Inspection on 08/01/09 for The Paddock

This inspection was carried out on 8th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Paddock 23/01/08

The Paddock 30/08/07

The Paddock 01/09/06

The Paddock 27/07/05

The Paddock 05/10/04

The Paddock 14/04/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

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Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Paddock The Paddock 80 High Street Lydd Kent TN29 9AN     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: Kim Rogers     Date: 0 9 0 1 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 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.csci.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 Paddock 80 High Street The Paddock Lydd Kent TN29 9AN 01797321292 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Laurence John Waitt,Mr Shaun Rigby Waitt Name of registered manager (if applicable) Mrs Judy Rees Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 19 The registered person may provide the following category of service only:Care home only (PC) to service users of the following gender: Either whose primary care needs on admisison to the home are within the following category : Learning disability (LD) Date of last inspection Brief description of the care home The Paddock provides personal care and support for 19 service users with a learning disability. It is a large detached house set in pleasant gardens. It is situated in the small coastal town of Lydd and the local shops, church and public houses are all within walking distance. The larger towns of Ashford, Folkestone and Hythe are all within easy driving distance and the home provides transport in order to access the available educational, recreational and cultural facilities. In the gardens surrounding the home there is a vegetable plot where the service users are supported to grow some of the Care Homes for Adults (18-65 years) Page 4 of 32 care home 19 Over 65 0 19 Brief description of the care home fresh produce for the home. Bedrooms are single and there are spacious communcal areas. There is parking at the front of the house. The fee range for this service is about £476.79 - £1281.35 per week. For more information about the fees and services please contact the provider. 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: This was a key inspection of the service which means that all of the key standards were assessed. This inspection was carried out by one inspector over two days, a total of about seven hours. The last key inspection was completed on 23rd January 2008. We looked at information provided by the manager in the Annual Quality Assurance Assessment, AQAA as well as other information we have received since the last inspection including complaints and notifications about accidents and incidents. The AQAA tells us how they have improved and how they intend to improve the service for people. We had a look around the home, spoke to the manager, service users and staff. We Care Homes for Adults (18-65 years) Page 6 of 32 made observations and sampled records. What the care home does well: What has improved since the last inspection? We found that the manager has made a small amount of progress towards meeting the requirements made at the last two inspections. For example, activities are still limited relying on staff to organise in house activities on an ad hoc basis. This means that for some people, who do not out to day centres, activities in house and in the community are limited. The manager has researched the provision of activities on offer at the local community centre. Monthly meetings between key workers and service users have been introduced to find out what activities people would like to try. More needs to be done to ensure that people have the opportunity to experience and take part in a range of fulfilling, meaningful, ordinary activities. Some imposed restrictions have been reviewed as previously required in that people have tried to use keys to their rooms. This has failed for some people but no other more suitable locking devices have been tried. This means that people cannot lock their rooms for privacy. Access to the kitchen and laundry is still restricted for some. Some people have had the water supply disconnected from their bedroom wash hand basins with no recent review. There are also other imposed restrictions that must be reviewed to ensure they are the least restrictive option, they are made in service users best interests and they are kept under close review to ensure they are still necessary. The manager took some steps to address this by the second day of the visit. Therefore we may not take enforcement action on this occasion. Risk assessments are now carried out before the maintenance man carries out any work at the home protecting service users. Person centred planning books have been introduced and key workers have started to complete them. Health action plan booklets have been introduced. This means peoples personal goals and aspirations can be recorded and supported. However, staff and the Care Homes for Adults (18-65 years) Page 8 of 32 manager need training and support so they have the skills to fully implement person centred planning. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 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 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is written information about the service with plans to make this more meaningful. Assessments are carried out or sought from care management before a person moves in. Evidence: There is some written information about the home giving details of what is on offer. The manager plans to improve this by making it more meaningful to people. This means that people will have meaningful information to help them make a decision about moving in. The manager talked about the assessment process and the need to ensure that she carries out holistic assessments. This could not be tested though as no one has moved into the home since the last inspection. We found past assessments by the home and care management in some files sampled. 