Inspection on 10/09/08 for The Views

This inspection was carried out on 10th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Views 3 Chitcombe Road Broad Oak East Sussex TN31 6EU     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: Michele Etherton     Date: 1 0 0 9 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. the things that people have said are important to them: They reflect 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 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 30 Information about the care home Name of care home: Address: The Views 3 Chitcombe Road Broad Oak East Sussex TN31 6EU 01424882396 01424751641 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Claire Nichols Type of registration: Number of places registered: Hastings and Rother Primary Care Trust care home 6 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 6. The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home 6 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 30 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 Quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. A key unannounced inspection of this service has been undertaken, this has taken account of information received from the service and about the service by CSCI since the last inspection, including an Annual Quality assurance assessment ()AQAA) completed by the manager. The AQAA has been completed to a reasonable standard and provides us with most of the information we needed, some areas would have been enhanced by more supporting evidence to illustrate what actions the home is taking to address identified Care Homes for Adults (18-65 years) Page 5 of 30 shortfalls in the service, activities of the service and future planning. The inspection includes an unannounced site visit to the home on 10th September 2008 between 9:30 am and 16:30 pm. During the visit a tour of the home has been undertaken, we also consulted with staff on duty, and met all residents, owing to their special communication needs we have been unable to consult directly with them to obtain their views about the service but were able to spend time observing some of their daily routines and the support they receive from staff. Survey responses have been sought from residents and other stakeholders but limited responses have been received, we will endeavor to analyse and incorporate any survey information that arrives before the final report is issued. As a new registration but not a new service all key standards have been assessed except that pertaining to recruitment, this is to be assessed by a CSCI representative separately and will take an overview of recruitment practice for all care homes registered with the PCT. A range of documentation has been examined during the site visit including care records, risk assessment information, menu records, medication records and storage, staff supervision and training records, complaints accident and health and safety information. In arriving at our judgment of the service we have tried to be proportionate in considering compliance with regulation and outcomes for the residents alongside the overall risks and impact of the identified shortfalls. Whilst generally we consider residents living in the home to be safe with systems in place to protect them from harm, the transfer from one PCT to another has meant that some key areas of equipment servicing, staff and manager training, and active consultation with residents has become overlooked and shortfalls in these areas have arisen which if not addressed will impact on the quality of service delivery experienced by residents and the health and safety of both residents and staff. What the care home does well: What has improved since the last inspection? What they could do better: The inspection has highlighted shortfalls in the repair and maintenance of essential equipment used for the care and support of residents, additionally we found that not all staff had updated there mandatory training in respect of moving and handling and first aid in particular and we feel that together these shortfalls could impact on the health and safety of residents and staff. We also found that whilst some stand alone quality audit measures are in place these do not currently form part of a quality audit and internal review programme for the whole service nor is there evidence of how residents views are influential in service development, requirements have been issued in these areas. A number of good practice recommendations have been made where we consider the service could improve existing arrangements in respect of the clarity, recording and accessibility of some information relating to license/contract agreements, support plans, risk assessments,menus medication, complaints and adult alerts and some suggested improvements to the environment. Care Homes for Adults (18-65 years) Page 7 of 30 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 30 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 30 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. Prospective and existing residents are provided with more accessible range of information about the service, but inconsistencies exist in terms and conditions information and needs further development. Systems are in place to ensure that prospective residents benefit from a full assessment of their needs and compatibility prior to admission Evidence: We looked at information that prospective and existing residents receive to tell them about the service and the terms and conditions of their stay. There have been some improvements in the format with the statement of purpose and user guide information in more accessible formats although it is difficult to know how much of this information the present resident group is able to process and retain, however although the licensee agreement has also been adapted to an easier to understand format and contains information about responsibilities for toiletries and transport, this is not the case with the contract copies of which have not been adapted are not completed and contain no reference to responsibilities of residents to fund their transport costs, this Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: