Inspection on 05/11/08 for Theobald House

This inspection was carried out on 5th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Theobald House 15/02/07

Theobald House 18/01/06

Theobald House 19/08/05

Theobald House 28/02/05

Theobald House 27/05/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Theobald House 46 Dartmouth Avenue Bath Bath & N E Somerset BA2 1AT     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: Paula Cordell     Date: 0 5 1 1 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: Theobald House 46 Dartmouth Avenue Bath Bath & N E Somerset BA2 1AT 01225338567 01225338567 carol.fyrth@dimensions-uk.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Carol Christine Fyrth Type of registration: Number of places registered: Dimensions (UK) Ltd care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: May accommodate up to 4 persons aged 18 - 65 years requiring personal care only Date of last inspection Brief description of the care home Theobald House is a care home operated by Dimensions UK Ltd, an independent voluntary organisation, to accommodate up to four people - two with a learning disability and two with a learning and physical disability. The lease on the home has currently expired through Bath and North East Somerset Council and the organisation is currently seeking a new Registered Social Landlord to take over a new lease and management of the property. The home is situated in the Oldfield Park area of Bath in a quiet cul-de-sac. The home is within a five minutes walk of Moorland Road, which offers a range of facilities, with Bath city centre only a five-minute drive from the house. The house itself is modern in design and offers accommodation on two floors. There are six single bedrooms in total, two on the ground floor, one of which is equipped with a wash hand basin, and four on the first floor, two of which are used by Care Homes for Adults (18-65 years) Page 4 of 30 4 2 Over 65 0 0 Brief description of the care home two staff members who provide sleep-in cover. There are two communal lounge areas, and a dining room on the ground floor. The home provides sufficient bathrooms and toilets; the ground floor bathroom is equipped with a ceiling track hoist, and an adapted whirlpool bath facility. The home has specific equipment for service users accommodated based on an assessment of their individual need. There has been an ongoing issue concerning the reconfiguration of the building in order to provide a suitable environment and meet the assessed needs of 2 individuals. This is now on hold whilst the issue of the lease is resolved. Care Homes for Adults (18-65 years) Page 5 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: 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: This was an unannounced visit as part of the key inspection process. The purpose of the visit is to review the requirements from the visit in June 2008. In addition to monitoring the quality of the care provided to the individuals living at Theobald House. The home last had a full inspection in February 2007 with a quality outcome of good being recorded. An Annual Service Review was completed which highlighted concerns about staffing and activities for one individual so a random visit was completed in June 2008. It was evident that the home was proactive in addressing these concerns. The Commission for Social Care Inspection have been kept informed of incidents that affect the well being of the individuals living in the home. In addition the home Care Homes for Adults (18-65 years) Page 6 of 30 completed an annual quality assurance assessment which provided evidence that the home was monitoring the quality of the care and had identified areas for further improvement. This information was used to plan the inspection along with questionnaires that were sent to the home prior to the visit. Feedback was received from two members of staff and two professionals. The visit was conducted over five hours and included a tour of the home, looking at records and care documentation and speaking with staff on duty. Feedback was given to the deputy manager at the end of the visit. 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 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. Individuals have available to them information about Theobald House and can be confident that their assessed care needs are being met. Evidence: The home has a statement of purpose and a service user guide. The deputy manager stated that this has been kept under review and updated due to recent changes in the organisation in respect of the responsible individual. The home has received a new certificate which includes the new responsible individual. There have been no new persons admitted to the home. The four people presently accommodated at Theobald House have lived there for many years. Theobald House has been open for 23 years. Individuals needs were regularly being reviewed by the placing authority as evidenced in care files. It was evident that where the care needs of the individuals had changed the home has actively sought advice from appropriate professionals. Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: Staff evidently have the skills to support the people living at Theobald House. Staff stated that the home is presently completing an Autism Accreditation with the National Autistic Society. From talking with staff it was evident that this was having a positive impact on supporting one person living in the home. Individuals are given a contract of care/tenancy agreement stating the terms and conditions of their stay. These were signed by the individuals representative. A member of staff stated that the individuals living in the home were unable to sign and would not fully understand the content of the document. Contracts were available in an easy read format including photographs. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals can be confident that their assessed care needs are being met. Care is tailored to the individual. Individuals can be confident that staff are knowledgeable about their changing care needs. Individuals are encouraged to take risks within a risk assessment framework which does not curtain them from being independent or leading active lifestyles. Evidence: Two persons care files were viewed as a means to determine how the home was continuing to meet the care needs of the people living in Theobald House. Care files evidently contained lots of valuable information that enables the individuals to be supported in a person centred way giving clear direction to staff. Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: Each person had a person centred plan in their bedroom which was in an accessible format. The deputy manager stated that the home accesses an external facilitator to assist with the drawing up of the plan. This is good practice. The deputy manager stated that each persons was being reviewed and the home was waiting for the facilitator to arrange and confirm dates. As noted at the random visit in June 2008 a lot of the care documentation was not dated or signed. This made it difficult to determine how current the information was. One persons care needs had been formally reviewed in the last six months and the other had not in the last year. The deputy manager stated that it was the responsibility of the key worker to review care files and staff were aware that this had to be done at least every six months. A record of the review was maintained at the front of each persons care file. This detailed any amendments that had been made and what was reviewed. It was noted that both of the individuals risk assessments had not been reviewed for a period of a year and many had been written prior to 2005. Whilst it was not noted that individuals needs had not changed significantly in respect of the risk assessments good practice would be for these to be formally reviewed in accordance to the level of risk. Risk assessments seen covered a wide range of activities and it was evident that these did not curtail individuals but ensured their safety. The home has responded to a requirement from last visit to update plans of care in relation to comments made at the last visit. In addition there was documentation to support the use of the monitor that is used at night in respect of ensuring the safety of one of the individuals living in the home. Individuals were seen accessing all parts of their home. It was evident that the care was tailored to the individual. Care files evidenced that where individuals are unable to make an informed decision then advocacy services had been commissioned. Good records were maintained on the decision processes. Each person had a plan of care relating to their capacity to make decisions and the control they have on their lifestyles. From talking with staff it was evident that they were committed to providing a person centred service, ensuring that individuals are not discriminated against. Care staff had a good knowledge of the needs of the individuals. From conversations it was evident that the key worker system was working well in supporting the individuals. Care Homes for Adults (18-65 years) Page 13 of 30 Care Homes for Adults (18-65 years) Page 14 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. Individuals are encouraged to lead full and active lifestyles and are supported by the staff to access leisure opportunities both in the home and in the community. Individuals are supported to maintain contact with friends and family. Evidence: Individuals have an activity plan that includes structured day care. Individuals are supported to attend a day centre in addition to day care workers visiting the home and supporting them in the local community. From talking with staff it was evident that the home has built positive relationships with the day care providers. Daily records, conversations with one individual and staff confirmed that individuals were supported to regularly go out in the local community. From talking with staff it was evident that individuals were encouraged to lead active lifestyles based on choice Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: and their learning disability or their physical disability did not curtail their opportunities. Activities included going to the pub, shopping, theatre visits, concerts, horse riding and places of interest. Each person had or was planning an annual holiday. Again from conversations it was evident that this was tailored to the individual. One holiday had to be cancelled due to staffing and the deputy manager confirmed that the individual had been reimbursed and that they were planning another holiday prior to Christmas. Individuals are supported to attend their local church and from conversations it was evident that individuals had built positive relationships with the congregation. It was noted during the random visit in June 2008 that one person was funding their day care. It was evident that the individual had been consulted in the expenditure and an advocate had been involved. However, what was not clear was whether the placing authority had been consulted as they may perceive that this is included in the fees paid to the home. The deputy manager stated that this had been discussed with the reviewing officer and the home was waiting for written confirmation in response to the recommendation from the visit in June 2008. The deputy manager said that the individuals activities are being reviewed to ensure it is in their best interest to continue with them. Care records evidenced that regular contact is maintained with family and friends. Photographs displayed in the home evidenced that relatives