Inspection on 16/02/09 for Three Trees

This inspection was carried out on 16th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Three Trees 25/01/07

Three Trees 28/02/06

Three Trees 12/10/05

Three Trees 15/02/05

Three Trees 14/09/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Muston Road (70)

Grayling

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: Three Trees 24 St Johns Avenue Bridlington East Yorkshire YO16 4NG The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home 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 full assessment a ‘key’ inspection. Lead inspector: Carol Haj-Najafi Date: 1 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. things that people have said are important to them: 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. They reflect the 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) 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 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Three Trees 24 St Johns Avenue Bridlington East Yorkshire YO16 4NG 01262601626 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Barrie Stephen Gosland,Mrs Christine Alma Gosland Mrs Christine Alma Gosland care home 21 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : learning disability Number of places (if applicable): Under 65 21 Over 65 0 Additional conditions: Date of last inspection: Brief description of the care home: D D M M Y Y Y Y Three Trees is registered to provide care and accommodation for up to 21 younger adults with a learning disability. It is a domestic style home that is situated in a Care Homes for Adults (18-65 years) Page 4 of 33 residential area of the seaside town of Bridlington in East Yorkshire. It is conveniently located for all of the main community facilities including the public transport network. The care home has a number of communal/lounge areas. There is a mix of single and shared bedrooms. The home does not have a passenger lift and consequently is only considered suitable for service users who are reasonably ambulant. The home has its own transport for taking people to day centres or on outings in the surrounding countryside and has good access to the local bus service and railway station. A statement of purpose, service user guide and copy of the most recent inspection report are available directly from the home. At the inspection the registered manager told us the fees are 335 pound per week. An additional charge is made for transport. Care Homes for Adults (18-65 years) Page 5 of 33 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 How we did our inspection: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations- but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The last key inspection was carried out in January 2007. Before this unannounced visit we reviewed the information we had about the home which included an annual quality assurance assessment (AQAA) that the manager completed. The AQAA provides us with information about the home and tells us what has happened in the last twelve months. We used this information to help us decide what we should do during our inspection Care Homes for Adults (18-65 years) Page 6 of 33 visit. Surveys were sent out to people who use the service and other people who have an interest in the service. We received surveys from ten people who use the service, thirteen staff and three care managers. Comments from the surveys have been included in the report. One inspector was at the home for one day. We spoke to six people who live at the home, four staff, the assistant manager, the registered manager and the owner. We looked around the home, and looked at care plans, risk assessments, daily records and staff records. We spent a total of 8.5 hours at the home. Feedback was given to the assistant manager, registered manager and owner at the end of the visit. What the care home does well: What has improved since the last inspection? People who live at the home are happy living there. One person said, Its a very nice place to live. Another person said, We get help when we need help. One person wrote a letter to us. They told us they have lived at the home for a few years and said, My life is very different now, and I am very happy. People are also very happy with the support they get from staff. One person said, Staff are very nice. Another person said, The staff are lovely. Surveys from people who live at the home told us staff always treat them well and carers act on what they say. People also told us they are involved in decision making. One person said, They always ask if were happy. Another person said, Staff have their meeting, then we have our meeting and they talk to us about their meeting. We talked to staff about the home; everyone said the home provides a very good service. The home has a very low turnover of staff. Everyone has worked at the home for at least two years and staff know the people who live there very well. They talked about peoples individual needs and gave good examples of how they provide good quality care. Every staff survey was very positive about the home and we received lots of information about what the home does well. These are typical comments, We provide a happy safe home. People receive excellent care and this is reflected in how content people are. Our service provides a homely, friendly environment. People have an enjoyable and varied lifestyle. People told us they have lots of opportunities to do different things. Daily records have good information about what Care Homes for Adults (18-65 years) Page 7 of 33 people do and they showed that peoples social needs are being met. We received surveys from care management reviewing officers. They told us the home is providing a good service. One person said the service strives to perfection and will take on board anything needed to help with this. Another person said Three Trees is an excellent provider. What they could do better: A better care planning process could be introduced. This will make sure peoples needs and wishes are met. As the care planning process is developed, potential risks to people who live at the home could be identified and assessed. This will make sure the risk of harm is minimised. People who live at the home could be more actively encouraged and