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. Service users know their needs will be recorded but work is needed to find out and support peoples aspirations and personal goals. All potential risks to people must be assessed so people are kept safe. Evidence: Each person has his or her needs recorded in a service user plan. We found that the way people prefer to be supported is recorded. This means that staff know what support people want. We found that a start has been made on developing individual person centred plans. Key workers have been completing person centred planning booklets with each person. This is at an early stage so most people do not have their personal goals and aspirations recorded. This was found at the last inspection. We found that some action plans to show staff what to do to support goals and Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: aspirations are not yet completed. The manager said this work would continue to ensure that everyones personal goals are recorded and supported. However, staff will need training in person centred planning to ensure they know what it actually is. Otherwise the booklets being completed will not make a difference to peoples lives and support them to lead the lives they want and will be just a paper exercise. The manager agreed that staff need training and support in person centred planning. We found that some potential risks to people have been assessed and recorded with action by staff recorded to reduce these risks. We found that some people are at risk but this has not been recorded and assessed. This means that staff may not be aware of how to reduce these risks to safeguard service users. For example staff said one person is at risk from choking when they eat. This has not been thoroughly assessed in the persons care plan so there are no recorded measures in place to say how staff reduce this risk of choking. Another person had falls in July and August and was taken to hospital by ambulance. Since then there are records to show that various bruises and cuts have been found on the person on a regular basis with cause not known recorded by staff. There is no assessment to consider what may be happening and how to reduce the risks to the person. The manager agreed to address this. Some people have communication needs. We found that communication needs are recorded in only basic detail in individual plans. For example one plan said, uses some Makaton and pictures of reference and understands some words. However there is no mention of what signs, pictures and words. This means that newer staff and other people may not know how people prefer to communicate and can give the right support to people to help them make choices and decisions. This was found at the last inspection. Some service users communicate by using Makaton, a sign language. The manager said that not all staff have had training in Makaton and therefore may not have the skills they need to communicate with everyone. We found that the environment does not fully support communication for example there is nothing to show who is on duty, what the meal choices are that day and what activities are on offer. The manager said that they plan to use photographs and pictures so people can see what is on offer rather than having to rely on staff telling them. On the second day of the visit the manager had taken photographs of staff and the cook and a service user had cut out some pictures of food and meals. They plan to laminate the pictures and photos and put them on display so people know more about choices and who is on duty. There is potential for people to have more control over their lives. For example nobody currently has any control of his or her medication or money. Assessments have been carried out in the past but do not allow for any involvement at all and need to be Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: reviewed. The manager agreed to review this practice to ensure people can have more control. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities to take part in a range of activities are still limited for some. Existing relationships are maintained but there are no plans to support people to make new friends. Food is nutritious but service users are not fully involved in planning and preparing meals. Evidence: We found that some people access a day centre a couple of times a week. Some people go to the local shops and library. For some people opportunities for activities are very limited. We found some people spend most of their time wandering around or sitting in the lounge and hallway. Requirements have been made at the last two inspections about providing opportunities for activities. A warning letter was sent to the Provider about this, which is the first stage of enforcement action. Since the last inspection the manager said that people meet their key workers each month and talk Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: about what they may like to do. However some staff have not had the training to enable them to communicate effectively with everyone. The manager has looked into accessing activities at the local community centre but says there is cost implication for people, which is delaying the application. This means that some people do not take part in any community based activities. The manager said that staff facilitate in house activities however nothing is planned and there is no shift plan organising activities. This means that activities are ad hoc and only happen if staff have the time and inclination to organise things. We found that one service user had only attended two in house activities in December, a Christmas party and aromatherapy. This person had only been out into the community four times in December, three times for a walk and once out with peers. Without a definite plan of what is on offer service users do not know what they have a choice of and many just wander or