are encouraged to visit and are invited to parties and social gatherings. Through discussion with staff and observations individuals are treated with respect and dignity. It was evident that staff are knowledgeable about the needs of the individuals. Records of meals are maintained. The record of meals evidenced that individuals have a varied and healthy diet available to them including variations to the planned menu. This showed that individuals preferences were accommodated. Staff training records evidenced that they had attended food hygiene. Records were maintained in relation to good food hygiene principles. Care Homes for Adults (18-65 years) Page 16 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. Individuals personal and health care needs are being met. Robust medication procedures and practices protect the individuals. Evidence: Care plans included information relating to personal and health care. Each person had a personal care statement detailing how and who should support them. There was clear information on the use of the specialist equipment and manual handling risk assessments. The home has specialist bathing equipment to assist the individuals. Care plans evidenced that other professionals are involved in the persons care including consultant psychiatrist and the local Community Learning Disability Team. Good records were maintained of visits and plans care were updated to reflect the advice given. Feedback from visiting professionals was positive. One professional stated there is good communication, good support for the people who live in the home. Other comments included there is a good level of engagement and the individuals are Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: encouraged to participate in reviews. Good records were being maintained in relation to health care appointments and follow ups. However it was noted that one persons dental appointment had been cancelled and there was no evidence that a further appointment had been arranged. The deputy manager has agreed to investigate and organise where appropriate an appointment. The manager completed an investigation and it would appear that the person attended an appointment in the autumn. Accident records were being maintained with clear evidence of the action taken to address the issue. The home is keeping the Commission for Social Care Inspection informed of incidents that effect the well being of the individuals. Where new risks have been identified it was evident that the home was looking at ways of minimising the risks. The home has relocated the medication cupboard to an office in response to a requirement from the visit in June 2008. Previously this was stored in a cupboard in the bathroom which meant that if someone was using the bathroom it was difficult to access the medication without compromising a persons privacy. In addition concerns were raised about the condensation and how this could affect the medication. Medication is now stored in accordance with the Royal Pharmaceutical Guidelines in an office on the first floor. Good records were being maintained of medication entering the home, the administration and records of disposal. Evidence was provided that the home could account for all medication with good auditing and stock control in place. Policies and procedures relating to medication were seen at a previous assessment and not reviewed on this occasion. Each person had a profile in their plan of care on how they are supported in taking their medication. This included clear information on the medication that they are prescribed and the side effects. Staff competence is routinely checked every six months and training attended as evidenced in discussions with staff and records seen. Care Homes for Adults (18-65 years) Page 18 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals can be confident that their concerns would be listened to and acted upon. Good systems are in place to ensure that individuals are protected. Evidence: The home has a complaint procedure that enables relatives and people who use the service to make a complaint. The Commission for Social Care Inspection has not received a complaint in relation to Theobald House. The home maintains a record of complaints. There has been one complaint since the last visit to the home. This related to the conduct of a member of staff whilst out in the community. Evidence was provided that this was investigated and was being monitored by the manager via supervision. Individuals living in the home are unable to communicate verbally and they express their views by physical gesture, body language and vocalisations. Care plans included how the individuals express pain or general dissatisfaction. It was evident that the staff had built good relationships with the individuals and had a good understanding of the communication needs of the individuals. Daily records included comments about the persons wellbeing. As already mentioned in this report the home has accessed an advocacy service to Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: assist in making decisions on behalf of an individual in respect of their day care and finances. From talking with the deputy manager and staff it was evident that relatives are involved and are included in the decision process where relevant. Care documentation included information where the individual can make decisions and where they need support. Staff confirmed that they had attended training in protection of vulnerable adults. Staff stated that this was covered during the induction and included attending a course with the local placing authority. The deputy manager stated that the organisation has recently purchased learning material which covers protection that staff can do on line using the homes computer. This was not viewed on this occasion and will be followed