inconsistency needs to be clarified and the contract made more accessible and where residents have capacity signed by them, it is recommended that these shortfalls are addressed. The home is full and benefits from having a stable group of residents who have known each other for some years and for the most part get on well together. We looked at some resident files and are satisfied that systems are in place to assess the needs of prospective residents prior to admission. Care Homes for Adults (18-65 years) Page 11 of 30 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. Individualized support plans are in place for each resident, these are reviewed but do not always incorporate important information from other sources to accurately reflect care and support needs. Daily routines enable and facilitate residents in making choices and decisions but informed decision making could be improved by more use of pictorial referencing and prompts. Residents are supported to take responsible risks but this information is not clear about risk reduction measures and is not sufficiently person centered. Evidence: We examined a random sample of three support plans, these are individualized to reflect the personal and preferred care and support needs of each resident, and are supported by detailed guidelines to inform staff about communication requirements amongst other needs. For the most part daily routines viewed evidenced where residents are able to make choices and decisions and are encouraged to participate in household tasks and activities, their ability to make more informed choices would Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: benefit from increased use of pictorial references and prompts when offering alternatives. Whilst there is evidence of regular review of support plans we found two instances where important changes in need reflected in the outcome of Health Action Plan meetings had not been transferred into the current support plan to inform staff about particular needs they should be monitoring, these omissions could impact on the overall welfare of the residents concerned if not addressed. We recommend that the provider ensures that information from personal planning meetings and health action plans are cross referenced to the support plan to ensure changes in need or support are incorporated. We viewed a range of risk assessment information relating to individual residents, although supported by detailed guidelines for staff to follow, the risk assessments themselves follow a standard format are not person centered and lack detail in respect of risk reduction measures considered and in place and we recommend the provider reviews risk management procedures to address these shortfalls. Care Homes for Adults (18-65 years) Page 13 of 30 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. Residents are given opportunities to participate in a range of activities within the home and in the community , they are supported to maintain links with family and friends and to make basic decisions in their daily lives. Residents enjoy a well balanced diet but would benefit from improved opportunities to select alternative menu choices in an accessible format, better recording of individual food intake for monitoring purposes is needed. Evidence: We looked at activity programmes for three residents these have been developed in a more accessible format making use of picture references and prompts this should be extended to alternative activities offered to further promote choice amongst residents. The activity planners highlighted lots of opportunities for residents to access the community and travel further afield using in some cases public transport or the home Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: vehicle, unfortunately such trips are limited by availability of transport. Whilst the planner suggest residents lead a busy active life a review of these against daily records and staff rotas indicates that a number of activities are in fact regularly cancelled with alternatives offered. An over reliance on MCCH to support the activity programme has following a reduction in their hours led to many activities not being continued with owing to the need to provide two staff, we looked at specific weeks and found that residents could have as many as nine activities cancelled in one week with in house alternatives offered, it is also clear that staff are trying to offer external visits out even to the local area when staffing allows and these are recorded on the planners, clearly present planners need amendment to reflect the realistic and actual activity levels of residents it is not satisfactory for the activity alternatives to mainly feature task based activities such as helping with laundry, cleaning bedroom, staff should also be making clear on planners the reason for cancellation. Contact with relatives has become increasingly limited owing to the age and infirmity of some relatives but where good contacts exist the home has facilitated and enabled residents to maintain these links. daily records viewed indicate that staff promote independence amongst residents by encouraging them to participate in their daily routines and household tasks, this facilitates opportunities for residents to make choices and decisions also. Residents eat in a pleasant dining area and this has been upgraded. Some residents need support in meal taking and good guidelines are in place to inform staff how support is to be offered, we noted one example where this was not being adhered to and this has been discussed with the manager who has agreed to look at the feeding programme for that resident. Staff have a good understanding of resident likes and dislikes and menus are developed to reflect this, records of food eaten are maintained but provide no evidence that residents are offered alternatives, the staff team are aware of the need to offer residents choice in meal choice and have been working for some time on the production of pictorial menus, progress has been disappointingly slow and now needs to be progressed to enable residents an active choice in meal selection. It is recommended that