sit and could be bored. This was found at the last inspection. Currently no one has any form of employment and there are no plans in place to change this. The manager said one person has the job of putting the bins out once a week. Two people were observed washing up and one service user was encouraged to lay the tables for lunch. Apart from this we found opportunities to learn and develop new skills like cooking, cleaning, doing laundry etc are limited. We found that staff do most of this. We found no plans in care plans to develop and increase peoples skills. This means that people will not learn to do things for themselves and have some control but have to rely on staff. We found that there is a cook who plans and prepares the meals at the home. The cook said she also prepares packed lunches for people who go to day services. The cook said there is no planned menu as meals are planned on a day to day basis. This means that people do not know what is on offer in advance and therefore may not have the opportunity to choose something else. This was discussed with the cook and manager. On the second day of the inspection the cook and a service user were cutting out pictures of food dishes from magazines with a plan to display them so people know what is on offer. The manager said that they get their food from a food wholesaler. This means that service users do not get the opportunity to experience the sights and sounds of the supermarket. Access to the kitchen is restricted for some people and we found that snacks and drinks are not readily available to all. This means that if a person wants a drink they have to make staff aware, rely on staff to know what they want and to provide it for them rather than get it for themselves. We found that information about family and friends is recorded in individual plans. We Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: found no plans to support people to make new friends and develop new relationships. This means that for some people who do not go out very much, opportunities to make new friends are very limited. This was found at the last inspection. Some people had a holiday abroad last year. Eleven people went together with staff support. The manager said that this was a trial and that holidays will be more individualised in the future. Some people enjoyed a day trip to France and Belgium organised by staff. Care Homes for Adults (18-65 years) Page 17 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know their personal care needs will be met. More needs to be done to ensure that health needs are supported and there is potential for people, with the right support, to have some control over their medication. Evidence: We found that personal care needs are recorded in service user plans. This means that people get the support they need in the way they prefer. We found no plans in place to increase skills in relation to personal care. Everyone looked clean. Bathrooms and toilets are sited near to bedrooms as no room has en suite facilities. However, bathrooms and toilets are stark and not at all homely or welcoming. All bedrooms have a wash hand basin but the manager said three of these have no water supply through fear of flooding. This imposed restriction has not been reviewed for some time and therefore may no longer be relevant. The manager thought about this and on the second day of the visit said she plans to reinstate peoples water supply. This means that everyone will have water in their rooms and can wash and brush their teeth etc when they want to in the privacy of their room. Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: We found that health needs are recorded in individual plans and a start has been made on completing individual health action plans. We found that some guidelines about a particular health need were not clear in that there was no mention that an ambulance should be called in some circumstances. We found that some people are at risk from health related needs but this has not been recorded and assessed. For example one persons plan had reports of repeated bruising and cuts with no record of any action taken by staff. Records showed cause unknown each time with no record of any investigation into why this is happening. One person is at risk from choking when eating but this has not been assessed and recorded. Records showed that one person had been unwell for a month before staff sought advice by phone from the GP. The manager said that care plans are reviewed in reaction to a health need changing, for example some ones health need changes and the care plan is reviewed. This means that changing needs may not be identified quickly and at an early stage. So staff are being reactive rather than proactive. People have medication reviews and yearly well person checks with their GP. We sampled aspects of medication practice. We found storage to be adequate although is in a central room that service users have to come to in turn. No one controls their own medication with the right support as staff control the medication. There are no plans in place to increase people skills in controlling their own medication. The manager agreed that there is potential for some people with the right support to have more control of their medication. As found at the last inspection staff have entered drugs on the medication administration records by hand without following good practice guidance. We found that staff have given medication to one vulnerable person without first seeking medical advice. Although staff may have done this with the best intentions this could place service users at potential risk of harm as possible conflict with current medication was not checked. Staff said they have basic training in medication but have not had training for some time. We found that the manager carries out yearly competency assessments with staff to make sure they are safe to administer medication. Care Homes for Adults (18-65 years) Page 19 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. There