Inspection on 06/11/08 for Trafalgar Lodge

This inspection was carried out on 6th 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

Bramley Avenue (73)

Paradise Lodge

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Upaya Ananda

15 Bramble Close

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: Trafalgar Lodge 70 Swan Lane Tharston Norwich Norfolk NR15 2UY 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: Lella Hudson Date: 0 7 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. They reflect the 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. 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 35 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Trafalgar Lodge 70 Swan Lane Tharston Norwich Norfolk NR15 2UY 01508536510 01508536500 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): BREAK Name of registered manager (if applicable) Amy Howarth Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 4 4 0 0 care home 4 learning disability physical disability Additional conditions: The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Physical disability - Code PD The maximum number of service users who can be accommodated is 4 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 35 A bit about the care home The Home is owned and managed by the BREAK organisation. It provides accommodation and support for four young people. Up until April 2008 the Home was registered as a Childrens Home and was regulated by Ofsted but now that three of the residents are over the age of 18 it is registered with CSCI as an Adult Care Home. Accommodation is provided on the ground floor only. All bedrooms are single with ensuite toilet and shower. The accommodation is accessible for wheelchair Care Homes for Adults (18-65 years) Page 5 of 35 users. The fees were not available at the time of the Inspection. The organisation has a service level agreement with the local authority who place residents at the Home. Care Homes for Adults (18-65 years) Page 6 of 35 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 Care Homes for Adults (18-65 years) Page 7 of 35 How we did our inspection: This is what the inspector did when they were at the care home This is the first Inspection for this service as it was registered with the Commission in April 2008. This report contains information gathered about the service since it was first registered. The Manager completed the Annual Quality Assurance Assessment in a detailed way which provided a lot of information about the quality of the service provided and the improvements that are needed. We also received two completed surveys from relatives. Care Homes for Adults (18-65 years) Page 8 of 35 The report also contains information gathered during an unannounced visit to the Home which was started on the 6th December and completed on the 7th December 2008. During the visit we spoke to clients, staff and the Manager. We looked around the Home and also looked at a selection of records. What the care home does well The Home is well managed in a way which puts the needs of the residents first. The Manager has an open style of Care Homes for Adults (18-65 years) Page 9 of 35 management and staff feel comfortable talking to her about issues. There has recently been a review of the management team and a new deputy manager is due to start work at the Home shortly and the roles of the two senior support workers have been clarified. The staff team are enthusiastic about working with the residents and were seen to support them in a kind, calm and friendly manner. The staff who spoke to us have a good understanding of the needs of the residents and how these should be met. Care Homes for Adults (18-65 years) Page 10 of 35 The importance of the residents being involved in making their own decisions is recognised and staff try hard to enable the residents to make their views known. Communication is given a high priority. The residents are supported to take part in a range of leisure, educational and employment activities. The importance of the residents being supported to take part in meaningful activities, both in the Home and in the local community, is recognised. Care Homes for Adults (18-65 years) Page 11 of 35 What has got better from the last inspection What the care home could do better There is a need to improve the standard of decoration of some areas of the Home. The accommodation meets the Care Homes for Adults (18-65 years) Page 12 of 35 needs of the residents but it would benefit from new flooring and redecoration in some areas. There is a need for some of the care plans to be reviewed to ensure that they are as clear as they can be so as to ensure that consistent care is provided to the residents. There is also a need to ensure that some of the recording relating to health and safety checks is carried out on a regular basis. Care Homes for Adults (18-65 years) Page 13 of 35 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Lella Hudson CSCI CPC1 Capital Park Fulbourn Cambs CB21 5XE 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 14 of 35 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 15 of 35 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 . There are suitable procedures in place to manage admissions to the Home. Evidence: The Home has recently been registered by the Commission as two of the residents living there are now over the age of 18. Previously the Home was registered as a Childrens Home and as such was regulated by OFSTED. The organisation submitted a revised Statement of Purpose and Service User Guide as part of the application for registration. The Manager said that they are planning to provide the Service User Guide in alternative formats which prospective residents may find easier to understand than the present format. There has been one admission to the Home within the last year. This was carried out as an emergency placement and so the usual admissions procedure was not able to be followed. However, the Manager made sure that there was information available about the residents needs and how these should be met. Information was then gathered