Inspection on 13/11/08 for Westbury Lodge

This inspection was carried out on 13th 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

Westbury Lodge 19/11/07

Westbury Lodge 24/01/07

Westbury Lodge 10/05/06

Westbury Lodge 13/12/05

Westbury Lodge 28/06/05

Westbury Lodge 25/10/04

Westbury Lodge 20/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Honeybourne House

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Westbury Lodge 130 Station Road Westbury Wiltshire BA13 4HT     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: Elaine Barber     Date: 1 4 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Westbury Lodge 130 Station Road Westbury Wiltshire BA13 4HT 01373859999 01373864512 westburylodge@craegmoor.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Clare Louise West Type of registration: Number of places registered: Parkcare Homes Ltd care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: Only the one named service user, referred to in the application dated 9 August 2005, may be in receipt of care due to having been assessed by a person qualified to do so as suffering from a disganosed clinical mental illness necessitating care and/or treatment. Date of last inspection Brief description of the care home Westbury Lodge provides care and accommodation for up to nine adults who have a learning disability. One person using the service has associated mental health needs. Some others also have sensory impairments. The home is owned by Parkcare Homes Ltd, a division of Craegmoor Healthcare, who operate a group of homes locally and across the country. Accommodation in the home is on two floors, with seven bedrooms on the first floor, and one bedroom and a semi independent flat downstairs. People with rooms on the first floor must be able to climb stairs without assistance, as there is no lift. The flat has a shower room, and the other ground floor bedroom has an en Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 0 9 1 Brief description of the care home suite shower. There are two bathrooms for general use upstairs, both of which also have showers. The ground floor also has a sitting room, dining room, kitchen, and laundry. There is a secluded and secure garden. The home is on the edge of a residential area, about ten minutes walk from the centre of Westbury. Bus stops and a main line rail station are a few minutes walk away. A small car park is available at the front of the building, with a driveway on to a busy road. Information for people who use the service is displayed in the home, including some in picture formats. Key issues are discussed individually, or within residents meetings. CSCI inspection reports are included in these discussions when they are received, and a copy is always available in the home. Fees charged for care vary, depending on the assessed needs of individuals. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We asked the home to complete an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how well they were performing. It gave us information about what has happened during the last year, and about their plans for the future. We sent surveys to the office to give to people who used the service. We received none back. We made two visits to the home. The first was on 13th November 2008 when they did not know that we were coming and the second was the day after. We looked at records, policies and procedures and talked to the manager, and four members of staff. Care Homes for Adults (18-65 years) Page 6 of 31 We spoke to three people who used the service and observed some of the routines of the home. The judgments contained in this report have been made from all the evidence gathered during the inspection, including during the visits. The last time that we inspected this home was on the 19th and 22nd of November 2007. What the care home does well: There was a statement of purpose and each person had a statement about the services provided and anything they would need to pay extra for. People had the information that they needed to decide whether the home could meet their needs. Peoples needs were assessed so that their needs would be met. Each person had a very detailed person centred plan including information about their life history, relationships, support needed and weekly activities. this meant that most of peoples abilities, needs and goals were reflected in their individual plans so that their needs would be met. Each person also had a series of risk assessments with the action to be taken to reduce risks and keep them safe. People were supported to make choices and decisions about their lives. People were supported with a range of day time and leisure activities and opportunities. these included, college, a work placement, trips out, walks, puzzles, bingo and swimming. They used community facilities such as the shops, pubs, cinema and cafés. People were able to maintain and develop appropriate relationships with family and friends. They were supported to choose a variety of meals and were offered a healthy diet. Peoples health care needs were being met. Each person was registered with a GP and saw a range of health care professionals according to their particular needs. People were generally protected by the homes policies and practices for managing medication. People were safeguarded by the home’s policies and procedures for complaints and protection. Each person was given information about how to make a complaint and any complaints would be investigated. Staff knew about the procedures about protection from abuse and had received training. There was a large lounge and dining room and these had recently been redecorated. Each person had their own room which was individually decorated and furnished. People were living in an environment which was mainly comfortable, clean, safe and suitable for their needs although some areas required attention. There were suitable laundry arrangements and most of the home was clean and hygienic. People were supported by suitable numbers of appropriately trained and qualified staff. There were between three and four members of staff on duty during the day and two at night. Staff had received a range of training and most of them had National Vocational Qualifications (NVQs). References and criminal records bureau checks were obtained before staff started work and people were protected by effective recruitment practices. The manager was appropriately experienced and had almost completed a relevant qualification. She had made several changes to the organisation of the service so that people were benefiting