Care Home: 23-25 The Warren

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What the care home does well Service users have access to a range of meaningful activities. The home has systems in place to ensure that service users care needs are recognised and met. Links are made with other professionals as and when necessary. There are good staff training opportunities available with a strong focus on ensuring staff are competent and equipped to look after people with Autistic Spectrum Disorders. The home has received accreditation from the National Autistic Society which is very positive. The partnership days held with service users and families each year provide a good means to share views, opinions and demonstrates that the organisation is proactive in addressing issues that may arise. The staff team demonstrated knowledge and skill in carrying out their duties. Service users records were of a good standard and well structured. 23-25 The Warren is currently providing good outcomes to the people it supports and is well run. What has improved since the last inspection? At the last inspection of the home in October 2006 two requirements and two recommendations were made. On the whole these have been fulfilled, apart from some extra additions and follow up that are identified in this report. Some environmental improvements have occurred since the last inspection that have upgraded areas. The home is a comfortable place to live in. A new Manager has commenced in post since the last inspection. It was evident that the Manager has worked hard whilst being in post since April 2008. This person showed commitment and dedication in the daily running of the home. What the care home could do better: As a result of this visit, three requirements and eight recommendations were made. An immediate requirement notice was issued on the day of the inspection in respect of two requirements for the home to action relating to medicine management and the risks associated with hot radiator surfaces. Since the inspection, the home have responded and confirmed the action taken to address these two requirements and that they have been met. The third requirement made is about the home reporting in writing to the Commission any significant occurrences that adversely affects the wellbeing or safety of any service user. The eight recommendations made include reference to some updating/additions to record-keeping and their accessibility to service users. As good practice, reviewing current banking arrangements. Arranging Nutrition training for staff in supporting service users and extending out quality assurance practices by obtaining feedback from other interested parties. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 23-25 The Warren Farthing Hill Ticehurst East Sussex TN5 7QY     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: Jo Mohammed     Date: 0 9 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (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: 23-25 The Warren Farthing Hill Ticehurst East Sussex TN5 7QY 01580201448 01580201448 stephan.barton@sact.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Sussex Autistic Community Trust (Care Services) Ltd 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 the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home 23-25 The Warren is situated on a small housing estate in the village of Ticehurst. The village with its local shops is approximately half a mile away. The home consists of a pair of inter-joining houses each with its own lounge, dining room and kitchen. The home is registered to accommodate three adults with Autistic Spectrum Disorders. 2325 the Warren is one of four care homes in East Sussex run by the Sussex Autistic Community Trust. The home makes the Commission for Social Care Inspection reports available to prospective service users and their relatives/representatives upon request. The current scale of weekly charges is 1,659 to 1,998 as at 9 December 2008. 3 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This report reflects a key inspection based on the collation of information received since the last inspection, a review of the homes Annual Quality Assurance Assessment [AQAA], service user questionnaires and an announced site visit conducted by two Inspectors on Tuesday 9th December 2008 between the hours of 10am and 3.15pm. 23-25 The Warren is an established home that provides long term residential care to three people with Autistic Spectrum Disorder. The site visit included a tour of both houses, an examination of some care, medication, staffing, menus and general records. We also had a discussion about the previous requirements and recommendations made at the last inspection in October 2006. Care Homes for Adults (18-65 years) Page 5 of 30 The visit included talking to a service user, the Manager and interviewing a member of staff. We also observed the interaction between staff and a service user. During the visit, we met two of the three service users living in the home and spoke with one of these people. The service user who we met showed us their bedroom, computer, a scrapbook and asked us questions. Surveys were sent to service users prior to the inspection, two were returned completed to the Commission. The feedback received from these was positive. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 7 of 30 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users continue to benefit from an admission process that ensures their individual needs and aspirations are appropriately and thoroughly assessed prior to moving into the home. Evidence: The home has not had any admissions since the last inspection, therefore Standard 2 was not inspected on this occasion. There are currently no vacancies. The last inspection report dated 12th October 2006 confirms that the pre-admission process and documentation used for a new service user at the time was good. The Manager reported the pre-admissions procedure since the last inspection has been further updated. A requirement made at the last inspection to include information about The Sussex Autistic Community Trust and the Responsible Individual in the Statement of Purpose has been done, although following examination it was recommended that further details relating to the Trust and organizational structure be expanded upon as this was brief, including showing revised fees and any changes to the staff team. Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: The home has placement agreements that have been signed by service users containing the service users guide. The document includes detailed information about the service provided in the home, although it did not appear to have been updated since 2004. It was discussed how accessible this documentation was to service users and we were advised this had been signed by service users and was accessible in the office. It was recommended this documentation be made more accessible to service users and up dated accordingly. The Manager said she would arrange for this documentation to be placed in a bookcase in each lounge and for the documentation to discussed at future tenant meetings. Care Homes for Adults (18-65 years) Page 11 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans include detailed information about service users individual support needs and provide staff with a clear overview of service users needs. Ensuring the detail in risk assessments matches the actual risk with the measures taken to reduce risks, will further enhance the systems in place within the home. Evidence: We tracked the care of two service users that included examination of their care records, discussions with the Manager and meeting one of the service users during the course of the inspection. These records were found to be detailed with several sections covering a wide range of care needs, goals, risk assessments, daily records and support guidance. Service users currently have three files containing their care information. The home is intending to consolidate this information into one file. Following examination of some risk assessments, it was recommended to review the details recorded in a medication risk assessment for one service user as the information had changed. Also necessary was to ensure all sections of service users Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: risk assessments were clearly written so that the information matches the detail recorded under the section headed risk reduction measures with the original risk identified. Regular formal service user reviews are held. The Manager advised that service users individual care plans were agreed at reviews that involved service users. It was said Social Workers and Care Managers were invited to reviews but did not routinely attend unless there was an emergency. A copy of the review minutes was sent to them. Following examination of a review form, it was recommended that the designation of people invited to reviews be included in the minutes. A recommendation made at the last inspection was that a risk assessment in relation to the use of restraint for one service user should be agreed and signed by the service users relatives and Care Manager. The Manager advised the means of restraint related to the use of key pads on the homes front doors. The Manager said the service user and relatives has signed this risk assessment and that it was reviewed every six months. However, because Care Managers did not routinely attend reviews their agreement was not included. We had a discussion around the reason for keys pads being on both front doors and were informed that two service users had absconded in the past, although not recently. The Manager stated that one of the key pads would be removed and when new front doors were installed, key pads would not be used. In the interim period whilst new doors are awaited, we advised the Manager how the use of key pads would fall under the Deprivation of Liberty Safeguards and from April 2009 Social Services had a responsibility to undertake assessments and formally agree this means of restraint if still being used. The Manager agreed to make a referral to Social Services about this matter if need be, therefore a formal requirement has not been made on this occasion. This matter will followed up at the next inspection. The financial records in respect of two service users were examined. It was noted that the organisation is the corporate appointee for these service users and they have their monies paid into the organisations account. It is a good practice recommendation to enable service users to have their own bank accounts and to promote financial independence. It is also required that the Manager ascertain how interest is accrued under the current arrangements and ensure that service users receive all monies that they are entitled to. Since the inspection, the home have advised that one service user has their own personal account and another service user has a financial risk assessment in place which highlights the potential issues that would arise if they were to have their own personal account. The good practice recommendation to enable service users to have their own bank accounts and to promote financial independence will remain with the wording altered to where possible. Care Homes for Adults (18-65 years) Page 13 of 30 Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is good at enabling service users to access the local community and participate in social and other meaningful activities. They are supported to maintain relationships with other people. Service users are supported to have choice over the meals they eat, but staff must ensure that all meals are nutritionally balanced. Evidence: When we arrived at the home, two service users had already left to attend their respective day centres run by the organisation, followed by community activities. One service user was at home due to a cold. A staff member from the day centre was in the home offering one to one time with this person. All service users are supported by staff on a one to one basis to attend day services and access the community. We met with the service user who was at home who showed us their bedroom, computer game, a pictorial scrapbook and we spent time chatting to this person. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: We were informed that one service user had clearly stated they did not want to meet with us or for us to see their bedroom whilst we conducted the inspection. Two of the service users attend one of the organisations resource centres in Battle supported by staff from the home five days a week between 9.30am-1pm. An example of some of the activities described as taking place included yoga, bowling, swimming, sports, literacy, numeracy and computer skills. The third service user attends a different resource centre also run by the organisation twice a week for two half hour sessions. This person accesses the community on a daily basis with staff, goes to the pub on Wednesdays and has a structured day which involves cleaning their part of the home. The Manager advised there were no issues with service users achieving their preferred lifestyles or accessing the community and that staffing levels, transport arrangements met service users needs. At weekends, it was said service users were supported by staff to go out to lunch, interact with each other and access the community. The most recent activity sessions evidenced as being provided by the home to service users included one to one talk time, computer sessions, board games, domestic work and reading. One service user goes home at weekends. Regular contact is maintained with relatives, no independent advocates are used at this time. There was evidence that tenant meetings take place with minutes posted on the kitchen notice board. There are different arrangements in place for menu planning. Menus are planned with two of the service users both of whom have a four week menu, one being pictorial and staff prepare the meals. The Manager advised that a Dietician has been involved in the menu planning for one of these service users and for the other person they are encouraged to eat more healthier and an increased variety of foods has been introduced. The third resident is being supported to budget, plan and purchase their own food. This person has a specific menu which has been devised with staff and kept in the office with a choice of four out of eight meals. The Manager advised this service user is now eating more variety of foods but has declined any input from a Dietician. Due to the comment made at the last inspection and findings from this inspection, it is recommended that the home arrange nutritional training for staff. Grocery shopping for two of the service users up until this week had been done by staff as the Manager advised that service users cannot manage big supermarkets, only local shops for small items and one service user goes up to the local shop every Sunday to purchase a dessert. During the week of the inspection shopping has instead been done on-line. A discussion around involving service users with the on-line shopping and general shopping practices was highlighted for consideration to enable service users to be more involved. Care Homes for Adults (18-65 years) Page 16 of 30 Care Homes for Adults (18-65 years) Page 17 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. Service users health and personal care needs are assessed and recognised with procedures and support in place to address them. Service users will however be better protected by the implementation of closer monitoring of medication systems within the home. Evidence: Two service users care records that were examined showed evidence that personal and health care needs are being met. Two service users have health information packs, showing input and involvement from medical professionals. One service user has declined to have a health information pack and an OK checklist is used instead. Records of weights are kept for two service users, one service user weighs self. Links are made as and when necessary with the Community Learning Disability Teams. Medication systems were assessed and examined by way of records, storage and discussion. Service users do not self medicate, medication is managed by staff and checked by two staff prior to administration. No controlled drugs are currently used. It was reported that staff do yearly external medication training and an in-house Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: competency test. Staff do not administer medication unless they have been trained. On examination of medicine supplies it was found that a When Required medication, dated September 2008 was out of date in the main medication cupboard. Also found in one of the kitchens was a bag containing an out of date and unnamed bottle of liquid medication, dated November 2008 for a service user located on top of the fridge. This medication was not stored safely or securely. The guidelines for this medication did not show evidence of when they had been compiled or reviewed. The Manager was asked to remove the medication. This was done immediately and returned to the office to store safely and replace with current named medication. As a result of these findings, an immediate requirement notice was issued on the day of the inspection in respect of the risks associated with out of date medication and appropriate storage. A requirement was made to take action to undertake an audit of all medication and ensure that all required stock is within date and securely stored. An external Pharmacist visits the home once a year. Other medication records examined were generally satisfactory. Corporate medication policies found were dated 2006 with no evidence of a local policy in place. The Manager advised this was currently being worked on at the main Managers meetings and would be in place. Care Homes for Adults (18-65 years) Page 