Care Home: 112 Wellington Road

Similar services:

• Polesworth Group Friary Road
• Polesworth Group Pooley Heights
• Polesworth Group 32 Station Road
• Polesworth Group 70 Long Street
• Breme
• Polesworth Group 64 Long Street
• Polesworth Group 68 Long Street
• 10 Whitfield Avenue

What the care home does well The organisation and newly registered manager have positively managed change by dramatically improving standards of care within a short period of time. The home has increased its quality rating from poor to good in the six months since July 2008 and in that time has worked positively with partner agencies and regulators. The home is now being managed well. Systems are now in place to keep people happy, safe and healthy. What has improved since the last inspection? All areas have improved and all previous requirements issued to ensure improvement have been deleted. Most significantly the atmosphere within the home has changed. There are positive relationships between staff and managers. There is a new team of motivated staff who are working for the benefit of the people who live there. Staffing levels have improved to ensure people are safer as they are better supervised. Risks to people have reduced and the number of serious incidents has reduced too. Medication systems are now robustly managed. This is ensuring that residents receive their medication to promote their health and that risk of harm through errors is minimised. Peoples living environment has improved and is more pleasant for them. Odours have been eliminated, and new furniture had been purchased. Adaptations have been made to protect people from the risk of the road. What the care home could do better: It is vital now that improvements made are sustained, that the manager is provided with sufficient time to manage and monitor the service and that continuity of care is achieved by further reducing reliance on agency staff. Staffing levels are safe but are not offering people full freedom to choose what they do. Access to the community, although improved is compromised for two people with higher dependency levels. We have made some varied recommendations to the manager some of which are as follows, To ensure documentation is provided in formats which are suitable for the people who live there, rather than for the purpose of regulation. To individualise meals and review the purchase of foods to ensure fresh vegetables are provided.To consider how each person would be evacuated in the event of a fire and to seek advice about further minimising the risk of fire. To consider how people are supported to maintain contact with their families. To fully implement the remaining recommendations from a recent infection control audit, ensuring latex rather than vinyl gloves are provided for staff to use when providing support with personal care. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 112 Wellington Road 112 Wellington Road Bilston Wolverhampton WV14 6AZ     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: Deborah Sharman     Date: 2 0 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (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 30 Information about the care home Name of care home: Address: 112 Wellington Road 112 Wellington Road Bilston Wolverhampton WV14 6AZ 01384410418 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Adelle Louise Rowley Type of registration: Number of places registered: Inshore Support Limited care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 3. The registered person may provide personal care (excluding nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 3 Date of last inspection Brief description of the care home 112 Wellington Road is based in the Bilston area of Wolverhampton and is registered as a care home providing personal care and accommodation for 3 younger adults with learning disabilities. It is part of the Inshore Support Ltd group of housing whose main office is in Halesowen. The home is located close to the centre of Bilston on the main A41 road with good local amenities including access to the metro tram within a twominute walk. It opened in 2007 and consists of a two-storey domestic style terraced property. Each person living at the home has a single room with washbasins. Bathroom and separate toilet facilities are available for shared use. There is a private pleasant garden with patio seating area at the rear of the property. Residents need to be able to Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 3 Brief description of the care home access stairs as bedrooms are on the first floor with no lift facilities. The two bedrooms are both for single occupancy with bathrooms and toilets close by. There are two lounges, a kitchen and dining area. There is a small-enclosed garden to the rear of the house. Weekly fees as at August 2008 range from £2,122.01 to £2,184.97 Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: One Inspector carried out this unannounced key inspection from 10.00 until 18.30 on 20 January 2009. Our Pharmacy Inspector inspected how medications are managed on 23 January 2009 from 11.00 until 2.00pm As both inspection visits were unannounced this means that no one associated with the home received prior notification and were therefore unable to prepare. As it was a key inspection the plan was to assess all National Minimum Standards defined by us as key. These are the National Standards which significantly affect the experiences of care for people living at the home. Information about the performance of the home was sought and collated in a number Care Homes for Adults (18-65 years) Page 6 of 30 of ways. Prior to inspection the Commission for Social Care Inspection was provided with written information and data about the home in an annual return. We sent surveys to staff who work at the home and also to independent health professionals who have contact with the home. The results were not available to us prior to the inspection but they were available to us at the point of report writing. It is currently our policy not to send surveys to relatives and no relatives were available to speak to on the day of inspection. We did not send surveys to the people who live at 112 Wellington Road because they would not have been able to make their opinions known using this