from a well run home. There was a comprehensive quality assurance process and peoples views were being sought about the service so that the service was being run in their best interests. There was a range of health and safety Care Homes for Adults (18-65 years) Page 8 of 31 checks and measures so that people and the staff were protected. What has improved since the last inspection? What they could do better: A record should be made of each persons ethnicity in their care plan and any cultural needs should be identified so that these needs can be met. The risk assessments should contain information about the benefits to people of being involved in activities that may pose a risk to ensure that their independence is promoted. Advice should be sought from the continence advisor for the benefit of one person. We noted one error in the medication administration records and the manager planned to follow this up with the member of staff concerned to ensure this did not happen again. Any controlled drugs must be stored in a cupboard that meets the current storage regulations: the Misuse of Drugs (Safe custody) (Amendment) Regulations 2007. A cupboard should be provided so that if controlled drugs are prescribed they can be stored properly. All parts of the kitchen must be kept in a good state of repair and be reasonably decorated so that people are safe and comfortable when using the kitchen. The strong odour in one of the bedrooms must be eradicated so that the person who uses the bedroom can sleep in a comfortable and pleasant environment. Consideration should be given to replacing the flooring in this room. Staff should receive supervision every two months so that people benefit from being cared for by staff who are well supported. The thermostatic valves on the hot water taps should be regularly serviced to ensure Care Homes for Adults (18-65 years) Page 9 of 31 that they continue to work and people are protected from being scalded. 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 10 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had the information that they needed to decide whether the home could meet their needs. Peoples needs were assessed so that their needs would be met. Evidence: We saw that there was a statement of purpose which contained most of the required information except the size of the rooms and the qualifications and experience of the staff. We looked at three personal files. We saw that each person had a copy of the complaints procedure in words and pictures. They also had a statement of services which told them about the services that were provided and any extras that they would have to pay for. When we looked at the files we saw that two people had detailed assessments of their needs. The needs of the third person were assessed when they moved into the home and they had assessment information as part of their person centred plan. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most of peoples abilities, needs and goals were reflected in their individual plans so that their needs would be met. However, more attention is needed to peoples cultural needs. Risks were identified and action was taken to keep people safe. People were supported to make choices and decisions about their lives. Evidence: We looked at records of three people. These contained sections including life history, relationships, support plans, weekly activities and risk assessments. Each person had a detailed person centred plan covering all aspects of their care and how they liked to be supported. There were sections in the plans about the persons religion and the language that they spoke. There was also a section about ethnicity. In one persons plan this had been filled in as not applicable so any cultural needs were not being identified and addressed. The statement of purpose said that care plans were reviewed at least annually. We Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: saw in the plans that a record was kept in each section of the plan of the date when the section was reviewed. Records were also made of monthly evaluations. The manager told us that staff update the care plans monthly if needs changed. A member of staff told us that one persons key worker was in the process of updating their plan because they had been in hospital recently and their needs had changed. When we read their plan we saw that some parts had been updated. We saw that each person had a series of risk assessments, for example about medication, swimming, scalding, and road use. The risk assessments identified the hazards and the seriousness of the risk posed and the control measures needed to reduce the risks. However, they did not contain information about the benefits to the person of participating in activities which may pose a risk. Each person also had a manual handling assessment. A record was made when the risk assessments were reviewed. A member of staff told us that choice is promoted in the home. They told us that people had chosen the decor for their bedrooms and their furniture. There were records in their files about how they had made these choices. In one persons records we saw that they had chosen the decor and furnishings for their room using pictures from a catalogue. We saw examples in the daily records of other choices people had made. These included the times that they got up and went to bed, and choices of meals and activities. One member of staff told us about one person who did not like to go out. They said that staff had encouraged them and taken them out to show them different opportunities. The person now liked to go out and visit different places. Another person who used to go to day time activities now chose not to go and a record was made of this in their daily notes. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were provided with a range of day time and leisure activities and opportunities. They used community facilities such as the shops, pub and cafés. People were able to maintain and develop appropriate relationships with family and friends. They were supported to choose a variety of meals and were offered a healthy diet. Evidence: When we looked at three files we saw that each person had an activity plan. One persons activity plan did not specify any activities but said personal choice. One persons plan included arts and crafts and music therapy. Another person had a work placement and a member of staff told us that this person was at their placement on the first day of our visit. We spoke to one person who told us that they went to college. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: We made a recommendation at the last inspection that the home should continue to develop the range and frequency of activities and opportunities offered to people. This was being addressed. Two members of staff said that a third member of staff had started to plan activities for each day and to allocate staff to support people and to ensure that the activities happened. The third member of staff confirmed this and we saw some of these daily plans. These plans showed that staff supported people with swimming, shopping, food preparation, a work placement, lunch out, going to cafés, doing puzzles, doing the washing, preparing food and going out for drives. On the first day of our visit staff took five people out for a drive in the country. The daily activity plans also showed that staff supported people with relaxation and sensory sessions, karaoke, foot spas, tidying their rooms and walking to the pub. A member of staff told us that staff were able to take people out on a one to one basis as well as in groups. Another member of staff told us that people would often choose not to attend the activity in their plan, for example going to college. They said that the staff group was rethinking the activity plans so that people could do activities suited to their changing needs. They also told us that the manager was requesting that peoples needs were reviewed by social workers as their needs had changed since they moved into the home and some people required more support from staff with activities. The individual activity plans showed that people had outings into the community including visits to the pub, cafés, restaurants, the cinema, shops and church. The daily records showed that people also went to a social club and to the local shop. On the second day of our visit staff had supported some people to go swimming. One of these people told us that they planned to go for a spa session at a nearby sports centre. When people participated in leisure activities this was recorded in their daily notes. We read the daily notes of three people and saw that they had a range of leisure activities both inside and out side the home. At home these included board games, television, going for walks, sitting in the garden, bingo, films, arts and crafts and making pizzas. People also went out for lunch to cafés, went to the pub, had music therapy sessions, went personal shopping and had a choice of outings. When we read the files we saw that people kept in contact with their families and friends. One person had regular phone calls and visits with members of their family. Two other people had information in their care plans about the support that they needed to keep in contact with their family. One person told us that they kept in contact with their sisters and brothers. They said that they sent them cards and bought them Christmas presents. A member of staff told us that everyone kept in contact with their family and they had friends through their work or college and through a social club that they attended. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: The records showed that a dietitian had visited and provided advice about the menu and the changes needed to improve peoples diets. We looked at the menu and saw that this advice was being followed. A member of staff told us about changes that had been made to the menu to include more fruit and vegetables. Each person had an individual record of the meals that they had eaten. We looked at three peoples records and saw that their meals were varied and reflected a balanced diet. An environmental health officer had visited in March 2008 and given the home a five star rating for food hygiene. At lunch time we observed staff offering people a choice of drinks and puddings. We saw that people were able to use the kitchen and to help themselves to drinks and snacks. A staff member told us that people chose their meals from pictures in magazines. One person told us that people chose the menus once a week and they enjoyed choosing their food. They said that they cooked once a week and they liked to make cakes. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health care needs were being met. People were generally protected by the homes policies and practices for managing medication. Evidence: When we looked at the person centred plans we saw that there was detailed information about how people liked to be supported. A staff member told us that they had received training about person centred planning and this made them more aware of peoples individual needs and how they liked to be supported. We saw from the records that each person was registered with a GP. Each person had a health action plan. These recorded any needs people had to keep healthy, for example with sight, hearing or foot care. There was a section in each person centred plan which recorded any action people needed with their health care. This included support to attend appointments with the dentist, optician or chiropodist. Appointments with health care professionals were recorded. We saw that people saw the GP, a consultant psychiatrist, a chiropodist, a dentist, an optician, a dietitian, a Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: community nurse and a speech and language therapist. We noted that there was an odour in one persons bedroom. A member of staff told us that they had sought advice from the continence advisor for the benefit of this person. We looked at three peoples records and we saw that each person had a record of the medication that they took in their person centred plan. Each person also had a medication risk assessment. We saw in one persons plan that they liked to take one of their medicines in cranberry juice and their risk assessment stated that they chose to take it that way. However, there was no information from the GP or the pharmacist about whether this was an acceptable way to administer this medicine. A member of staff told us that the GP had not given advice about this. On the second day of our visit the deputy told us that they had contacted the GP who agreed that this was acceptable practice and they were sending a letter to confirm this. Medication was stored in a locked cupboard in a walk in cupboard. There was a separate section in the cupboard for each persons medication and it was stored in an orderly way. A monitored dosage system was used and there were medication administration records. These were on the whole well recorded. Any changes to the record sheets which were handwritten by a member of staff were signed and dated by the staff member