supported to be involved in all areas of daily living in the home. This will help promote their independence. Medication administration could be managed more carefully. Staff could always administer medication in accordance with the prescriber’s directions. If these are not suitable for the person receiving the medication staff could contact appropriate healthcare professionals. This will make sure people receive the right medication. Peoples medication needs could be identified through a risk assessment and care planning process. This will make sure peoples needs are met. Hand written medication records could be checked by a second member of staff. This will help make sure medication administration records are accurate. The homes safeguarding procedure could include details for making a safeguarding referral to the local authority. This will make sure everyone knows who is responsible for making alerts and who should be contacted. An environmental risk assessment could be in place for windows that fully open. This will make sure people are safe because potential risks will be identified. All staff could receive appropriate health and safety training. This will make sure people are safe. The home could also have policies and a staff development programme that identifies how often staff should attend training courses. This will make sure staff practice is kept up to date. Care Homes for Adults (18-65 years) Page 8 of 33 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 Details of our findings Contents Choice of home (standards 1 – 5)........................................................................ 11 Individual needs and choices (standards 6 – 10) ................................................... 13 Lifestyle (standards 11 – 17) .............................................................................. 15 Personal and healthcare support (standards 18 – 21) ............................................. 18 Concerns, complaints and protection (standards 22 – 23) ....................................... 20 Environment (standards 24 – 30) ........................................................................ 22 Staffing (standards 31 – 36)............................................................................... 24 Conduct and management of the home (standards 37 – 43) ................................... 27 Outstanding statutory requirements..................................................................... 29 Requirements and recommendations from this inspection ....................................... 30 Care Homes for Adults (18-65 years) Page 10 of 33 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 who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are properly assessed before they move into the home and they are assured their needs will be met. Evidence: Since the last inspection two people have moved into the home. They both confirmed they spent time at the home before they decided to move in. They said they are very happy living at the home. One person said the manager and assistant manager asked me what I wanted before I moved in and when I moved in they checked everything was ok. I had a review and was asked if I was ok. Surveys from people who live at Three Trees said they were asked if they wanted to stay at the home, and received enough information to help them decide if they wanted to stay. In the AQAA the manager explained the process they follow before people move into the home. This includes providing people with information about the home, organising visits to the home and completing care plans and assessments. We looked at one persons file who had moved into Three Trees since the last inspection. Social services gave the home a detailed assessment and a care plan. Care Homes for Adults (18-65 years) Page 11 of 33 These contained good information about the type of support the person required. Daily records showed that peoples visits to the home were being monitored to make sure the home could meet their needs. Some people had recently moved rooms within the home. The manager explained this was done through a consultation process and details were recorded. We spoke to one person who had changed rooms. They said the management team discussed the changes with them and they are happier in their new room. Care Homes for Adults (18-65 years) Page 12 of 33 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 who use the 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 happy living at the home. In the main, peoples care needs are met but their wishes and aspirations could be overlooked because these are not always identified through the care planning process. Evidence: We spoke to people who live at the home. Everyone told us they are happy living at the home. One person said, Its a very nice place to live. Another person said, We get help when we need help. One person wrote a letter to us. They said, I have lived at the home for five years, my life is very different now, and I am very happy. People told us about monthly house meetings and said staff talk to them about the home. One person said, They always ask if were happy. Another person said, Staff have their meeting, then we have our meeting and they talk to us about their meeting. We talked to staff about the home; everyone said the home provides a very good service. The home has a very low turnover of staff. Everyone has worked at the home for at least two years and staff know the people who live there very well. They talked about peoples individual needs and gave good examples of how they provide good Care Homes for Adults (18-65 years) Page 13 of 33 quality care. Every staff survey was very positive about the home and we received lots of information about what the home does well. These are typical comments, We provide a happy safe home. People receive excellent care and this is reflected in how contact people are. Our service provides a homely, friendly environment. We looked at three peoples care plans and assessments. These were basic. They had information about personal care, mobility and family involvement. Some information was specific, which is good practice because this gives clear guidance on how a persons needs should be met. For example one care plan stated that night staff should