during the residents first few weeks at the Home and a care plan developed from this. Care Homes for Adults (18-65 years) Page 16 of 35 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 . The needs of the residents are assessed and the care plans contain information about how to meet their needs. Risks are identified and assessed with guidance available. The residents are involved in decisions that are made about their lives where possible. Evidence: We looked at two of the care plans and risk assessments. These contain a lot of information about the residents and some detailed guidance about how to meet individual needs. Three of the young people living at the Home are now over the age of 18 and therefore now receiving the support of the adults learning disability team whilst the other two young people are still receiving support from the childrens teams. The care plans contain assessments and guidance from health and social care professionals involved in the residents lives. The care plans are, in some cases, not very clear as there is no cross referencing to other documentation within the care plan which indicates a review of the information. For example, one of the care plans contains conflicting information about the continence needs of the resident as it is not clear that the information has been Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: reviewed and updated. The staff who spoke to us were clear and consistent about the care plan that is in place but the records are not clear. There is also little reference to other documents such as the sanctions and restraint records. The care plans show that risks are identified and that guidance is in place for the risks to be managed effectively. Discussions with the Manager and staff show that there is a lot of discussion amongst the staff team and with the residents to ensure that the management of risks is not placing unnecessary restrictions on the life experiences of the individual residents. The care plans contain information about the way in which individual residents prefer to communicate and the staff who spoke to us have an understanding of the most effective forms of communication for each resident. One of the residents is shortly going to have a new electronic form of communicator. The staff were observed to clearly explain decisions to the residents. There was a particular situation taking place during our visit and the staff followed the care plan and spent a great deal of time explaining the situation to the resident involved. Staff spent a lot of time during our visit with the residents, either supporting them to do something or just chatting about their day. Staff gave examples of how the views of the residents are sought on a regular basis and how they try to involve them in decision making about issues that affect their lives. There is also evidence that the families of the residents are involved in decision making where appropriate. A referral has been made to an advocacy service on behalf of one of the residents. The residents are encouraged to take part in household tasks such as shopping, cooking and helping to keep their rooms tidy. One of the residents has recently been involved in the recruitment of staff who are going to be employed to provide the resident with one to one support. We looked at the arrangements in place for looking after the residents money. The Manager is appointee for three of the residents. Regular audits of the records is undertaken but it would be more effective if this was also carried out by someone who is not responsible for looking after the money on a day to day basis. We saw the records and cash held for one of the residents. Appropriate records and receipts are kept. There is information within the care plan about the arrangements in place to support the resident with their money. Each of the residents has their own safe in their bedroom in which they are able to keep their valuables. There is also a safe to which only the Manager and deputy have access. Care Homes for Adults (18-65 years) Page 18 of 35 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 . The residents are supported to take part in a range of leisure and educational activities. The residents enjoy their meals and are encouraged to make choices about menus. Evidence: Two of the residents still attend school on a full time basis and the other two residents attend local colleges and day services. Discussions with staff confirmed the information within one of the care plans about the process that was followed when one of the residents left school but did not like the original college placement that they had. The resident now attends a mix of activities during the week which includes one day when they are supported by staff on a one to one basis to take part in leisure activities. The Home has transport to enable the residents to attend college and to take part in leisure activities at weekends. There are always staff on duty during the day so that if any of the residents are unable to attend school or college then they can stay at home Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: and have appropriate support. The rotas confirm the discussions we had with the Manager and staff about the usual staffing levels. During the week there are usually two staff on duty during the morning and three during the afternoon. At weekends there are three staff on duty from 7am to 10pm to enable residents to be able to take part in leisure activities away from the Home as well as within the Home. The Manager said that they are currently recruiting for additional staff to work at weekends and during school holidays which is when they really need the extra staff to enable residents to have one to one support. In addition to this one of the residents has funding to have a one to one member of staff during the evenings. The resident is involved in recruiting these staff and currently chooses only to have this support for a few days each week until suitable staff can be found to provide the support all week. The Home has a communal lounge and seperate dining