Inspection on 06/02/09 for The Shires Care Centre

This inspection was carried out on 6th February 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

St Marys Nursing Home

Thornham Grove

Chater Lodge

Conifer Lodge

Tixover Care Home

Toynton College (Cluster Five)

Egerton Lodge Care Home

Cedar Court Nursing and Residential 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 Shires Care Centre The Oval Sutton In Ashfield Nottinghamshire NG17 2FP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Richards     Date: 0 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 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 31 Information about the care home Name of care home: Address: The Shires Care Centre The Oval Sutton In Ashfield Nottinghamshire NG17 2FP 01623551099 01623550788 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Leyton Healthcare (No 5 Limited) Name of registered manager (if applicable) Lindsay Pargin Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of users who can be accommodated is: 42 The registered person may provide the following category of service only: Care Home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD, maximum numner of places, 42 Date of last inspection Brief description of the care home The Shires is registered to provide nursing and personal care for up to forty two people with physical disabilities. It is located in a residential setting, close to local amenties and a bus route, on the north western outskirts of the town of Sutton-in Ashfield, which lies approximately three miles to the east of Junction 28 of the M1 motorway. It provides single room en suited accommodation for people over two floors accessible by stairs and a shaft lift. A variety of environmental aids and adaptations are provided, including level wheelchair access, specialist bathing facilities and an emergency call system throughout. There is a choice of comunal lounges, including an activities area, Care Homes for Adults (18-65 years) Page 4 of 31 care home 42 Over 65 0 42 Brief description of the care home library room and a large dining room and with a dedicated wheelchair storage facilitiy which provides for electrical charging. There is also a small garden area and car parking spaces. People are provided with care and support from a team of nursing, care and hotel services staff, including three activities co-ordinators, led by an acting manager and with good external management support. Information about fees charged can be obtained directly from the home, together with key service information. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two stars. This means the people who use this service experience good quality outcomes. For the purposes of this inspection we have taken account of all the information we hold about this service. This includes our annual quality assurance assessment questionnaire (AQAA), which we ask the home to complete on an annual basis in order to provide us with key information about the service. We also received survey returns from ten people who use the service and from three staff who work there. We also received a number of comments from people who use/visit the service. Some of these are referred to below. Care Homes for Adults (18-65 years) Page 6 of 31 I like living here, the staff help me when I need help and I like my own room. You get good support and I like doing the voluntary work I do and going to church. I can see my friends and family when I want to. I like going on holiday with my sister. I like to arrange my own holiday. I am going to Skylarks this year. Although the service is well established, this is the first inspection there since its registration with this provider six months ago. We used case tracking in our methodology, where we looked more closely at the care and services that three people receive. We did this by talking with them, where we were able to do so, observation of staff interactions with them, looking at their written care plans and associated health and personal care records and by looking at their private and communal accommodation. We spoke with staff about the arrangements for their recruitment, induction, training, deployment and supervision and we examined related records. We also spoke with the acting manager who came into post in November 2008, but who is not yet registered with the Commission, about the arrangements for the management and administration of the home and we examined associated records. All of the above was undertaken with consideration to any diversity in need for people who live at the home. At the time of our visit all people accommodated are of British white backgrounds and of Christian religion. 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.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 8 of 31 Care Homes for Adults (18-65 years) Page 9 of 31 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 31 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. People are suitably informed and to assist them in choosing the home. Peoples overall needs and aspirations effectively accounted for. Although the assessment process does not best account for individuals capacity to consent to their care and treatment and to make key decisions about their lives. Evidence: In our annual quality assurance questionnaire completed by the home, they told that they ensure that people are well supported throughout their admission to the home and that their needs are fully assessed. They told us about some of the improvements they aim to make over the coming months. These include a review of their statement of purpose and service user guide, including the provision of these in alternative formats, to be more suitable for people who use the service and consulting with people about how they can improve their admission process. They also provided us with some statistical information that we asked for about the Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: needs of people accommodated. At this inspection people told us that they were asked if they wanted to move into the home and received enough information about it to assist them. One person said they came as an emergency admission into the home, but felt confident as they had heard good feedback from people they knew who had used the service. We saw that the service guide was displayed on the noticeboard in large print format, although the content referred to the previous registered provider. The manager advised that this was to be revised and updated along with the homes statement of purpose, with the aim of providing an easy read format. People told us that they usually receive the care and support they need. Staff spoken with were overall, conversant with the needs of people we case tracked and their needs assessment records