check every hour because the person had started having more epileptic seizures. Other information in some care plans was not specific. One plan said needs support to get from A to B. The manager said this related to when the person went out into the community. Staff confirmed the person sometimes walks from the home to the day centre independently so the plan did not accurately reflect the persons needs. The care plans did not contain enough information about peoples aspirations or goals. The registered manager said the social services annual review report usually identifies peoples wishes and aspirations. We looked at two annual review reports. One said no recommendations. The other report said assist to look for voluntary placement. It is important that peoples goals are recorded as part of the homes care planning process to make sure individuals wishes and aspirations are more clearly identified. People who live at the home gave us examples when changes have been made to meet their individual needs. One person said they had reduced their daycare because they are getting old and want to take things easy. Staff record important information about people and what they have been doing. The records are very detailed and show how peoples needs are being met. This is good practice because peoples health, welfare and lifestyle can be properly monitored. Keyworkers complete a monthly review. These contain good information about what people have done the previous month. Staff confirmed they look at daily records, check where people have been and what they have been doing. These show that peoples welfare is being properly monitored. People have an annual review which is arranged by social services. The purpose of the review is to identify if the persons needs are still being met and is attended by the person and other people they want to invite. The home prepares a report for the review. The reports give a good detailed account of what people have done over the last twelve months. Care Homes for Adults (18-65 years) Page 14 of 33 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 who use the 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 have an enjoyable and varied lifestyle. People are encouraged to be independent when in the community but opportunities to be involved in daily living limits independence in the home. Evidence: People told us they enjoy living at Three Trees and have lots of opportunities to do different things. One person said they enjoy going to shows and shopping with staff. Another person said they enjoy going out for meals with staff. Some people were having a sing-a-long, others were doing crafts when we visited. People at the home and staff said craft is a very regular activity and several people join in. They have recently knitted hats for premature babies and have raised money for other charities. People said they have parties and everyone enjoys them. The weekend before the inspection they had a Valentines party. Care Homes for Adults (18-65 years) Page 15 of 33 In the AQAA the manager said, We provide a service that caters for service users with vastly differing needs ranging from those who are relatively independent thereby requiring only minimal staff support to those who are totally dependant on staff support. Staff said the home is good at meeting peoples individual needs. One person who lives at the home said, Everyone goes out. Some people go out on their own, and other people get help from staff. Daily records have good information about what people do and they showed that peoples social needs are being met. We talked to people about what they do during the day. Some people attend day centres, others attend college. Some people do voluntary work in local shops. Daycare packages are varied. Some people go out five days a week; others go out fewer days. In the AQAA the manager told us people participate in many local leisure and social activities including attending churches, clubs, darts and pool teams, arts and drama classes, shows, cafes and shopping. People talked about the social activities many of which are arranged on an evening and a weekend. One person said they loved playing in the pool team, and showed us photographs of when they had represented England. Another person said, I like going to clubs on a Tuesday and Wednesday. Some routines at the home are quite structured because the service is supporting twenty-one people. These routines do not always give people flexibility of choice and chance to develop independent living skills in the home. For example the cook or staff prepare and cook the meals. We talked to people who live at the home about daily living skills. Everyone told us staff are responsible for cleaning the house, laundry and cooking the meals. Some people said they take their bedding off when it needs changing but most people said staff put clean bedding on. One staff member said people had stayed at home recently because of the bad weather and then a couple of people had helped empty bins and other small tasks. One person said they like cooking at the day centre and making Yorkshire puddings but they didnt cook at home. Care plans did not contain information about daily living skills. People should be supported to be more independent and encouraged to take responsibility within their own home. In the AQAA the manager told us they encourage regular contact with friends, families and representatives many of whom are regarded as part of the Three Trees extended family. Daily records showed us that the home maintains regular contact with family members when it is appropriate. One person who lives at the home said they had talked to the management team about having a friend to visit on a regular basis. This was arranged and the friend visits twice a week. The person said this has made them very happy. Care Homes for Adults (18-65 years) Page 16 of 33 People who live at the home said they enjoy the meals. One person said, The cook makes good meals. Another person said, I enjoy the meals. We looked at the menus, which are varied and nutritious. A cook is employed five days a week, and the staff or member of the management team cook meals the other two days. Care Homes for Adults (18-65 years) Page 17 of 33 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 