up at the next visit. The home has a policy on Whistle Blowing and a safeguarding policy as seen at previous visits. Staff confirmed that they were aware of these. Financial records were checked for 2 people and the amount held in the home corresponded with the record. Each person had their own bank account and a building society account. Good financial procedures were in place to protect the individuals from financial abuse. Care records included information on how the person should be supported in respect of their finances and information relating to their income. Records were seen at the last visit that detailed guidelines and approaches for staff to positively support individuals that may challenge the service. These included recognition of stress and strategies for support. Staff had attended training in supporting individuals that may challenge. Care Homes for Adults (18-65 years) Page 20 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. Individuals benefit from a homely, comfortable and safe environment to live in. One individual would benefit from having a bedroom that meets the National Minimum Standards. Evidence: The home is a detached two storey property that is situated in the Oldfield Park area of Bath in a quiet Cul-de-sac. The home is accessible to local amenities with Bath City Centre being only a short drive from the home. Individuals have access to two communal lounges, a dining room and a kitchen. All areas were homely, comfortably furnished and free from odour. It was noted that the carpet in the communal areas could benefit from a deep clean in some areas due to staining. Each person has a bedroom that has been personalised to reflect their taste and interest. One of the bedrooms falls below the National Minimum Standards (6.3 square metres) and it is evident from feedback from professionals and the staff that the individual accommodated in this room would benefit from a bigger bedroom. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: There are adequate bathing facilities for the individuals living in the home. The home has demonstrated compliance to a requirement to tile the bathroom on the first floor as noted during the visit in June 2008. The deputy manager stated that a new heating system has been installed as concerns had been raised on a previous visit as the old system was not adequate. The deputy manager stated that this has now been resolved. The home maintains a record of repairs and it was evident that there was a good response time with works being completed. An environmental health and safety audit is completed on a six monthly basis. The home is equipped to meet the needs of people with a physical disability. This includes bathing and manual handling equipment. From records it was evident that these were being routinely maintained. As discussed and noted at previous visits plans have been drawn up for the home to be extended. This includes moving the kitchen to another part of the home, extending two of the bedrooms and making the home more accessible by installing a passenger lift to the first floor. The deputy manager stated that funding is available but it depends on whether the organisation can secure the leasehold on the building from the local council. From conversations with the deputy manager it was evident that there was still no timescale for the work to be completed. The home has good infection control practices and policies to guide staff ensuring the protection of the individuals in the home. Staff stated that this is covered in their induction. sufficient hand washing facilities were in place. Presently the laundry facilities are situated in the garage which is accessible from the dining area. As part of the refurbishment plans a laundry will be sited in the house on the ground floor. Staff stated that laundry is not taken through the kitchen or the dining area when food is being prepared or eaten. Care Homes for Adults (18-65 years) Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals benefit from a stable staff team who have the necessary skills to support them. Minimum staffing levels on occasions could mean that care is being compromised. Evidence: Staffing levels in the home are generally adequate to meet the needs of the people living in the home. There are two staff working in the home during the day and two staff providing sleep in cover at night. However, from looking at the duty rota it would appear that some afternoons in the last month there has only been one member of staff for a period of up to two hours. This was also commented on in the communication book when individuals were unable to attend an appointment for their flu jab and on another occasion when a member of staff was on their own and unable to provide personal care due to staff shortages. This is unacceptable and could potentially put individuals at risk. The deputy manager said that this was rare and usually due to staff absences and agency cover coming slightly later to reduce the cost. However, the deputy manager was working in the home from 1400 to 1700 on the day of the visit. It was noted that all four individuals were at home from 1530 and one of these individuals could at times need two staff to support them with personal care. The deputy manager said that two new staff were being employed and would Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: cover this shortfall and that this would not reoccur. From conversations with staff it was evident that if no personal care was required then one staff is sufficient however personal care can be unpredictable. On the day when the person was unable to provide the personal care it was due to the day centre not ensuring the manual handling sling was in place. The deputy manager stated they would investigate why the sling was not in place and reinforce its importance to the