room. There is another room which, in recognition of the increasing age of the residents, has recently been turned from a playroom into a sensory, music room. The Manager said that they are reviewing the play equipment in the garden as it needs replacing with more appopriate equipment. One part of the garden has been used to grow vegetables and another part has been made ready to have chickens. On the first day of our visit one of the residents was spending time with their family and two residents went to see the turning on of the Christmas lights in Norwich during the evening. The care plans contain information about the leisure interests of the residents and how they like to spend their time within the Home and in the local community. There is also information about the arrangements in place to enable the residents to maintain contact with relatives. We received two completed surveys from relatives. One of these state that the Home are good at keeping in touch with them and the other states that this doesnt happen all the time. Currently the staff are responsible for shopping and preparation of meals. The residents choices of meals are included in the weekly plan of menus and they are encouraged to take part in meal preparation and cooking if they wish to do so. There is fruit available in the dining room for residents to have when they wish to. The care plans contain some information about the dietary needs of the residents and the support that they need at mealtimes but this is not clear for all residents. Care Homes for Adults (18-65 years) Page 20 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The personal and healthcare needs of the residents are met in a way which respects their privacy, dignity and personal preferences. Improvements in some of the recording relating to medication would provide increased protection to the residents. Evidence: The care plans contain information relating to the residents personal and healthcare needs although some of the information relating to healthcare appointments needs to be updated. The care plans contain evidence that health and social care professionals from the childrens and adults disability teams are involved in the residents care and that their guidance is incorporated in to the care plans. For example, one of the residents has very complex epilepsy and there is lots of information about this and the support that they need to manage this safely. The care plans contain information about the personal care needs of the residents and how they like to have this care provided. Staff said that male staff do not provide personal care to female residents. Male staff who spoke to us were quite clear about the limits of their role with regard to this issue. Staff are also aware of the importance of respecting the privacy and dignity of the residents. The staff are aware of the importance of appearance to young people of this age and efforts are made to support Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: the residents with clothes, hairstyles and makeup. The emotional health of the residents is also considered within the care plans. For example, one of the care plans contains guidance about how to support a resident with dealing with situations that they find difficult. The guidance is clear about the recognition that it is alright for the resident to be angry about a situation but that it is the inappopriate behaviour in response to this that they need support with. Discussions with staff show that they have an understanding of this. We looked at the arrangements for looking after residents medication. This is stored in a locked cupboard. One of the staff is responsible for ordering medication. Only staff who have completed medication training are allowed to administer medication. The record of medication doesnt include the strength of the prescribed tablet but does include the rest of the necessary information. When residents need to take medication to school/college or home when staying with relatives the staff keep a record of what is given to their support person but there are no records of confirmation that the support person has received them. Some sheets of tablets were not in the original box in which they were dispensed in and so it was not clear as to who the medication belonged to, nor what the dosage should be except for what is written on the Medication Administration Record. There are two different sets of guidance for one of the medications that one of the residents takes and these are slightly different as the situation has been reviewed but the original documentation is still available. The training matrix that we were given shows that the majority of the staff have completed medication training and have also completed training so as to be able to administer specific medications for one of the residents. Care Homes for Adults (18-65 years) Page 22 of 35 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 . Staff training and the systems in place for raising any concerns or complaints provide protection for the residents. Complaints are taken seriously and action taken to address issues as they arise. Evidence: The Commission has not received any complaints about the service. We looked at the complaints record kept by the Home and saw that the Manager takes all concerns and complaints seriously. Records are kept of any concerns/complaints that are raised and records are kept of the outcome of investigations. One of the completed relatives surveys states that they are not aware of the complaints procedure and one could not remember if they had been given a copy. The Manager gave examples of improvements that have been made with regard to communication with relatives so that any issues can be identified at a very early stage and action taken to address them. The organisation has a complaints procedure and this is another document which the Manager intends to make available in an easier format. Staff have been receiving training with regard to Safeguarding Children on a three yearly basis but the Manager said that this is going to be provided on a more regular basis. Safeguarding Adults training has started to be provided as two of the residents are now over the age of 18. Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: We had discussions with four members of staff and they were all clear about the standards of care that are required and what constitutes an allegation of abuse. The staff were all clear that they would feel able to report any concerns that they may have. The senior staff were not clear about the role of the local Safeguarding team with regard to investigating allegations of abuse. Care Homes for Adults (18-65 years) Page 24 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The accommodation meets the residents needs but is in need of redecoration in many areas. Evidence: We looked around the Home. One of the residents showed us their bedroom. Each of the residents has their own bedroom with an ensuite toilet and shower. The residents have been encouraged to personalise their bedrooms. One of the residents has specialised equipment with regard to mobility, such as an electric bed. This resident also has a call bell as they are unable to get out of bed unaided. Due to the specific needs of one of the residents a new bath has been purchased so that all of the residents now have the choice of a shower or a bath. On the day that we visited one of the ensuite shower rooms was out of use due to maintenance work being carried out. This bedroom is also due to have new flooring fitted. The Home has a communal lounge and seperate dining room, there is a sensory/music room and a quiet room which is mainly used when visitors come. There are two offices and a room in which medication is stored. The staff room is used as a staff sleep in room also. In general the Home is looking in need of redecoration and there are areas which are Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: not very homely. For example, several doorways and corridors have damage from the wheelchairs. The kitchen has at least one cupboard door missing and the flooring has been patched in one place where the cooker has been moved. There were several areas in the kitchen which would benefit from improved cleaning. There are two areas on the wall in the lounge where replastering has taken place but no redecoration. Some areas of the Home have photographs and ornaments around which does make it look homely but this is not consistent throughout the Home. The bathrooms also look a bit basic and functional. The Manager is aware of the improvements that need to be made, and requests have been made for this work to be undertaken. Care Homes for Adults (18-65 years) Page 26 of 35 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 . Staff receive appropriate training and support to carry out their roles. Appropriate recruitment procedures are followed prior to staff starting work at the Home. Staff know the residents well and are enthusiastic about their work with the residents. Evidence: The Manager had stated within the Annual Quality Assurance Assessment the number of staff who have left the Home in the last year and that this has meant that the use of agency staff has been high. However, discussions with staff and the Manager show that this has reduced recently and that ongoing recruitment is successful with several new staff having started work at the Home. The staffing rotas confirm the information that staff gave us about the staffing levels at the Home. There are usually two staff on duty during the mornings on weekdays and three on duty in the afternoon/evenings. There are three staff on duty morning and afternoon/evenings at weekends. In addition to this there is often an additional member of staff on duty during the evening. There is one waking night staff and one sleep in staff on duty overnight. The Manager explained that the addition of the sleep in staff took place earlier this year. As previously mentioned in this report one of the residents also has funding for a one to one member of staff for each evening. The resident has been involved in the recruitment of staff to this post. The staff said that when agency staff are used this tends to be staff who have already worked at the Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: Home and who know the residents. The rotas confirm this. Some of the permanent staff at the Home had originally worked there as agency staff. Staff told us that there have been some unsettled times within the team over the last few months but that this has improved. The deputy manager left the Home a few months ago and following this the roles of the deputy manager and two senior support worker posts have been reviewed with greater clarity about their individual responsibilities. A new deputy manager is due to start work within the next month. Regular staff meetings have taken place but the provision of formal supervision to staff has not taken place on a regular basis. Staff said that they have received support from the seniors and the Manager but that this has not always been formally recorded. The Manager and seniors now have a plan for future staff supervisions and are keeping records of the reasons for sessions not taking place. The staff who spoke to us were enthusiastic about working at the Home with the residents and are keen to make improvements in the lives of the residents. One of the staff had only recently started work at the Home and said that they are receiving good support and induction from the staff team. We observed staff supporting the residents in a calm, kind and friendly manner. We were given a training matrix which shows that the majority of staff have received mandatory training but that this may have been two or three years ago. The Manager said that she is having discussions with the training department about how some of the training is provided. For example, staff only receive moving and handling training every three years but the Manager recognises the need for increased training for those staff working with residents with mobility needs. The Manager is a moving and handling trainer and so provides training on a more regular