who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are met. Safe medication procedures are in place but these are not always followed and this could result in medication not being administered correctly. Evidence: We received three surveys from care management reviewing officers. They told us peoples healthcare needs are always properly monitored, and the service always supports people correctly with the administration of medication. They also told us the service always respects peoples privacy and dignity. One person said the service strives to perfection and will take on board anything needed to help with this. Another person said Three Trees is an excellent provider. We talked to people about privacy and dignity. People who live at the home said staff always respect their privacy and dignity. People also said staff knock on their door before entering. Staff gave us good examples of how they promote privacy and dignity. In the AQAA the manager said, We regularly review each service users care plan to ensure they receive the personal support that they require and prefer. Staff are encouraged to be observant and report back to management any signs of change to the service users physical or emotional health. Care Homes for Adults (18-65 years) Page 18 of 33 Staff said the home is good at meeting peoples personal and healthcare needs. People who live at the home said they have good support with their personal care and staff make sure they get the right healthcare support if they are unwell. We looked at information that showed us people regularly attend healthcare appointments. The home has an appointments diary that shows when people have attended appointments. Individual records have good information about appointments and showed us that staff are vigilant and look for changes in peoples well-being. Care plans did not contain details of peoples healthcare needs or medication administration needs. Individual care plans should contain this information to make sure peoples healthcare needs are identified and met. People at the home do not administer their own medication. Individual assessments should be carried out to establish if some people who live at the home could take some responsibility for their medication. If people are assessed as being able, they should be encouraged and supported to take some or all of their own drugs. This helps promote independence. In the AQAA the manager told us all staff that handle medication have received both internal and external accredited training. Staff told us they thought the medication training gave them the knowledge and skills to administer medication safely. We looked at medication administration records (MAR) which are handwritten by staff. Medication guidance says printed MAR charts are not essential but they are better than handwritten charts. This is because there is less risk of error. But if a handwritten MAR is the only available option, there must be a robust system to check that the MAR is correct before it is used. Currently only one staff writes and signs the handwritten instructions. A second signature to confirm these had been checked would make the system more robust. The handwritten sheets do not have a code for recording why medication was not administered. This is important to make sure there is a record if people have not received their medication as prescribed. We observed administration of medication. One person was given their medication with food but the medication administration record stated that it should be administered before food. The registered manager said healthcare professionals were aware the medication was being administered with food. The registered manager said she contacted the pharmacist on the day of the inspection and they said the before food instruction is automatically generated. It is very important that when administering medication staff follow written instruction and the written instruction is correct. This will make sure people receive the right medication. Care Homes for Adults (18-65 years) Page 19 of 33 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 who use the 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 confident that they will be listened to and that appropriate action will be taken when necessary. Evidence: Surveys from people at the home told us they know who to speak to if they are unhappy. One person said they talk to their keyworker if they are unhappy. Another person said I tell staff if Im upset and they always sort it out. Staff surveys told us that they know what to do if people have any concerns about the home. Staff said they would report any concerns to the management team and they are confident they would deal with them promptly and appropriately. The registered manager and assistant manager told us they have completed a train the trainer safeguarding course and have trained staff at the home in safeguarding policies and procedures. They have very recently attended a refresher course which they are planning to pass on to staff. Staff were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They were also able to describe the different types of abuse. The home has good information about protecting people and have local authority procedures available at the home. A local procedure on what action should be taken by the home in the event of an allegation being made was not available. The registered Care Homes for Adults (18-65 years) Page 20 of 33 person agreed to introduce this to make sure everyone knows who is responsible for making alerts and who should be contacted. We looked at personal allowances for two people. The money held corresponded with the financial record. Personal monies are held individually and each person has a record of transactions. Staff check these to make sure they are correct. Care Homes for Adults (18-65 years) Page 21 of 33 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 who use the 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, pleasant and comfortable environment. In the main, the home is well maintained and safe but some hazards had not been assessed, which could put people at risk. Evidence: Surveys from people who live at the home told us the home is always clean. When we looked around the home it was