mostly accounted for these, including relating to personal risk and safety. However, peoples individual capacity to make key decisions about their lives and to consent to their care and treatment is not consistently accounted for. We saw for example, where one person case tracked had frequently recorded behaviour that could suggest that they may not be in agreement with their medical treatment. Their written care plan determined staff interventions to prevent her from carrying out this behaviour, including having a staff member with her at all times. There was no assessment record as to their mental capacity to consent to their care and treatment. Others had signed various consent forms, including relating to their medication and specified medical interventions. Again there was no record within their needs assessment as to their mental capacity to consent to their care and treatment. Care Homes for Adults (18-65 years) Page 12 of 31 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. Overall peoples independence and rights and their assessed and changing needs are reasonably well promoted and accounted for. Although their individual capacities to make key decisions about their lives and to consent to their care and treatment are not best accounted for, which may not always ensure their best interests. Evidence: In our annual quality assurance questionnaire completed by the home they told us that they ensure peoples individual mental capacity is accounted for in respect of their decision making. And that they effectively support peoples independence and rights to take risks and to promote their individual strengths and choices. They identified one way they aim to improve their promotion of a person centred approach to care by way reviews they undertake of these with service users. At this inspection some people told us that staff support them in the way they prefer and when needed and we saw that their written needs assessment and care plans Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: accounted for many of their preferences, likes and dislikes and daily living choices. Some aspects of peoples care plans were signed by some them and all those seen detailed individual key worker arrangements and had regularly recorded reviews. However, although some attempt has been made at introducing a recorded risk assessment format to account for some of the decisions and choices people make, these were not always well completed. And as detailed under section one of this report. Individuals capacity to make key decisions about their lives and to consent to their care and treatment was not always fully accounted for, including where people managed their own finances, or where support and tuition may be needed to assist them in doing so. In all other respects care plans were reasonably well written in were generally in accordance with peoples risk assessed needs. And saw from talking with some people and looking at their care plans, examples of ways in which they are supported to take risks as part of an independent lifestyle within the context of their daily chosen activities. Care Homes for Adults (18-65 years) Page 14 of 31 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 benefit from a wide range of opportunities and support for their personal, social and educational development. Evidence: In our annual quality assurance questionnaire completed by the home they told us that they ensure peoples social inclusion, both in and outside the home. That they promote links with the local community, flexible personal routines for people and their rights to independence. and choice and their daily living responsibilities. They say they aim to continue to improve and develop these by way of consultation with people about their care plans. At this inspection people told us that they can make decisions about what they do each Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: day and at weekends. Comments that people made, included I like to go to church on Sundays and sing. We choose which college classes and activities we do. I like my computer and pet care class. I am looking forward to a red carpet achievement award event coming up. The home employs three dedicated activities co-ordinators who each work almost full time and flexible hours to suit peoples activities needs. On the morning of our visit a group of residents were playing a quiz board game in the dedicated activities area and another group chose to watch and film during the afternoon. We saw that a variety of information was provided for people to assist them in their daily lives, including for educational, occupational, leisure and social activities, both within and outside the home. These included poetry reading, wellbeing days, adult literacy and numeracy, complimentary and sensory therapies, pet care class, access to counselling, life skills, health cookery, world cookery, computer skills and with a dedicated computer room. Information was posted on the residents noticeboard about resident action meetings and quality circle meetings and with recent minutes posted there and photographs of residents participating in various activities and events were displayed there. People told us about the monthly activities planner and that tutors come into the home from Sutton Centre Adult Education Centre. That a variety of courses and classes offered in regular consultation with people who use the service in order to review their satisfaction with these and to determine future planning. From discussions we had we also found that some people attend evening classes, including one person that we case tracked who told us she is working towards a computer qualification using her own laptop. Another person told us he had completed this and was moving to a higher award. Others regularly attended a day centre and different local churches of their choice, including a church based social group. People told us about relationships and contacts they enjoy with people outside of the home and also arrangements they have made for their holidays this year, which tells us they are well supported to establish and maintain these in accordance with their own choices. One of the people whose care we looked at more closely told us that she regularly attends church and enjoys voluntary work at a local womens centre and was looking forward to a red carpet event via the college, to be held to celebrate peoples Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: achievements there. People also told us about a resident who had chosen to move into the local community via supported living arrangements, who reguarly visits their friends at the home. They told us they usually like the meals, although some felt they quality could be improved, although said they are provided with an