate sheet to make it easier for staff to follow treatments or appointments, without having to go through all of the daily recording sheets over a period of time. These also provided information to show Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: that individuals health needs are met. Records examined confirmed that service users health needs were met by GP, dentist, chiropody and that they had access to a wide range of other health professionals e.g. psychologist, if and when required. Discussion with Service users and staff and observations confirmed that the staff promoted service users dignity, privacy and respect. Staff were observed to promote these in their interactions with service user. Home from Home Care has robust medication policies and procedures that include receipt, storage, administration and disposal of medication. The medication policy, states that people coming into the home can self medicate if they wish to after a risk assessment has been completed and agreed. No one currently chooses to administer their own medicines. The home currently uses Boots The Chemist blister pack system. The medication system and records were found to be accurate up to date and well managed. Medication is only administered by a senior member of staff who has completed medication training and has been judged competent to do so. Care Homes for Adults (18-65 years) Page 18 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service experience adequate quality outcomes in this area. People using the service feel able to air their concerns without any fear of repercussions. The staff vetting procedure is sufficiently robust to ensure the safety of the service users. The safety of people living in the home may be compromised by the lack of safeguarding situations within the home being referred to the Local Authority. The judgement has been made using available evidence including a visit to this service. Evidence: All of the surveys received back from service users indicated that the service users knew who to go to if they had a complaint or concern. All minor issues were dealt with through the house meetings. More serious issues were taken to the manager and a mechanism is in place for responding to these areas of concern and/or complaint. The home had a well developed complaints procedure. This contained contact details for the CSCI and the ombudsman and gave an assurance that service users and their families would not be victimised for making a complaint. The timescale given for responding to complaints was 21 days. The home is also looking into how a complaints policy could be developed for service users using the picture Exchange Communication System, where pictures are used to describe events. There have been no recorded complaints received by the home or in relation to the home. However examination of incident sheets indicate dissatisfaction with elements of the service, but these had not Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: been recorded in the complaints book, nor was there evidence to demonstrate that any action had beeen taken in respect of these. Feedback from staff, and people living in the home demonstrated that they were aware of the complaints process and who they needed to go to with any concerns of any sort. However concerns raised with staff had not been recorded in the complaints book, questioning their understanding of their role regarding the management of complaints or identifying complaints. People felt that they would be listened to and were confident that any concerns would be taken seriously. Staff were aware of their role in the complaints process, including supporting service users with any concerns or complaints they might have. They were also aware of local advocacy services and how they could be contacted on service users behalf. The home has a separate whistle blowing procedure. The manager oversees the recruitment process,an application form, two written references, a Criminal Records Bureau check and a Protection of Vulnerable Adults check are undertaken prior to a person starting employment. On the day of the visit three staff files were examined and all information was available in each file as requested at the previous inspection visit. Discussion with recently appointed staff members indicated that the recruitment process had been fully adhered to and all the necessary checks completed prior to them being given a date to start work in the home. The risk of harm to people is minimised due to the stringent procedures for staff recruitment in place. During a random check of incident records, a number of incidents were noted that should have been referred as safeguarding issues to the local authority. However,details of these had not been sent to the CSCI or the local safeguarding team. This was later discussed with the manager so that any further issues can be properly addressed. Despite this appropriate action had been taken by the home for each situation and the individuals care plans amended to reduce the risk of further situations occurring. There was also evidence to show that this had been closely monitored following the incidents. When this was raised with the maanger, she explained that she had been on holiday at the time and a relief manager was standing in. On her return from leave she asked oif a safeguarding refrral had been made regarding these incident and the operations maanager had said that they hadnt been nor was there a need for these to be referred.This would put into question what the organisations understanding of the local authorities safeguarding procedures are. this was made a requirement at the last visit and acted upon by the previous manager. Further action needs to be taken to ensure that all staff have a clear understanding of the local authorities referral procedures, to ensure that all safeguarding incidents are apprpriately referred. There was evidence from the homes recruitment and selection processes, staff training records, staff understanding of the referral process, complaints log and the use of risk assessments that the manager ensured that service users were protected and safeguarded from abuse. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service experience excellent quality outcomes in this area. The residents have been provided with a homely, comfortable environment that is clean and has been decorated to a high standard, with both private and communal space being suitable for their needs. The judgement has been made using available evidence including a visit to this service. Evidence: The Old Vicarage is situated in the village of Stallingborough and is owned by Home from Home Care. The accommodation is provided in a two storey detached building, set in a large private garden with generous parking facilities to the front and rear of the building. The home is close to local transport links, parks and the resort of Cleethorpes. All fixtures/fittings and furniture were of a very high good quality and on the day of inspection the house was extremely clean and tidy and very well presented. The home has 10 single bedrooms all with en suite bathroom facilities. There is a range of communal rooms and facilities including a lounge, activity room, dining room with a quiet sitting area, sensory room, and spacious kitchen. There is also an office, staff sleeping in room and additional toilet facilities. There is a lift available between the ground and first floor for anyone unable to use the stairs, however there are Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: bedrooms available on the ground floor of the home. Since the last inspection three self contained flats have been built and registered with the CSCI. These have been built to a high standard with high quality fixtures and fittings . Only one of the flats is currenly occupied.Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager or staff on the home. People living in the home said that they were proud of their home and were keen to show the inspector their rooms and how they had personalised them. The person living in the Mews was delighted with their new home and having the opportunity to choose their own furnishings for it. The home is spacious and offers a range of communal facilities for individuals to use. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service experience good quality outcomes in this area. People living in the home are supported by staff who are supervised and undertake training. The staff vetting procedure is sufficiently robust to ensure the safety of the residents. The judgement has been made using available evidence including a visit to this service. Evidence: There are currently nine people living in the home who are supported by the manager and five care staff in the morning and four care staff in the afternoon with a further two staff to support identified times with people who have additional funding for specific times of the day. There are two waking staff available during the night and one sleeping in staff member available for additional support if required. Recent incidents in the home have occured at night, so there may be a need to review the ciurrent staffing levels in order that the necessary staffing is available to support the needs of people living in the home. the staffing levels have been reduced at night since the last inspection although numbers have increased by a third. Previously there were three waking and one sleeping in staffmemeber, whilst now there are two waking staff and one sleeping in staff member. The staff also provide support with domestic tasks and Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: with cooking. Some of the people living in the home have identified additional support needs and additional staffing hours have been agreed to support with this. However it was not clear from the staffing rota, which staff were working with which individuals to provide this. When staff and people living in the home were spoken with it was clear that this additional support was in place and each staff member was aware of their duties during the shift and which individual or individuals they were responsible for supporting. This ensures that service users diverse needs and person centred plan goals can be met and planned for. Observation of staff practices confirmed that the majority of the team have developed appropriate relationships with service users and treat them in an age appropriate way and with the utmost of dignity and respect whilst offering guidance and support in a firm but sensitive manner. One staff member was observed using inappropriate language in front of peopel living in the home. The staff team are supported by a wide range of health professionals e.g. psychologist and audiologist. Three new staff members files were examined as part of the site visit and this evidenced that Home from Home Care recruitment policies and procedures are robust and staff have CRB disclosures, POVA checks, all identity as required by regulation and references obtained prior to commencement in employment. Supervision records were examined and were in order and the current staff team are up to date with their mandatory training and have undertaken other specialised training relevant to the needs of the service users, i.e. epilepsy, autism, managing difficult behaviours, health action planning, person centred planning, and introduction to learning disabilities. All new staff members complete the Learning Disability Award Framework training during their induction, providing them with a good knowledge base to understand the needs of the people they are supporting and offer them the appropriate support. Only one staff member has completed a national vocational qualification at level 3, they also have an assessors award. The remaining staff are registered to complete this award. 37.5 of staff have achieved an NVQ at level 2 or above. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience 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 this service experience good quality outcomes in this area. People using the service overall benefit from a safe and well managed place to live. The judgement has been made using available evidence including a visit to this service. Evidence: Mrs Susan Wilson is the registered manager at The Old Vicarage. The registered manager has considerable experience in working with adults with learning disabilities and managing residential care settings. Regular residents meetings that include staff and service users, staff supervision and the key worker system ensure that staff and service users have the opportunity to influence the way the service is delivered. The senior staff supervisions records were not up to date, although they said that met regularly with the manager. During discussion, staff had commented that communication systems were not as good as the could be and information was not always passed on. The manager is considered by staff and people living in the home as being approachable and open to suggestions. The organisation has a corporate periodic service review in place where every aspect of the service is looked at and Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: certain criteria met. This quality assurance audit demonstrates how the service is performing and what action needs to be taken to improve any areas that need to be further developed.In addition to this regular visits are made by the area manager to audit areas of the home and practice within the home. These visits are recorded and action plans agreed for any areas which are considered to need improving. Areas recorded on the AQAA document for improvement in the forthcoming year included to make policy and procedures more accessible to service users, involve service users more in quality assurance processes and feedback, and to work to establish 50 of the staff group achieving an NVQ qualification. As part of the inspection all maintenance records were seen and were up to date and in order ensuring that the service users live in safe environment. This corresponded to the information provided by the home in the AQAA document. Staff spoken with said that they felt well supported by the manager. Information from staff team minutes and discussion with staff indicated that they can attend regular meetingsand express their views. Safeguarding issues within the home have not been referred to the safeguarding team , although appropriate action was taken within the home to safeguard people. This was also found at the previous inspection and action needs to be taken urgently by the home to rectify this. This information needs to be reported so that individuals are protected from harm. similarly complaints and concerns from relatives had not been logged, nor was there evidence of any action taken to resolve the complaint. (see standard 23) Gaps in the recordimg of individuals care plans and evaluations need to be imroved , to ensure that information is current and staff have the correct infomation to ensure that people are effectively supported. This information is also critical when agency staff are being used on a regular basis. similarly any changes in need need to be identified and care plans updated to refelect the change in need and how this is to be managed. Risk assessments should also be reviewed to accomodate the change in need. Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 23 37 The registered person must ensure that all safeguarding issues are immediately reported to the local authority in accordance with their safeguarding procedures. 04/12/2007 Care Homes for Adults (18-65 years) Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 14 The registered provider shall 30/06/2009 ensure that the care plans of people living in thehome are kept under review and any changes are recorded within the care plan. This would ensure that staff have the correct information as to how people need to be supported and the appropriate action is taken to ensure individuals needs ar supported and met. 2 23 37 The registered person must ensure that all safeguarding issues are immediately reported to the local authority in accordance with their safeguarding procedures. This would ensure that people living in the home re protected from harm 01/04/2009 3 31 18 The registered provider should ennsure that all staff receive training in dealing 30/06/2009 Care Homes for Adults (18-65 years) Page 29 of 32 with complaints in line with the organisations policies and procedures. This would ensure that staff are aware of their rol in dealing with complaints, so they record details of complaints as they arise and appropriate action is taken to resolve these. 4 31 18 The registered person shalll ensure that all staff receive training in the organisations complaints procedure. This will ensure that staff will have a clearer ubnderstanding of their role in dealing with complaints and that all complaints are recorded and an action plan developed to resolve the complaint. complaints brou 5 33 18 The registered person should ensure that senior staff effectively communicate and provide necessary information and guidance to staff in the home. This will ensure that staff have the up to date information in order to meet the needs of people living in thehome effectively. 6 33 18 The registered person 30/06/2009 should ensure that there are adequate staffing levels provided at all times in order to meet the individual needs 30/06/2009 30/06/2009 Care Homes for Adults (18-65 years) Page 30 of 32 of the people living in the home This will ensure that the safety and welfare of the people living in the home is maintained at all times. 7 36 18 The registered person shall ensure that all staff receive a minimum of six recorded supervision sessions a year. This will ensure that staff are up to date with information and are supported in their roles. 30/06/2009 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 31 The manager shall ensure that any staff not complying with the homes policy and procedures regarding dignity towards people living in the home are dealt with immediately. The manager should consider how communication accan be improved within the home so all staff receive all the current information that they need. 2 38 Care Homes for Adults (18-65 years) Page 31 of 32 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 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!