19 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. The home has systems in place to protect service users from harm, however these would be further improved if key information was more accessible to service users. Evidence: There have been no complaints or safe guarding alerts in the last twelve months. The Manager advised a computerised record of these would be kept if they did occur. One service user has the complaints procedure on display in their kitchen, another is in the office. The Manager said during talk time with keyworkers and at tenants meetings issues could be raised by service users. It was discussed and recommended that there should be a review of making the complaints procedure more accessible to service users. In respect of the complaints notice displayed in the office, it was recommended that Social Services details be added as a means of contact as they would take the lead in investigations. The home does not currently have a copy of the latest Sussex Multi Agency Policy and Procedures for Safeguarding Vulnerable Adults. The Manager agreed to obtain these. The organisations training Manager provides safeguarding training to staff and advised that staff attend yearly refresher courses on this topic. 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. Service users benefit from a comfortable and homely environment that meets their needs. Reviewing and attending to specific health and safety matters reflected in this section of the report will further enhance service users safety within the home. Evidence: A full tour of one house and partial tour of the adjoining house took place. Both houses are two storey and interlinked via a door between the kitchens. There are separate front doors, both currently fitted with key pads, this practice has been covered under the Individual Needs and Choices section in the report. There are three bedrooms in total, two were seen, one service user showed us their bedroom. These were found to be homely and personalised. The bedroom of one service user was not viewed as they were out and had not given permission. Both houses have a lounge, bathroom and kitchen all of which were seen to be clean, tidy, free from odours and decorated to a good standard. In the house that has one bedroom there is also an office, sleeping in room. Since the last inspection one of the bathrooms has been decorated and the Manager advised the Housing Association that manages the property may refit both bathrooms. New double glazing windows and a new fire panel have been installed. New front doors are to be fitted at some point. Both kitchens were refurbished in June 2008. These are domestic in style and Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: practical. The Manager reported that risk assessments for the cooker hobs have been done. It was seen that the extractor fans in both kitchens required cleaning and there was no hot water from a small wash hand basin in one of the kitchens. The Manager agreed to address these matters. The garden is primarily laid to lawn, with plans to develop a vegetable patch. In addition to the Housing Association, the organisation also employs a maintenance person. During the tour of the premises, a very hot to touch radiator at the foot of the stairs by the front door was found. As a result of this an immediate requirement notice was issued on the day of the inspection, in respect of the risks associated with unguarded radiators that are currently set to a high temperature. The action required by home is to ensure that risk assessments are undertaken in respect of unguarded radiators and appropriate action is taken to ensure any risk is minimised. A previous requirement made at last the inspection in October 2006 was to include in the homes fire risk assessment that there is only one fire door and that one of the service users always refuses to leave the building when the alarms sound. All staff and residents must be given the opportunity to take part in drills on a regular basis. Both these points were discussed. The Manager advised a fire risk assessment was completed by an external company in October 2007 and reviewed by the home in March 2008. However it was reported this did not include reference to the service user who refuses to leave the building when the alarms sound although an individual risk assessment about this was in place. It was evidenced that a good rotation of staff and service users now participate in regular fire drills. The Manager will arrange to include herself in future drills as well. According to information recorded in the homes Annual Quality Assurance Assessment five staff have received training in infection control. 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. Service users benefit from a dedicated, trained and competent team of staff. They are protected by the organisations recruitment procedures. Evidence: The Manager and a staff member from the daycentre were in the home when we arrived. The atmosphere was good with evidence of positive working relationships and professionalism. The Manager reported the home was fully staffed, that staffing levels were fine with one staff member due to leave. The home does not use agency staff, regular established relief staff are used instead. The Manager is allocated two days a week to do paperwork. A new staff member is currently undertaking their induction and is supernumerary for two to three weeks. Service users are funded by Social Services, two service users are one to one funded and another person is one to one funded when they go out. A recommendation made at the last inspection in respect of recording one to one hours on the staff duty rota will be carried forward as the Manager confirmed this had yet to be done. The Manager and Training Manager confirmed that the organisation provides a lot of training and specialist training in Autism and behavioral Aspergers. All staff except one have either a National Vocational Qualification in care at