is a complaints procedure but this is not meaningful to everyone. Service users are protected from harm but restrictions must all be reviewed to ensure peoples rights and freedoms are upheld. Evidence: We found that there is a written complaints procedure, which is displayed in the home. This is not produced in a way that is meaningful to people who use the service. This means that people may not know how to make a complaint or raise a concern. The AQAA says they plan to improve information like the complaints procedure to ensure it is meaningful to people. The lack of good communication support means that service users complaints and views may to be understood and acted on. Staff need training and support to enable them to communicate effectively with people who use the service. We found that some staff have attended training in how to safeguard vulnerable adults. One staff said although they have not attended the training they covered this on their National Vocational Qualification course. We found that staff are aware of types of abuse and know who to report any concerns to. A requirement was made at the previous two inspections for imposed restrictions to be Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: reviewed and agreed with people who use the service. This is to ensure that any imposed restriction is the least restrictive option, is made in peoples best interest and is kept under close review. This is to ensure that peoples rights, liberties and freedoms are not restricted. A warning letter was issued to the Provider, as this was not done at the last inspection. A warning letter is the first step of our enforcement process. We found that imposed restrictions continue. For example, one persons bedroom was locked and they had no key or way to get in, three people have no water supply to their bedroom sinks at all, access to the kitchen and laundry is restricted and one person had padlocks on each of their bedroom cupboards. No one has a front door key and most have no suitable locking device on their bedroom doors. We found that these restrictions have not been reviewed for some time. The manager agreed that some are no longer necessary. The manager said she has tried keys with some people and this failed. However no other more suitable locking devices have been explored. By the second day of the visit the manager had removed some of the padlocks from bedroom cupboards and agreed to trial the reinstatement of water to all bedroom sinks. We sampled some peoples money records. No one controls their own money although there is potential for some people with the right support, to take control of their money. We found that records are individual with entries showing expenditure and receipts are kept. The manager said the area manager audits money records during monthly visits and checks. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally clean but could be more homely. Evidence: We found that the home is generally clean and safe. As found at the last inspection some parts of the home would benefit from upgrading and improvement. For example the communal parts of the home are stark and not all homely. There are no photographs of service users individually or a group and not many pictures. There are some large notice boards in the hallway and second lounge that are bare. Staff said the boards have been painted and they plan to put some photographs up. Some of the chairs in the dining room are stained and marked. The manager said the chairs were purchased second hand and they plan to recover them. In the meantime service users are using the chairs. The track holding a net curtain in the lounge has bowed and this means that net curtain is hanging down and does not look pleasant. Some of the bathrooms are stark and not welcoming. Improvements to the environment will enhance service users lives. All bedrooms are single and none have en suite facilities. All have a wash hand basin although three have had the water supply cut off through a past risk of flooding. The Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: manager agreed to review this imposed restriction to ensure it is still the least restrictive option. People have free access to the rear garden, which is safe and enclosed. As mentioned no one has a front door key so they have to wait for staff to open the front door.Suitable locking devices should be researched to ensure everyone can keep their valuables safe and lock their room for privacy. 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. Staff need training and support in areas related to service users needs and learning disabilities if the service is to improve. Recruitment checks are sound protecting service users. Staff deployment must be more effective to give service users more opportunities. Evidence: As found at the last inspection staff deployment could be more effective. We found that staff quality time with service users is limited. We found that there is no shift plan in place so staff come on duty not knowing what they are to do that day apart from tasks like driving and laundry. There are usually four support workers on duty during the day supporting sixteen service users and two staff on duty at night. Staff take people to the day centre, do the laundry and some cleaning. It is left to staff to organise in house activities but there is no one allocated to this so it may not happen. We found people who do not go to a day centre spend lots of time at home doing not very much. This means that not everyone is leading a fulfilled ordinary life, as they should be. We found that levels of participation and engagement for some people are low but Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: without the right training staff will not have the skills to improve this and empower service users to do more themselves. Key workers are in the process of filling in the person centred planning books for individuals but have had no training in person centred planning. Without the right training staff will not have