format. Instead, we used a variety of other methods during the course of the inspection to make a judgement about how the people living there are cared for. The registered manager was available throughout the day to answer questions and support the inspection process. We also spoke to all staff on duty and observed their practice. We assessed the care provided to two people using care documentation but given previous concerns about health management we looked at the health support provided to all three people who live there. In addition, we sampled a variety of other documentation related to the management of the care home such as training, recruitment, staff supervision, accidents and complaints. We toured the premises and we were able to observe the care of residents during this time. All this information helped to determine a judgement about the quality of care the home provides. What the care home does well: What has improved since the last inspection? What they could do better: It is vital now that improvements made are sustained, that the manager is provided with sufficient time to manage and monitor the service and that continuity of care is achieved by further reducing reliance on agency staff. Staffing levels are safe but are not offering people full freedom to choose what they do. Access to the community, although improved is compromised for two people with higher dependency levels. We have made some varied recommendations to the manager some of which are as follows, To ensure documentation is provided in formats which are suitable for the people who live there, rather than for the purpose of regulation. To individualise meals and review the purchase of foods to ensure fresh vegetables are provided. Care Homes for Adults (18-65 years) Page 8 of 30 To consider how each person would be evacuated in the event of a fire and to seek advice about further minimising the risk of fire. To consider how people are supported to maintain contact with their families. To fully implement the remaining recommendations from a recent infection control audit, ensuring latex rather than vinyl gloves are provided for staff to use when providing support with personal care. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been no discharges or admissions to and from the home. More could be done to enable people who live at the home and their representatives to know their rights and responsibilities. Evidence: There have not been any discharges or admissions to the home, so we could not assess peoples experiences of this. The people living there are a settled, all female group who have lived there since it first opened. We looked at what is available to help people to choose whether to live at 112 Wellington Road and for those already resident, what is available to support their rights and responsibilities. Documentation such as a Statement of Purpose, Service User Guide and redesigned contracts outlining the terms and conditions of residency are all available. They continue to contain some shortfalls which have been explained to the Registered Manager. The new contract formats although now pictorial are not in a format that the people living there could understand and to date, no attempt has Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: been made to explain the content to them. Efforts have been made to identify and meet the needs of people living at the home from minority groups. Guidance for staff is improved following consultation where possible with families and they are aware of peoples key needs. For example we found one person has traditional dress to wear on special occasions and another person is being provided with culturally appropriate meals. However, we identified a one size fits all approach and the need to ensure that care provision is sufficiently individualised. This is discussed further later in this report. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has individual plans of care for people and staff know and understand what they need to do to meet the needs of the people who live there. Evidence: Written guidance is in place to help staff know how to provide appropriate and safe care. Peoples choices, preferences and rights are explicit within the guidance. The care guidance has been reviewed monthly to check for any changes but records indicate there havent been any changes in need. We talked about this with the manager and staff who confirmed that peoples key needs have not significantly changed. Steps have been taken to improve guidance for staff about the cultural needs of people from minority ethnic groups. Staff are aware of peoples needs as where possible families have been consulted and the information has been transferred into plans of care. The extent and limitations of peoples customs are understood by staff which is Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: positive as this shows us that care for these people is individualised. People who do not belong to these groups however must also have their individualised needs met. For example, we found someone who is not from these groups having rice and peas for Sunday dinner without evidence that this is the expressed wish of that person. Staff were able to explain the care that people need. From what we saw we could see that staff understand how people make choices on a day to day basis when they cannot use words to express themselves. For example we saw staff responding with patience when people tipped snacks on the floor to indicate they didnt want them. One person was given a cup of tea but handed it back and was given alternatives, which were declined. Another person receives daily light therapy and we saw this in action. We discussed this with staff who understood the function, purpose and benefits to the person receiving it. Staff have an improved understanding of risk management. Steps have been put in place to minimise the opportunities for risk and there has been fewer incidents. An alarm has been placed on the front door, locks attached to the rear gate which we found secure and a self closing gate and railings sympathetic to the style of the house have been put in to minimise risk to people from the busy road. Records show accidents to have been minor in nature. Given recent incidents the home has prioritised keeping people safe and have asked Social Services to assess the appropriateness of their actions where this may have implications for peoples liberty. We found a record of a recent incident involving two service users after they had gone to bed. What happened is unknown as there were no witnesses but one person sustained a minor injury which may or may not have been connected to the action. A risk assessment acknowledges the risk of this person going into the bedroom of others. It raises the question of supervision once people have retired and we discussed the need for fuller guidance based on an assessment of the risk, for staff. The manager has agreed to investigate the circumstances of this matter. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are beginning to take part in activities at home and have some improved access to the community. The frequency and variety of community activities could be further developed for some people. Evidence: Activity levels have improved significantly since the last key inspection for all three people living at 112 Wellington Road, who do not attend externally commissioned day activity. At the more recent random inspection we found that community access had improved enormously for one person and to a lesser extent for the two other people who live at 112 Wellington Road. This inspection found the same. At the last random inspection, two of the three people went out during the morning and at this inspection, the same two people went out, one to take her glasses for repair and to have lunch out and the other to do some shopping. Staff are more committed to providing Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: opportunities and we can see that people are receiving more stimulation at home with foot spas, hand massages, music and are encouraged to join in with cards and games provided. Two people who need the support of two staff each when accessing the community are enjoying more community access but the variety and frequency of this is still limited. For example, we found one person went out on five occasions in nineteen days for a ride in the car, a meal out, bowling and for a walk in the park twice. In the same period of time the other person went to a disco, to a country park, went shopping on one occasion and went for a ride in the car on five occasions. Positively all three people have had a holiday in 2008 separately from each other and staff are beginning to think about planning 2009 holidays. We could see that some people had received contact from their families. All contact appeared to be instigated by the families. We discussed this with the manager and she said she would liaise with families to review the arrangements. We could see that culturally diverse meals are being provided to meet the needs and preferences of people from different backgrounds. The norms and cultures of each person however need to be recognised and meals individualised. We found for example that everyone was having the Caribbean meal of chicken, rice and peas for Sunday dinner. Whilst everyone may enjoy this from time to time it may not meet the cultural norms and expectations of all residents and should be reviewed. A staff member commented that the person had stopped eating the rice and had been given potatoes instead. With only three residents it will be possible to provide individualised meals. The manager resolved to support the staff to achieve this consistently. Similarly the manager agreed to achieve consistency with the purchase of food. There was, other than salad for example no fresh vegetables available as this is determined by the preference of the staff member doing the shopping. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are receiving personal support in the way they prefer and require and their health needs are being met. Evidence: Good progress has been made to support peoples health needs. We looked at the health care provided to all three people living at the home. We can see that they have now had a range of routine health screening with for example the dentist, audiologist and optician to ensure any changes in health can be identified and acted on early. It is important now that having had some health screening for the first time that this is sustained and people are supported to attend all future check up appointments. Whilst we were there one person was going with a staff member into town to get her glasses repaired. The manager is working in partnership with Social Services to start to make decisions for those lacking capacity who do not consent to health screening and treatment. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: Advice and treatment from the GP has been sought when minor changes in health have been identified. It was positive to see an effective system in place to ensure medical test results have been sought without any unnecessary delay. Also the manager has reviewed areas of uncertainty with the peoples consultant and GP. We were able to see all three people on the day of inspection. They were all well dressed, clean and presented as being calm and comfortable. We talked to staff who said they had no concerns about peoples current health. Staff reported no deterioration in health but an improvement and were able to give examples of this. It was also positive to see medication prescribed as required for the management of behaviour to have been discontinued for one person on the basis that it hadnt been needed. This indicates the person is becoming more settled, that behaviours are being managed effectively and the subsequent reduction in the need to take medication is positive for the person concerned. We found that the recording of the receipt, administration and disposal of medicines had significantly improved compared to the last inspection. As a result of these improvements, we could see that all medication could be accounted for and that the people who used the service were receiving their medication as it had been prescribed by their doctor. We found there to be more information about the administration of medicines in the care plans and more information about changes being made to the original prescribed directions. We found that protocols for as required medication had been formulated and were in enough detail to ensure that the person receiving the medication would receive it safely and at the appropiate time. We found that all of the staff who were administering the medication had been subjected to a drug assessment by the manager. We also found that the staff had more confidence in the handling and management of the medication. As a consequence of these improvements we found that the home had met all of the requirements carried over from the last inspection. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured their views are listened to and acted upon. People are better protected as staff and managers are more familiar with what the risks are and how to minimise them. All incidents must be promptly investigated however to ensure protection is sustained. Evidence: At the last key inspection complaints and protection were judged to be poor. We were not satisfied that people living at the home were sufficiently protected. The manager and organisation since this time have worked cooperatively with investigating authorities to resolve concerns and steps have been taken to minimise known risks. The manager who sees herself as a new and developing manager has learned alot from the safeguarding investigation processes and can see how it has served to positively improve peoples safety. All staff have received relevant training and in discussion could explain what abuse is and their role in protecting people. Accident records alerted us to a recent incident with no witnesses where one service user was found with blood on them. We would have expected the manager to have investigated this to monitor to what extent the service users involved were supervised at the time. The manager will now investigate what happened and if necessary will ensure more detailed protocols known to staff are put in place for supervision after Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: residents have retired to bed. We looked at how peoples money is protected and are satisfied that effective systems are in place. We are satisfied that complaints are taken seriously and are investigated and recorded accountably. In the last 12 months there has been an anonymous complaint made to us about a number of issues including cleanliness, activities and recruitment checks. We passed most of the issues raised to the organisation to investigate. They fed back the outcomes promptly and had judged none of the complaints to be upheld. Records of their investigation were available to us at inspection. Some aspects of the complaints, we investigated ourselves at the random inspection in December 2008 and found there to be no substance in the issues raised. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable, homely and safe environment. Evidence: At the last inspection we considered the environment to be adequate. We now consider that a good living environment is being provided for the people living there to enjoy. There have been several improvements since we last inspected. The Primary Care Trust carried out an infection control audit at the home in December 2008. The outcome was a score of 71 percent or an amber rating. We have seen the action plan for improvement and apart from the provision of latex gloves for staff to use when providing personal care, most recommendations appear to have been met. Latex gloves, or the equivalent for staff with latex sensitivity must be provided, as the vinyl ones in use do not provide sufficient protection against cross infection for staff and people living there. The environment is spotlessly clean and is now odour free. Some carpets have been replaced with laminate effect washable flooring. Also, the old suite has been replaced with a good quality leather suite. This provides a clean and modern alternative that better supports the management of spillages. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: Institutional labelling of bedroom drawers and cupboards has been removed, providing a more homely and dignified place for people to rest and where storage units had been damaged, these have been replaced with new furniture. Steps have been taken to reduce the risks to people from the road including the provision of decorative railings, a self closing front gate, secured back gate and an alarmed front door. Social Serices have been asked to assess the suitability of this measures as there may be implications under new legislation for peoples liberty. The environment is now clean, safer and more pleasant and is, subject to planned assessments about liberty, better meeting the needs of the people who live there. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supporting by a motivated and developing staff team who feel well supported. Checks have been done to ensure workers are suitable to work with vulnerable people. Staffing levels are safe but do not fully promote peoples freedom to choose to go out. Evidence: At a recent random inspection, we looked at how new staff are recruited and could see that steps are taken to protect vulnerable people. We could also see that Criminal Record Bureau checks were in place for all staff. No new staff have started since we last inspected so we looked at how the service assures itself that checks have been carried out on agency staff that it uses to cover unexpected and planned staff absences. A log is available to show that Criminal Record Bureau checks have been carried out by the employing agency. A training programme is in place and records help the service to accurately identify what training has been provided and is needed. Since concerns were identified about the performance of the service, staff have received training and retraining to help them gain the required knowledge and skills for their job role to meet peoples needs. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Recently appointed staff have received training in a number of key areas and staff we spoke to feel that this has helped them to gain confidence in their role. One staff member has since we last visited received training in the management of behaviours. She said she had not escorted people out of the home until she had had this training and with the training, now feels confident to do this. Another staff member we spoke to who has not done this or medication training said she is not involved in supporting people outside the home alone and does not administer medication either, so is not taking responsibility for aspects of the job for which she is not trained. This serves to protect the people who live there from the risk of error. We spoke to a bank staff member who has not received training in the 15 months since she started. We could see that more recently appointed bank staff are receiving training and the manager has agreed to arrange retrospective training for the person we spoke to. New staff feel well supported. We could see that in the first three months of employment a new staff member has received formal and recorded supervision on six occasions and this exceeds the minimum target of six for the year. We looked at how often a more established staff member had received supervision and found this fell short of the national minimum target as there was evidence of supervision being provided on two occasions. The three people who live at 112 Wellington Road each need the support of one staff member when at home, this means that to be safe three staff are needed in waking hours. This is being provided as a minimum. Four staff are being provided for part of each day to support activity. This is supporting some activity, but as two people both need the support of two staff in the community, the ability to come and go is not fully and freely available to all of the people all of the time. Choices and compromises are required. Social Services are aware of the issues and are reviewing this. The organisation and manager have done well to improve morale. Managed changes within the staff team have had a positive effect on the teams motivation and morale and people are now living in a happier house and are supported by a more effective team. People spoke to us about the need to further build a permanent team of staff with less reliance on temporary agency staff. The manager explained that agency usage has reduced and with new staff starting imminently it was hoped that this would reduce further achieving more continuity of care for the people living there. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at 112 Wellington Road are benefitting from a well run home. The environment is safe for people because health and safety practices are carried out. Evidence: There has been a considerable improvement in the management of the service since the last key inspection. There is now a permanent manager who has been registered with us, who recognises her learning needs but who has significantly contributed to the improvements for the benefit of the people living there. There is now a happy and motivated staff team who appear to value the people they are supporting and better understand their needs. Systems have been put in place to minimise risks to people. These include improvements to the environment to safeguard people, changes to the staff team, increased staff training, working with partner agencies and improvements to staffing levels to increase the support and supervision available to people. Most significantly huge improvements have been made to how medication is being managed reducing the risk of harm from medication error. Together, these improvements along with the positive management of complaints, assure us that the home is being Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: managed well. At the recent random inspection we could see that the service has sought feedback about the quality of service it provides and perusal of responses showed that people including independent professionals believe the standard of care to have improved. The manager has not received formal supervision, but has felt well supported and monthly visits have been carried out by the organisation without fail to monitor the services progress. All service maintenance records that we requested were available and up to date to show the environment is being safely maintained. We looked at the recently updated fire risk assessment and advised the manager to consult with The Fire Service to see if they were satisfied with the control measures given the risks were judged to remain as medium. We also advised the manager to formally consider and record how each individual person would be evacuated in the event of a fire. In addition the manager agreed to review risk assessments in place for hazardous chemicals given that they were last reviewed nearly two years ago. However systems are in place to ensure that staff only purchase products which have been assessed so that risks from unknown products are not brought onto the premises. The manager feels the priority now is to continue to support and build the new and developing staff team. Essential to this and to the continuity of care for people is the need to recruit sufficient permanent staff to negate the need for agency staff. This will also provide the manager with more time to manage and monitor the service to sustain and promote ongoing improvement. This is however in hand, with new staff recruited and waiting to start. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 1 To ensure documentation is fully provided in formats which are suitable for the people who live there, rather than for the purpose of regulation. Recommendation January 2009 2 15 To consider how people are supported to maintain contact with their families. Recommendation January 2009 3 17 To individualise meals and review the purchase of foods to ensure fresh vegetables are provided. Recommendation January 2009 4 30 To fully implement the remaining recommendations from a recent infection control audit, ensuring latex rather than vinyl gloves are provided for staff to use when providing support with personal care. Recommendation January 2009 5 36 All staff including the manager should receive at least six recorded supervision meetings to support their practice development. Care Homes for Adults (18-65 years) Page 28 of 30 Recommendation January 2009 6 42 To consider how each person would be evacuated in the event of a fire and to seek advice about further minimising the risk of fire. Recommendation January 2009 7 42 Risks imposed by hazardous substances should be reviewed and updated. Recommendation January 2009. Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (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. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!