and countersigned by another member of staff. The changes could therefore be cross referenced with the persons records to show when the doctor made the change. A member of staff had signed the record each time they administered medication to a person. There was one gap where a member of staff had not signed. The manager said that they would follow this up with he member of staff concerned as there was a procedure for retraining staff if they made an error. There were also records of medicines received into the home, returned to the pharmacist and destroyed. We made three requirements about medication at the last inspection. The first that all medicines which are not used often must have clear guidelines for use and be reviewed regularly with the prescriber. This had been addressed and staff had requested a review and advice. The consultant had provided instruction for two of these medicines and reviewed their use regularly. The second requirement that risk assessments and procedure must be in place for any medication given to residents to take themselves was no longer relevant. No-one now was managing their own medication. The third requirement that all controlled drugs must be stored in a cupboard that Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: meets the current storage regulations: the Misuse of Drugs (Safe custody) (Amendment) Regulations 2007 was not relevant at this time. A cupboard had not been provided as there were no controlled drugs. An appropriate cupboard will need to be in place if controlled drugs are prescribed in the future. Care Homes for Adults (18-65 years) Page 20 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were safeguarded by the home’s policies and procedures for complaints and protection. Evidence: There was a complaints policy. Each person had a copy of the complaints procedure in their personal file. The procedure was in simple words and pictures. A record was kept of all complaints. There had been no complaints since the last inspection. There was a policy about protection of vulnerable adults. Information was available for staff about safeguarding vulnerable adults and the local multi-agency procedures. A member of staff told us that staff received in-house training about safeguarding adults. When we looked at the training schedule we saw that all the staff except one, who had started work recently, had received training about protection from abuse. The manager told us that there had been one referral to the local vulnerable adults unit and the police were investigating this. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were living in an environment which was mainly comfortable, clean, safe and suitable for their needs although some areas required attention. Most of the home was clean and hygienic. Evidence: We saw that the home was a large detached house set in its own grounds close to the station in Westbury. Maintenance and decor were generally good and there was an ongoing programme to address any tasks needed. The home employed its own handyman. There was a large lounge and a separate dining room. The bedrooms were individually furnished and decorated. We made a requirement at the last inspection that the lounge and the kitchen must be kept in a good state of repair and reasonably decorated. The manager told us in the AQAA that the lounge, bedrooms and dining room had been redecorated since the last inspection. They also told us that there were plans to refit the kitchen and replace the hall and stair carpet and the dining tables and chairs. We saw that the lounge and dining room were well decorated although the radiator cover in the dining room had been removed. A member of staff told us that this had broken and was due to be replaced. They also told us that the other radiator covers were to be replaced too. We Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: saw that the kitchen was still in a state of disrepair. A member of staff told us that there were plans to replace it but these had not yet been approved by the organisation. We saw that the accommodation was clean throughout. There was a large separate laundry room away from food storage and preparation areas. There were arrangements for the separation of dirty and clean washing. There were infection control guidelines and staff received infection control training. A member of staff told us that two people were supported to do their own laundry. One of the bedrooms smelled strongly and a member of staff explained that the odour had penetrated the carpet. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were supported by suitable numbers of appropriately trained and qualified staff. People were protected by effective recruitment practices. Supervision of staff needs to be more frequent so that people benefit from staff who are well supported. Evidence: Three different members of staff told us that there are three or four staff on each shift during the day and one member of staff awake and one asleep at night. When we looked at the rota we saw that three or four staff worked during the day and two worked at night. At different times during our inspection we noted that there were three or four members of staff on duty. The manager told us that they needed to recruit the equivalent of 1.5 members of staff. We saw a training schedule which showed that most staff had training about manual handling, health and safety, Control of Substances Hazardous to Health (CO SHH), basic food hygiene, first aid, protection of vulnerable adults, infection control, equal opportunities and fire safety. There was additional training about crisis prevention, medication and Makaton, a form of communication through signs. We saw the training certificates which confirmed the training that individual staff had received. We met one member of staff who had just started work. They told us that they were in the process Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: of their induction. We saw an induction folder which was based on the common induction standards. We made a recommendation at the last inspection that the home should continue with planned steps for National Vocational Qualification (NVQ) training to ensure it remains above the 50 target of staff with NVQ level 2 or above. This had been addressed. The manager and the deputy told us that most of the staff have NVQ level two or three and one was working towards level 2. We saw the certificates which confirmed this. There was a comprehensive recruitment procedure. We looked at the recruitment records of three new members of staff. Each of the staff