basis for the staff team at the Home. As several of the staff team are new they have not yet completed their induction and their mandatory training. We looked at a sample of staff files and these show that the appropriate checks are carried out prior to staff working at the Home. Criminal Records Bureau checks are carried out at an enhanced level as well as two written references being obtained. Care Homes for Adults (18-65 years) Page 28 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The Home is well managed in a way which puts the needs of the residents first. Maintenance of equipment takes place but record keeping is not sufficient with regard to health and safety. Evidence: When the Home first opened there was one Manager shared between this Home and the other Home next door. In June 2007 this was changed so that each Home has their own Manager. Amy Howarth originally worked as the senior suport worker and has also been a deputy manager in another home belonging to the organisation. In 2007 she was promoted to become the Manager at this Home. Ms Howarth has a professional qualification and has also completed management training. She is due to start the Registered Managers Award shortly. Staff who spoke to us spoke highly of the management style of the Manager. They said that she has an open style and encourages staff to talk to her about any issues. They said that she works shifts on occasion but is always happy to provide support to the residents as needed. We observed the Manager providing support to the residents and she clearly knows the residents well and they responded positively to her. Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: A new deputy manager starts work at the Home within the next few weeks and this role as well as that of the two seniors has been reviewed. There is now more clarity about the different roles and responsibilities. Currently only the Manager provides on call support but this will be part of the role of the deputy so will be a shared responsibility. The Manager receives formal supervision from her line manager. The Manager had completed the Annual Quality Assurance Assessment in a detailed way which provides a good review of the service provided and an awareness of areas which are in need of improvement. The Manager is due to meet with her line manager to discuss the best system of quality assurance to use at the Home. She wants this to include information gathered from residents, staff, relatives and health/social care professionals about their views of the service. It is not clear who will be carrying out the monthly visits to the Home as per Regulation 26 as this has recently changed since the Home became registered as an Adult Care Home. We looked at a selection of health and safety records. These show that records have not always been kept updated although regular maintenance and servicing of equipment has taken place. The clarifying of responsibilities of the senior care staff means that there is a named person who is responsible for ensuring that the checks are now carried out on a regular basis. The Manager said that the hot water temperature is regulated and that the radiators are all covered to provide protection from burns and scalds. Care Homes for Adults (18-65 years) Page 30 of 35 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 31 of 35 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 Description 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 Description Timescale for action 1 20 13 It is required that medication 31/12/2008 is stored in the original packaging This is to ensure that the medication is administered as per the prescribring instructions 2 24 23 31/03/2009 It is required that redecoration and new flooring is provided to those areas of the Home in need of it. This is to ensure that the residents live in a Home which is well decorated and maintained. 3 39 25 It is required that monthly visits are carried out by a representative of the organisation and that a report is provided to the Home following the visit 30/01/2009 Care Homes for Adults (18-65 years) Page 32 of 35 This is to ensure that the senior management of the organisation have an understanding of the quality of the service being provided 4 42 13 It is required that records relating to health and safety are kept up to date 31/12/2008 This is to ensure that routine checks are carried out to provide protection to the residents and staff 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 It is recommended that the format of the care plans is reviewed to ensure that when information is updated that this is clearly identified. It is recommended that the cash point cards are kept in the main safe to reduce the amount of people that have access to them and therefore provide further safeguards of the residents money It is recommended that the information within the care plans about the residents dietary needs and the support that they need at mealtimes is made more clear It is recommended that clearer records are kept of medication which is handed over to someone else on behalf of the residents. It is recommended that the information relating to the use of PRN - as prescribed - medication is clarified in order to prevent confusion and possible errors. It is recommended that the senior staff become more familiar with the local Safeguarding Adults procedure to ensure that the correct action is taken if an allegation of abuse is made. 2 7 3 17 4 20 5 20 6 23 Care Homes for Adults (18-65 years) Page 33 of 35 7 8 9 24 30 35 It is recommended that the accommodation is made more homely It is recommended that the kitchen is kept in a cleaner condition It is recommended that the training provided to the staff is reviewed to ensure that appropriate training is provided in a timely manner. This includes the provision of mandatory training and that which is specific to the residents individual needs. It is recommended that formal supervision is provided to staff on a two monthly basis 10 36 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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