pictorial menus are introduced and that staff record individual food intake each day for monitoring purposes Care Homes for Adults (18-65 years) Page 15 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Physical emotional and health care needs of residents are generally supported, but would be enhanced by suggested improvements. Evidence: Personal support plans are more person centered and delivery of support has benefited from improved continuity of staffing, the mixed gender team also offers residents a choice of who supports them. Resident files viewed provided evidence of access to routine and specialist health care appointments, and referral and liaison with a range of health professionals in the best interests of the residents, a therapist who responded to survey information commented that I think they are doing a great job, i have some experience of the older persons care home sector and I wish they had the same standards as the views Residents benefit from regular health action plan meetings, however, in cross referencing health action plan information with support plans we noted some omissions of important information not integrated into support plans and this has been addressed Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: elsewhere in the report. Residents have access to a range of equipment to support their care needs, the majority with moving and handling needs requiring hoists, shortfalls that could compromise the health and safety of both residents and staff concerned have been noted and addressed elsewhere in the report. Medication arrangements are generally satisfactory but would better safeguard residents by implementing suggested improvements, We observed some medication administration and noted that the resident concerned was asked to take a number of large tablets at one time, we have suggested that some consideration should be given as to whether these can be offered individually on a spoon from the pill pot and the home has agreed to establish whether the resident finds this acceptable. We noted one example of a handwritten entry that had been signed for but not dated, we would recommend that such entries are always signed and dated for audit purposes. We looked at medication storage and noted that creams are not routinely dated upon opening , it is recommended that all liquid medications and creams are dated upon opening. At present the home does not administer any controlled drugs to residents and do not have appropriate storage facilities for this medication, the home should be mindful that in the event of such medication being prescribed to a resident storage in keeping with current legislation must be available at the time of receipt of the medication into the home. Care Homes for Adults (18-65 years) Page 17 of 30 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. A more accessible version of the complaints procedure has been developed but the present residents are unable to use this effectively . Systems are in place to safeguard residents from overt harm and abuse, but attention is needed to ensure shortfalls in some areas of care and support do not indirectly compromise this. Evidence: A more accessible complaints procedure has been developed that makes use of pictorial prompts and is displayed in the home as well as each resident having a copy in their room. Unfortunately discussion with staff highlighted that the current resident group would still find difficulty in making use of the complaints process as it stands as most express their concerns and distress by the use of non verbal signs, unsurprisingly no complaints have been received from the residents. Staff have a very good understanding of what residents non verbal signs and gestures might mean and detailed guidelines have also been established to affirm these and inform staff, more thought therefore should be given to recording these signs as indications of distress, concern or dissatisfaction particularly where this can be linked directly to an incident e.g. cancellation of an activity, also attention must be paid to reports of activity support staff or other helpers where they have made clear reference to the behavior of the resident that could evidence anger/distress/unhappiness and what action has been taken to establish its cause, these are recommendations. All staff have received adult safeguarding training, and the PCT has established a Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: timescale for this to be updated, currently the managers update training in this area is long overdue and we stress the importance of this being updated in order that the manager can advise and inform staff appropriately of the correct procedures to follow and this is a recommendation. The home is notifying CSCI appropriately of incidents that occur in the home and is also referring incidents to adult social care teams where they consider there may be safeguarding issues, we are concerned that a culture of informality has developed around the management of this type of referral between PCT and social care staff and as a consequence inconsistent responses to the take up of alerts is happening with the service unable to evidence outcomes of contacts between themselves and the Adult Social care teams, it is important that the service makes clear they are raising an alert and that this should follow a proper pathway in order that the home can evidence the outcome of the referral and this is a recommendation. Care Homes for Adults (18-65 years) Page 19 of 30 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. Residents will benefit from improvements to the maintenance of equipment to safeguard and support them, and from suggested improvements to the external space available to them.. Evidence: Residents live in a spacious generally safe and comfortable home. Decor is homely and furnishings of a good quality, although some communal hallways are in need of upgrading. Residents bedrooms are individualized and to a very good standard, the majority of bedroom furniture has been purchased from resident monies, it is unclear how decisions around expenditure of residents monies for this purpose has been made and we would expect