had completed an application form that contained a declaration that they had no convictions. Proof of identity had been obtained, for example a copy of their passport, photo driving license or marriage certificate. One member of staff had two written references, a Protection of Vulnerable Adults (POVA) first check and a Criminal Records Bureau (CRB) check before they started to work with people. Another member of staff had two written references and a POVA first check. They had started to work with people and worked under supervision until their CRB check was received as is allowed by the regulations. A risk assessment had been written about working under supervision before the CRB check was returned. We met the third member of staff during the inspection. Two written references and a POVA first check had been obtained for them before they started work. The manager said that head office had received a clear CRB check but she had not yet seen a copy. The member of staff was in the process of their induction and was working as the fourth member of staff, under supervision until a copy of the CRB was obtained. We saw a plan of supervision for staff this showed that they aimed to provide supervision for each staff member every two months. However, when we looked at the supervision records we saw that this had not been happening as regularly as planned. Supervision records were very comprehensive. One staff members records showed that they had supervision in June 2007 then not again until August 2008. There had been no deputy in post for several months to provide supervision. Another staff members notes showed that they had supervision in August 2008 and October 2008. A third staff member had supervision in August and September 2008. The new deputy told us that this was an area for development and they planned to improve this. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were benefiting from a well run home. Peoples views were being sought about the service so that the service was being run in their best interests. People and the staff were protected by the systems for maintaining health and safety. Evidence: The manager had an NVQ Level four in management and had almost completed the Registered Managers Award. Two of the staff, on separate occasions, told us that the manager had made several changes since they took up post and the home was much more organised and was running well. We looked at the records and saw that there were various processes for auditing and monitoring the quality of the service. There was a clinical governance team to oversee these. The manager had to submit weekly and monthly reports. There were visits by senior managers and the area manager visited at least once a month. There was an Overview Audit that set out targets for improvement and actions to be taken to meet Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: these. We made a requirement at the last inspection that systems for quality assurance and service development must include the views of people who use the service. This was being addressed. A new audit tool based on outcomes was being introduced. A quality improvement plan was developed from all the audits. this was very comprehensive and included the experiences of people who lived in the home and looked at service user involvement, lifestyle and person centred planning. A staff member told us that questionnaires were sent to families once a year and the results were fed into the quality improvement plan. They also told us that staff were obtaining feedback from people, for example about the food they liked. They also obtained feedback during annual reviews. There were health and safety policies and procedures. Staff received training about health and safety. There were safety measures in place including thermostatic valves on taps and radiator covers. One of the radiator covers in the dining room was missing and there was a plan to replace this and all the radiator covers. A member of staff told us that the thermostatic valves on taps were not serviced. Portable appliances had been checked within the last three weeks and staff were waiting for the report. A survey of asbestos had taken place, there were gas safety checks and the boiler was serviced. The hot water was checked for Legionella and staff checked the hot water temperatures and electrical sockets. There were health and safety audits and a fire risk assessment had been completed. The fire safety measures were checked at the intervals advised by the Fire Officer, there were monthly fire drills and staff had fire instruction. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The statement of purpose must contain information about the qualifications and experience of staff and the sizes of the rooms. So that people have all the information they should about the home. 31/12/2008 2 20 13 Any controlled drugs must be stored in a cupboard that meets the current storage regulations: the Misuse of Drugs (Safe custody) (Amendment) Regulations 2007. So that controlled drugs can be stored safely. 27/02/2009 3 24 16 The registered person must make sure that all parts of the kitchen are kept in a good state of repair and reasonably decorated. So that people are safe and comfortable when using the kitchen. 28/02/2009 Care Homes for Adults (18-65 years) Page 29 of 31 4 30 16 The strong odour in one of the bedrooms must be eradicated. So that the person who uses the bedroom can sleep in a comfortable and pleasant environment. 31/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 A record should be made of each persons ethnicity and any cultural needs should be identified so that these needs can be met. The risk assessments should contain information about the benefits to people of being involved in activities that may pose a risk to ensure that their independence is promoted. Further advice should be sought from the continence advisor for the benefit of one person. A cupboard that meets the current storage regulations for controlled drugs, the Misuse of Drugs (Safe custody) (Amendment) Regulations 2007 should be installed so that any controlled drugs that are prescribed can be stored safely. Consideration should be given to changing the flooring in the room with an odour. Staff should receive supervision every two months. The thermostatic valves on the hot water taps should be regularly serviced to ensure that they continue to work and people are protected from being scalded. 2 7 3 4 19 20 5 6 7 30 36 42 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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