alternative on the menu and that food is plentiful. Discussions with the cook and manager told us that menus are currently under review. We also saw at lunchtime that people who needed assistance, either by staff and or by way of equipment, such as adapted cutlery were provided with these. Also in the main dining room lower height work surfaces with drinks making facilities and a microwave are provided to enable people who are wheelchair independant to access to these. Individual records of each persons choices and preferences, arrangements for, engagement in and satisfaction with activities. Care Homes for Adults (18-65 years) Page 17 of 31 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 are well supported, usually in the way they prefer and their health care needs met, including for their medicines. Evidence: In our annual quality assurance questionnaire completed by the home, they told us that where possible, they promote peoples independence to manage their health care, including for their medicines and ensure peoples access to outside healthcare professionals, including for the purposes of rehabilitation. They did not tell us about any specific improvements they may have made or aim to make here. At this inspection some people told us about ways in which they are supported in respect of their personal and health care needs. Their written plans and information given by staff consistently accounted for these, including for the purposes of routine health screening and in respect of any specialist advice from relevant health care professionals involved in their care. And with regularly recorded reviews. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: We also found there were satisfactory arrangements in place for the ordering, storage, receipt, admininstration and disposal of peoples medicines. Staff responsible confirmed they have received suitable training for these and we saw evidence of their medicines training in their personal files. Although we saw that on one persons medicines administration record (MAR) sheet, that staff were not properly recording for the administration of their prescribed creams. Staff advised that their creams were kept in those peoples own rooms, although we saw that there was no suitable lockable storage provided for this purpose and one of those people was not capable of administering these themselves. We also saw for the same person that a specified medicine prescribed on an as required basis did not have a maximum dose within any twenty four hour period specified. This instruction was hand written, but not signed or dated by the person writing it or countersigned by a staff member witnessing it. However, when we looked at other MAR sheets for people who had as required medicines recorded there. These all had a maximum dose specified. Also we saw that where other medicines were hand written that these were signed and countersigned as necessary. The manager told us that she had introduced a quality auditing system for peoples medicines and we saw the record of the first audit undertaken at the beginning of January 2009. This identified some short falls in respect of medicines records and also with regard to peoples medicines care plans. There was an action plan in place, together with a review date. This tells us that the home is proactive in monitoring medicines practises in the home. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People may be assured that any concerns or complaints they raise will be listened to, taken seriously and acted upon by the home and that they will be protected from harm and abuse. Evidence: In our annualy quality assurance questionnaire completed by the home, they told us that they provide people with the information they need to assist them in making a complaint, including about local advocacy services. And that suitable systems are in place to promote peoples protection people from harm and abuse. They identified that they could improve by ensuring that staff are conversant with the implications of the Mental Capacity Act Deprivation of Liberty Safeguards. They tell us that they aim to achieve this over the coming months and to continue to listen to what people who use the service tell them about it and act on accordingly. They also gave us some statistical information that we asked for, including about complaints they have received over the last twelve months. At this inspection people told us that they know who to speak with if unhapy and how to complain. We looked at the homes complaints records and saw that the complaints they told us about in the questionnaire were detailed there, including as to the Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: investigation, action taken and outcomes. Both were relatively minor in nature, each raised by a service user about specific incidents concerned with their personal care and both are resolved. Staff that we spoke with were conversant with their roles and responibilities concerned with dealing with complaints, recognising abuse and responding to any suspicion or witnessing of the abuse of any service user. And we saw from speaking with staff, looking at their individual training records and the homes training programme that staff receive regular training and updates concerned with protecting people from harm and abuse. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely, comfortable and safe environment, which suits their needs. Evidence: In our annual quality assurance questionnaire completed by the home, they told us they aim to provide people with well maintained and comfortable surroundings, with single en suited accommodation, that is suitably adapted, equipped, decorated and furnished in consultation with them. And which is clean and hygienic. They also told us about their environmental improvement plan commenced since their registration and ongoing in consultation with people who use the service. At this inspection people told us that they home is always fresh and clean. And at our visit we saw some of the improvements they are making, including the provision of new tables and chairs delivered on the day of our visit. People told us they are satisfied with their own rooms, which they felt suited their needs and we saw from looking at some of these, that they were personalised and suitably equipped in accordance with peoples choices and assessed needs. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: We found that communal bathroom 1 was very cluttered with commodes and general storage of equipment there, including moving and handling equipment and were told that this bathroom was hardly used. Although the reason for this was not clear. However, we also saw that there is a dedicated large storage room provided for electric wheelchairs and for the purposes of their electrical charging when not in use. Overall we found areas of the home that we saw to be warm, safe, clean, comfortable, well maintained, suitably equipped and reasonably well decorated. And with suitable laundry facilities. Although some areas were tired in decor, this was to addressed by way of the homes environmental improvement plan. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that their needs will be met from staff that is effectively recuited, inducted, trained and deployed. Evidence: In our annual quality assurance questionnaire completed by the home, they told us that residents are involved in staff recruitment. That they ensure a comprehensive staff induction and training programme, including access to NVQ training and that staff is deployed in accordance with peoples needs. And that they aim to continue these. They also told us that they have improved recruitment and selection procedures since their registration and gave us some statistical information we asked for relating to staff employed. At this inspection people told us that staff always treat them well, listen and act on what they say and are usually available when they need them and with good support for activities. Staff described suitable arrangements for their recruitment, induction, training and deployment and related records that we looked at reflected this. We saw that out of Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: thirty four permanent care staff, twenty four staff have at least NVQ level 2, two have achieved Level 3 and five had recently signed up for these. There was a staff training matrix development programme in place and a revised induction package introduced, which accords with recognised national care sector traning standards. And which was in progress of completion for the most recent staff starter. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in peoples best interests and their health, safety and welfare is overall well promoted and protected. Evidence: In our annual quality assurance questionnaire completed by the home, the information they gave us indicated that the home is well managed and run in consultation with people who live there. They also told us about improvements they are making, concerned with policy and procedural review and development and about the arrangements for the servicing and maintenance of equipment at the home, which are satisfactory. At this inspection we spoke with the acting manager who came into post in November 2008. She advised that she intends to submit an application for her registration with the Commission and is in process of preparing this. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: We spoke with her about the homes quality assurance and monitoring system, including consultation with people who use the service or have an interest in it. We looked at the survey return results collated from the most recent satisfaction survey conducted with residents in December 2008. These covered areas such as standards of general care and support, cleanliness of the home, call bell responses, environment, health needs, social needs and staff attitude amongst other areas. Results show an overall satisfaction via a scoring system uses. And we saw from speaking with people and looking at meeting minutes that feedback to residents is via their quality circle meetings and action agreed with them for matters arising. We also saw that there a full systems audit is operated and with regular audits of the services provided, its operational systems and the environment. We saw results of the most recent audits relating to residents care plans and medicines together with action plans arising from these, which include the phased introduction of a revised care planning format and areas of improvement relating to medicines practises, some of which we have referred to under the healthcare section of this report. We were also advised that the homes fire risk assessment was completely revised following consultation with the local fire authority. Staff described good arrangements for the management and administration of the home, including arrangements for their supervision and support an effective communication systems to assist them in providing people who use the service with the care and support they need. Staff made very positive comments about the improved arrangements for the management and administration of the home, since the registration of this provider granted within the last six months. We looked at the arrangements for the management and handling fo peoples monies at the home via case tracking and saw that the arrangements for the safekeeping of these was satisfactory. We held general discussions with the administrator responsible for these who advised that a number of residents have their own bank accounts and PIN cards, and that staff sometimes assist them with these. However, we found that peoples needs assessment records did not fully record these arrangements and in respect of their individual capacities to make key decisions about their finances. We have referred to this under the relevant sections of this report and made a requirement about this Staff spoken with described satisfactory arrangements for ensuring safe working practises, including the provision of suitable equipment and during the course of our Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: visit we saw that the home was generally free from observable hazards to peoples safety. Care Homes for Adults (18-65 years) Page 28 of 31 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 29 of 31 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 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 2 The format for recording peoples individual needs assessment information should be developed so as to effectively account for their individual mental capacity to make key decisions about their lives and to consent to their care and treatment. Where it is not possible to draw up a care plan with the involvement of the service user, due to an assessed lack of mental capacity, this should include advocacy as appropriate in accordance with the Mental Capacity Act 2005 Deprivation of Liberty Safeguards. Peoples individual decisions associated with managing their own finances should be clearly accounted for within their needs assessment and care planning records with consideration to their capacity to do so. This should include any support and tuition that may be needed, with the reasons for and the manner of support documented and reviewed. So as to optimise peoples rights to independence and to protect them from any potential abuse. 2 6 3 7 Care Homes for Adults (18-65 years) Page 30 of 31 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). 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