day centre. No requirement has been made as the deputy manager said they would ensure adequate staffing and investigate the concern re the sling. Staff recruitment records are held at the organisations local office as agreed with the Commission for Social Care Inspection. These records can be subject to an inspection at any time. Staff confirmed that there is a comprehensive induction in place which includes attending a four day course which covers the role of the carer statutory training, protection of vulnerable adults, equalities and diversity and values training in supporting individuals with a learning disability. In addition to the new worker completing the Learning Disability Qualification and an in house induction on the care needs of the individuals. The home has devised an overview of training which includes all statutory training (fire, manual handling, first aid, Health and safety, manual handling and food hygiene). It was noted that staff were up to date in all areas other than health and safety and the deputy manager stated that this is being arranged for the individual staff members that require the update. Other training included epilepsy, autism, intensive interaction, positive behavioural support to name a few. Four staff have an National Vocational Award in Care at level 3 and one person at Level 4. In addition the manager has a nursing qualification and the Registered Managers Award. It is evident that the home is committed to meeting the National Minimum Standard to ensure that at least 50 of the workforce have an National Vocational Award in care. Staff stated that they felt supported in their roles. Regular staff meetings were taken place covering all areas relevant to the care of the individuals and the running of the home. In addition staff meet with the manager on a monthly basis for a one to one supervision. Records were maintained of the discussions. Care staff spoken with during this visit had a good understanding of the needs of the individuals living in the home. Many of the staff have worked in the home for many years offering the individuals consistency. The last person to have been employed was Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: over a year ago. Two new staff are planning to start work in the home, one person is transferring from another care home in the local area. Positive comments were received about the team moral and support offered to them. It was evident that staff saw the recruitment of the new staff as being positive. Care Homes for Adults (18-65 years) Page 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals benefit from a well managed service which actively reviews the quality of the care provision. Individuals safety is paramount. Evidence: The registered manager has now returned to her substantive post at Theobald House. Ms Fyrth had been seconded to an area managers post for a period of six months and the deputy manager had taken on the responsibility for managing the home in her absence. Comments from staff were positive about the management arrangements both during this visit and the visit in June 2008. It was evident that there was an open door style of management. Evidence was provided that there were good quality assurance systems in place in respect of the running of the home including monthly audits on staffing, training, Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: supervision, absence monitoring, medication, care planning and the environment. The team have completed a Planning for the Future exercise with an action plan being developed. The deputy manager said that he was unaware of any quality assurance initiatives that sought the views of relatives, people who use the service or other stakeholders on the quality of the care provided at Theobald House. Good practice would be that a questionnaire be devised and sent periodically to individuals. In addition to the above the home is visited monthly by a representative of the organisation in respect of regulation 26. Copies of the report are held in the home. Good systems were in place in relation to health and safety. These included safe storage of cleaning products, checks on the equipment, risk assessments and policies and procedures. An opportunity was taken to review the fire records. Good evidence was seen in respect of the training and the checks on the fire equipment. However, it was noted that staff have not had a fire drill in the last eight months. It is recommended by the fire authority that staff take part in a fire drill once in a six month period. A fire risk assessment was in place and had been kept under review. Records were maintained in respect of fridge freezer temperatures and good practices and procedures were evidently in place in relation to food hygiene. Other areas noted where safety of the individuals is being assured is that the radiators are protected and water temperatures are maintained at safe levels to prevent scalds. This included the recording of water temperatures on a routine basis. Care Homes for Adults (18-65 years) Page 27 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 28 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 30 23 Ensure the carpet in the communal areas is routinely cleaned. Ensuring the carpet is clean and free from stains. 06/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 To ensure that care plans and risk assessments are reviewed at least once in six month period or more frequently depending on the care need. For the organisation to develop a questionnaire for relatives, people who use the service and other stakeholders which would seek their views on the quality of the service being provided. 2 39 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. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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