clean, tidy and looked homely. The home is reasonably well maintained, furnished and decorated. In the AQAA they gave us good examples of how they have improved the environment which includes improved lighting, creating a new wet room, refurbishing two communal bathrooms, installing a new en suite and decorating and carpeting several areas. They told us they plan to decorate more areas, upgrade the remaining bathroom and upgrade the amenity rooms in all three units. All of the bedrooms we looked at were furnished and decorated to a good standard. People had individualised their rooms by furnishing them with their personal belongings. There are a relatively high percentage of shared bedrooms but from discussions with the staff it was apparent that most people sharing had done so for a long time. People who share bedrooms said they are happy sharing. The home does not have a passenger lift and consequently the majority of bedrooms Care Homes for Adults (18-65 years) Page 22 of 33 are only suitable for people who are reasonably ambulant. People who have mobility problems have a bedroom on the ground floor. The home has a large lounge and dining room which is where people spend most of their time. The home also has two group living areas which have a separate kitchen/dining area and lounge. People living in these areas could make snacks and hot drinks for themselves although as stated in the life style section promoting independence should be further developed. These facilities are very good and could be used much more. At the last inspection we recommended that some radiators should be fitted with guards and the baths should be fitted with thermostatically controlled valves. The assistant manager said each radiator recommended for a guard now had one fitted and baths had temperature control valves fitted. We checked water temperatures around the home. The water in one bathroom was running very hot and exceeded 50C. The owner contacted an engineer who visited the same day. Apparently there was a fault with the temperature control valve and the engineer was returning the following day. We also checked some windows on the first and second floors. Several could be fully opened. The owner explained windows previously had restrictors but new windows had been fitted. An environmental risk assessment should be completed for windows that can be fully opened to assess potential risk. In the AQAA the registered manager told us equipment has been tested as recommended by the manufacturer or other regulatory body. Fire equipment was tested in November 2008 and gas appliances were tested in December 2008. The catering kitchen was inspected by environmental health in August 2008. The report confirmed that the environmental health officer was satisfied with the facilities and no recommendations were made. Clinical waste is properly managed and staff have access to protective clothing when attending to the personal care needs of people who live at the home. Care Homes for Adults (18-65 years) Page 23 of 33 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 who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are supported by a caring and competent staff team. Staff are skilled but because all training needs are not properly identified some training needs could be overlooked. Evidence: People who live at the home told us they are very happy with staff and management. One person said staff are very nice. Another person said the staff are lovely. Surveys from people who live at the home told us staff always treat them well and carers act on what they say. Surveys from the care management reviewing officers told us staff and managers always have the right skills and experience to support individuals social and health care needs. One person said staff are highly trained and work really well as a team. Another person said staff have excellent and supportive relationships with service users. Staff told us people who stay at the home receive a very good service. We received thirteen staff surveys and spoke to four staff. We received a good range of comments of what the service does well. One person said people receive excellent care and this reflects in how contented the service users appear. Another person said we do everything well. Care Homes for Adults (18-65 years) Page 24 of 33 The home has had a very low turnover of staff. Staff said this has contributed to the good quality service because people receive consistency and continuity of care. In the AQAA the registered manager said, By ensuring good working conditions and offering flexible arrangements we have been able to retain staff members for many years. We therefore have been able to offer exceptional continuity of care for the service users. Staff said they enjoy working at the home and everyone works well together. Several people talked about the good atmosphere and good teamwork. One person said staff and management work well together. This makes a happy place to live and a happy place to work. Staff said everyone has a good understanding of their role and they regularly meet with management to discuss how they are working. Everyone attends regular staff meetings, which helps build teams and gives everyone opportunities to talk about the home. Staff told us staffing levels were generally good. Seven surveys said there are always enough staff; four surveys told us there were usually enough staff. Staff told us they receive training that is relevant to their role, and helps them understand and meet the needs of people living at the home, and keeps them up to date with new ways of working. One staff was completing a learning disability qualification. The registered manager said they were arranging some training in epilepsy. In the AQAA the registered manager told us nine staff out of the thirteen staff have NVQ level 2 or above in social and health care. This is a good percentage of staff that are qualified. The homes does not have policies or guidance for the frequency of attendance for some training courses. Staff have worked at the home for many years and some have not attended refresher courses. It is important to identify how often staff should attend training courses to make sure their knowledge is up to date. We asked about induction training. An