this to be as the result of a multi disciplinary meeting of all stakeholders and the service is reminded that this should be the case with all future purchases where there are issues of resident capacity. Residents have use of a small patio area that affords privacy and enables them to undertake some planting in raised tubs and pots, they would also benefit from improvements to the external space that would enable them use of a large lawned area that is currently fenced off. Thought needs to be given to the provision of a more accessible greenhouse as this would enable more residents to be actively involved in Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: the positive work already being done with one resident to involve him in growing vegetables and this is a recommendation. We looked at the fire log and fire arrangements for the home, staff reported that a new fire risk assessment has been developed and a copy of this has been provided post site visit. The fire log confirmed that the testing of fire alarm and fire fighting equipment is happening regular but the frequency of checks has at times been irregular, although the servicing has been maintained. Staff have attended fire drills but only one has been held to date in the last twelve months, it is recommended that the home standardize the frequency of tests of equipment and ensure that all staff participate in a minimum of two fire drills within any twelve month period. We are advised by staff that a contractor to remove broken items of furniture and equipment has been found and this relieves the necessity for staff to take such items to the dump themselves. The majority of residents have moving and handling needs and have use a range of equipment to support their care needs, we found that all of the hoists in use have not been serviced and this is now overdue by at least four months, staff reported that a contract is being negotiated with ARJO but has not been finalized, repairs to a trolley for use with residents bathing is also awaiting an outstanding repair. The home is required to address servicing shortfalls and repairs for all outstanding equipment and to ensure serving timescales are maintained in line with manufacturers guidance The home is generally maintained to a good standard of cleanliness with no unpleasant odours, however on the day of our visit we noted several areas of carpet that were stained we are advised that the carpets are cleaned professionally every 12 weeks and would therefore recommend cleaning schedules are revised to respond more flexibly to specific incidents and ensure the home is maintained to a good standard. Staff reported they have access to protective clothing and that appropriate infection control measures are in place to manage soiled clothing and bedding. Care Homes for Adults (18-65 years) Page 21 of 30 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. Residents are benefiting from improved levels and continuity of staffing but this needs to be kept under review to ensure staffing arrangements do not impact on day to day routines adversely. Staff are provided with a good range of training but mandatory training is not always updated in a timely manner to ensure residents and staff are safeguarded. Residents can be more confident that staff performance is being monitored more frequently. Evidence: The AQAA information tells us that 80 of the staff team are now NVQ2 qualified, our observations during the visit highlighted staff demonstrating good commitment and detailed knowledge and understanding of residents needs and the home is commended for achieving this. Improvements in recruitment within other houses in the PCT has led to fewer staff needing to be moved elsewhere and provided greater continuity for residents and the permanent staff. Staff tell us that the levels of staffing have improved although examination of the duty rota over several weeks against activity planners for residents would indicate that on occasion the home is still operating with only two staff on duty on a day time shift and other times two out of the three people are agency directly Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: impacting on any external activity arrangements for residents. Although it is an improving picture in respect of staffing this needs to be kept under review. We are unable to review staff recruitment files on this occasion and this will be undertaken centrally at a later stage by a representative form CSCI. We looked at staff induction and are satisfied that a comprehensive programme of induction is now in place for new staff. Staff told us that they have access to a good range of training both mandatory and more specialized needs training, we looked at the training matrix and found that four out ten staff have moving and handling updates outstanding by some months and three are overdue first aid training, the manager is overdue updates in safeguarding and health and safety. These are all key areas of staff training and a failure to update staff and manager knowledge of changes in practice could compromise resident and staff safety a requirement is issued for these shortfalls to be addressed. Staff tell us that they feel well supported by the manager and have opportunities to express their views and ideas and some of these are acted upon, they reported that they found the new PCT more proactive in addressing issues. Staff indicated that the frequency of regular supervision has begun to improve and this is borne out in supervision records information which indicates clearly an improving picture emerging for this year, this now needs to be progressed to ensure all staff receive a minimum of 6 supervisions annually. Care Homes for Adults (18-65 years) Page 23 of 30 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 health safety and welfare of residents is not satisfactorily protected at this time and residents would benefit from suggested improvements in key areas. Evidence: The manager is experienced and qualified, the home is generally well managed but shortfalls in some key areas have developed that need attention, some of these lie outside the control of the manager. The training matrix tells