the knowledge and understanding they need to make a difference to peoples lives. The booklets become a paper exercise and will not change lives unless the staff culture changes. Staff have control at present, for example staff control things like medication and peoples money, staff have keys and service users do not. Staff wear uniforms that differentiate them from people who use the service so they look different and not the same. The manager agreed to review the staff uniform so people are equal. Staff will need training and support to enable the control to shift to service users. The induction for new staff is adequate and training for staff is limited to mandatory courses like food safety and first aid. Although these courses are important staff need skills relating to service users specific needs if outcomes for people are to improve. For example, some people have autism but not all staff have had training in autism. Some people have communication needs and use Makaton but not all staff are trained in this area. Some people have health needs that not all staff are trained in. We sampled staff files and found that checks are carried out before a person starts work at the home. This protects service users. Service users meet prospective staff when they come to the home for a look around and an interview. We found that staff have job descriptions and contracts of employment. Staff said they have regular supervision and have the opportunity to attend regular staff meetings. Supervision records showed that staff have the opportunity for regular supervision giving them mentoring and support from the manager. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is adequately managed but audit and monitoring must improve to protect service users. Quality assurance must be developed to ensure it is service users views that underpin the review and development of the service. Evidence: We found that the management of the home has not changed since the last inspection. The manager has several years experience of working in the care sector and has the qualification required by the Minimum Standards. The manager has no qualification in learning disabilities. This means that she is not up to date with the latest research and developments in the learning disability field and currently does not have the skills to support service users specific needs and improve outcomes for people. We found that a lack of audit and monitoring has lead to some poor practice being missed. For example poor recording on the medication administration record for one service user was not noticed by the manager until pointed out by the inspector. Delays by staff in responding to a persons health need were not noticed by the manager for Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: some time. The manager said an area manager carries out monthly visits and samples records and speaks to service users. The shortfalls found at this inspection had not been picked up by the manager or monitoring visits and suggest they need to be more effective. The manager said that there is no formal quality assurance system. Views are not sought of stakeholders like relatives, visiting professionals, GPs and service users on a formal basis like yearly surveys. Therefore there are no results or action plan to show a baseline for continuous improvement. Service users meet with key workers each month but due to the lack of training for staff in alternative communication service users cannot be sure their views will be listened to and acted on and underpin the review and development of the service. The AQAA shows that health and safety checks are carried out of the premises and equipment. We found that fire drills are held regularly. We found that staff have training in areas relating to health and safety including first aid and food safety. Since the last inspection the manager ensures that she is aware when any maintenance work is to be carried out. This is so she can complete a risk assessment and let service users and staff know that work is to be carried out. This addresses a previous requirement. Care Homes for Adults (18-65 years) Page 27 of 32 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 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 20 13 The manager must ensure 31/03/2009 that staff are competent in medication practice. Hand written entries on MAR must be checked and countersigned. Staff must not give people medication without first seeking professional advice. To ensure that service users are safe, get the right medication and do not get given a medication that contraindicates with an existing medication. 2 32 18 Staff must have the training 30/06/2009 and support they need to improve outcomes for people. This includes person centred planning, communication and autism awareness. To ensure that staff understand what person centred planning is, to enable staff to communicate Care Homes for Adults (18-65 years) Page 29 of 32 effectively with people and have the skills to increase opportunities, engagement and participation. 3 37 9 The manager must have the 30/09/2009 training and skills necessary to meet service users needs and improve outcomes for people. The manager should complete a qualification relating to learning disabilities. To ensure that the service is improved for people and people have the support they need to live the lives they want. To ensure that the manager has the skills and competencies to improve opportunities, engagement levels and participation. 4 39 24 There must be an effective 31/05/2009 quality assurance and quality monitoring system in place. Review and development of the home must be underpinned by service users and stakeholders views and opinions. To ensure that service users views are sought and acted on. To ensure that the service develops and continually improves outcomes for people and to keep people safe. Care Homes for Adults (18-65 years) Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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