induction pack was available but it was not detailed and did not cover all key areas. This could result in a new staff member not having a thorough induction when they start working at the home. The registered manager agreed to review the induction programme. Some people had not received mandatory training for a number of years and we have covered this in more detail in the management and administration section. The home did not have a development programme to identify which training staff should attend to make sure they have the right skills and knowledge to meet peoples needs. No staff have been recruited in the last two years. We did not look at pre employment records at this inspection. The last inspection found that the home had implemented a Care Homes for Adults (18-65 years) Page 25 of 33 good staff selection and recruitment procedure. Staff surveys told us the employer carried out proper checks before they started working at the home. Care Homes for Adults (18-65 years) Page 26 of 33 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 who use the 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 everyone feels very supported. In the main, health and safety is promoted but some staff might not have the right knowledge because they have not attended health and safety training for several years. Evidence: People told us they are very happy with how the home is managed. One staff said, Managers listen and really support us. Another staff said, Management works well with staff and they never leave us feeling unsure. The registered manager is very experienced in the management of care services. She has been the registered manager of Three Trees for a number of years. The assistant manager works very closely with the registered manager and shares responsibility for the day to day management of the home. Everyone said this works well. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. The AQAA gave us very good information about the service. It gave us good examples of what they do well, how they have improved and what they want to do better. They also told us about changes they have made as a result of listening to people who use the service. Care Homes for Adults (18-65 years) Page 27 of 33 The home has very good systems in place for monitoring the quality of the home. People who live at the home attend regular meetings and are asked about the quality of the home. Surveys results from August 2008 were analysed and everyone was very complimentary about the home. The owner is looking at how they can develop their system to encourage people to make more suggestions for how they can improve the service. We asked to look at monthly reports (Regulation 26 reports) and other audit material which are completed as part of the quality monitoring process. These are very detailed and show that the service is regularly monitored. We looked at health and safety records, which included fire alarm testing and environment checks. These had all been carried out on a regular basis. In the AQAA the manager told us they have all relevant policies and procedures in place. We looked at staff training records. Staff had not completed some important health and safety training for a long time. This included first aid, food hygiene and moving and handling. For example one staff had not completed moving and handling training since 2003, another staff had not attended first aid training since 2004. Staff have completed fire training and attended regular updates. The majority of staff have not received training in prevention and control of infection. The assistant manager said they had identified staff had not completed this training and were planning this for the near future. Care Homes for Adults (18-65 years) Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes No Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 33 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 Peoples needs and 30/06/09 aspirations must be properly identified through a care planning process. This will make sure peoples needs and wishes are met. 1 20 13 The support that people need with their medication must be identified through a risk assessment and care planning process. This will make sure people get the right support and their healthcare needs are met. 30/06/09 3 20 13 Staff must administer medicine in accordance with the prescriber’s direction. This will make sure people 30/06/09 Care Homes for Adults (18-65 years) Page 30 of 33 receive the right medication. 4 24 23 Environmental risks must be 30/06/09 properly identified and appropriate risk management strategies put in place. This will make sure people are safe because the home will be free from hazards. 5 42 13 All staff must receive 30/06/09 appropriate health and safety training. This will make sure people are safe. 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 9 As the care planning process is developed, potential risks to people who live at the home should be identified, assessed and risk management strategies agreed. This will make sure the risk of harm is minimised. People who live at the home should be more actively encouraged to be involved in all areas of daily living in the home. This will help promote independence. Peoples healthcare needs should be identified through the care planning process. This will make sure their healthcare needs are identified and met. Hand written medication records should be checked by a second member of staff. This will help make sure medication administration records are accurate. The homes safeguarding procedure should include details for making a safeguarding referral to the local authority. Page 31 of 33 2 16 3 19 4 20 5 23 Care Homes for Adults (18-65 years) 6 35 The home should have a staff development programme that identifies staff training needs. This will make sure individual training needs are identified and met. The home should have policies that identify how often staff should attend each training course. This will make sure staff practice is kept up to date. 7 35 Care Homes for Adults (18-65 years) Page 32 of 33 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. ©This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Care Homes for Adults (18-65 years) Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!