us that the manager has not updated adult safeguarding or health and safety for some time, we consider this reduces her effectiveness in assessing staff performance in these areas against current best practice. Staff we spoke with spoke positively about the support they receive from the manager and are enthusiastic about the new PCT which they feel is more proactive and is already making improvements particularly in the area of staffing. Regulation 26 visits we viewed are completed to a good standard and undertaken monthly, in addition there are some stand alone quality audits in respect of medication and finance but no integrated quality audit and review system at this time. Staff told Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: us that they are aware a quality audit programme is being introduced and some user consultation has already taken place as part of this, We have been advised post visit that a programme of audit is being rolled out and should be in all PCT homes by Mid October 2008. The home is required to implement and operate a programme of internal quality audit and review that incorporates consultation with residents and other stakeholders, analysis of quality audits and resident feedback should be published as a report annually and made available for inspection. The AQAA tells us that policy and procedure information has not been updated for some time despite changes in legislation and guidance in some areas, the new PCT is trying to address these shortfalls and updates are being sent out in a phased manner as this documentation is reviewed, there is a need for this to be progressed so that staff have access to update information for reference. The AQAA tells us that all health and safety servicing and checks have been completed and we sampled a few of these and found them to be current. However, some equipment e.g hoists essential to the support of residents has not been serviced and contracts with the servicing company are still under negotiation, similarly equipment in need of repair is also subject to delay currently because of the change of PCT and contractual arrangements, as a result of this and other shortfalls in some key areas of staff training and integration of some health information into care records we do not consider that the health, safety and welfare of residents is satisfactorily protected at this time. We looked at accident/incident records and these are completed to a satisfactory standard and evidence that residents and staff experience minimal accidents at this time and these are dealt with appropriately. Care Homes for Adults (18-65 years) Page 25 of 30 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 26 of 30 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 29 23 That all equipment used for the care and support of residents is maintained in accordance with manufacturers guidelines to ensure that the health and safety of residents and staff is not compromised by faulty equipment 05/12/2008 2 35 18 All staff are required to receive mandatory core training and updates in a timely manner in keeping with existing guidelines So that the health safety and welfare of residents and staff is not compromised by failure to implement new and best practice 05/12/2008 3 39 24 The home must implement 05/12/2008 and operate a system of internal quality audit and review that incorporates the views of residents and other stakeholders. A report of quality outcomes Care Homes for Adults (18-65 years) Page 27 of 30 and resident/stakeholder feedback must be published and available for inspection to ensure the service monitors service delivery and can evidence resident/stakeholder views are influential in service development 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 That license agreement and contractual information contain the same information about what residents are responsible for funding themselves. That contractual information is developed into a more accessible format so that those residents with capacity can make a more informed decision to sign Support plans should always accurately reflect changes in need and support identified from other sources e.g Health Action Plans, to ensure residents health and welfare is not compromised. A review of risk assessment information is needed to ensure this is person centered and clearly identifies risk reduction measures considered and in place. Residents should be offered opportunities to select alternative menu choices with information provided in an accessible format. A record of individual daily food intake should be maintained for audit purposes All handwritten entries added to printed medication administration records should be dated as well as signed by the person entering the information. Creams and liquid medications to be dated upon opening. 2 6 3 9 4 17 5 20 6 22 Greater consideration should be given to recording and linking of non verbal signs of anger/distress/unhappiness of residents in relation to specific incidents as signs of complaint. The home should ensure that alerts made by them to the adult social care team are treated formally and that 7 23 Care Homes for Adults (18-65 years) Page 28 of 30 evidence of the outcome of such alerts can be viewed. The provider should ensure that the manager is routinely updated through training current protocols and best practice in respect of adult safeguarding in line with PCT guidelines and to ensure staff performance in this area can be effectively measured and monitored from a sound knowledge base. 8 24 Staff should participate in a minimum of two fire drills annually The frequency of tests and checks of fire alarm and fire fighting equipment should be maintained A review of external space is needed to ensure that a more accessible greenhouse is provided to enable residents to more actively participate in garden, pathways developed to improve use of lawned area. revised cleaning schedules should be developed to ensure that the overall appearance of the home is maintained and that carpet cleaning can be flexibly responsive to specific incidents. 9 24 10 30 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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