level 2 or 3. The Deputy Manager has a National Vocational Qualification in care at level 4. Training takes place Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: in the organisations head office resource centre. There is a set training plan for the organisation, a copy of the 2009 training schedule was given to us during the inspection. This showed a wide variety of training available. The Manager is responsible for keeping staff training records up to date. The Manager confirmed monthly supervision sessions for all staff take place. There was evidence of regular staff meetings being held. The Manager is involved in the recruitment of new staff and advised that during the second stage of the interview, prospective candidates visit the home to enable service users to be involved in the recruitment process. Staff files examined provided evidence that robust recruitment procedures are followed with all documentation viewed being in order. 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. The home is managed by a competent Manager and team of staff who work hard to provide a safe and well run home to service users. Evidence: Since April 2008, a new Manager has been in post, their application is currently being processed by Commission. The Manager holds a diploma in Managing Health and Social Care and has prior experience of being a registered Manager. The Manager reported she was getting to know the homes systems and had reviewed service users care records. She stated she felt very supported in her role. It was evident from observation that the Manager plays a hands on role in the daily running of the home and was seen to execute her duties with competence and professionalism. The Manager advised that unannounced Regulation 26 visits were undertaken every month by other Managers in the homes run by organisation with an action plan drawn up each time, the duration of these visits is about three hours. On examining the most recent Regulation 26 visit carried out, we recommended that a record be included in respect of which service users and staff records had been examined on each occasion Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: to aid future rotation of record-keeping. The Manager agreed to do this. The home is accredited with The Investors In People Award and was awarded centre of Excellence in 2008 and 2007. The home is also accredited by the National Autistic Society and a detailed report relating to this accreditation carried out in October 2008 was available to view. In respect of quality assurance, annual questionnaires are sent to service users and family members. Specific findings are collated and written action plans drawn up for the home to address any matters raised. Annual partnership days are held involving service users, families. Service user meetings have also recently been introduced. It was recommended that the views of other interested parties also be sought. Records in respect of health and safety were not viewed on this occasion, the information provided in the homes Annual Quality Assurance Assessment [AQAA] indicates these matters receive attention and are in order. As part of the inspection process, comment cards were sent to the home for distribution to the service users living in the home to express their views on the care they receive. All the service users require some degree of support to complete the forms. Out of the surveys returned positive comments were made. A significant incident that occurred in September 2008 relating to one service user was discussed in respect of an accident with a kettle leading to this person burning their arms. The Manager advised of the action taken to ensure this does not happen again and that a new risk assessment had been compiled. The Manager was requested to forward details of this incident with action taken in writing to the Commission and reminded to forward in writing any future incidents that affect the well being of service users. 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 1 42 37 The Registered Person must 30/01/2009 without delay notify the Commission in writing of any event in the home which adversely affects the wellbeing or safety of any service user in the home. The Registered person must in accordance with current regulations report significant occurrences in writing to the Commission. 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 The Registered Person should add further information to the Statement Of Purpose to incorporate more details about the Sussex Autistic Community Trust and organizational structure including any revised fees and changes to the staff team. The Registered Person should arrange for service users to have their own bank accounts to promote financial independence where possible. The Manager should ascertain how interest is accrued under the current arrangements to ensure service users Page 28 of 30 2 7 Care Homes for Adults (18-65 years) receive all monies they are entitled to. 3 9 The Registered Person should arrange for the detail in all service users risk assessments to be reviewed to ensure it is accurate, up to date and the information matches the different risk assessment headings. The Registered Person should arrange for staff to attend nutritional training. The Registered Person should ensure that key information such as the complaints procedure is made more accessible to service users. The Registered Person should following consultation with the Fire Department ensure the detail in the homes main fire risk assessment contains all the necessary information in respect of a service user who refuses to leave the building when the fire alarm bells sound. The Registered Person should include on the staff duty rota a record of one to one hours worked by staff. The Registered Person should explore ways to obtain other stakeholders and interested parties views in measuring the quality of the service. 4 5 17 22 6 24 7 8 33 39 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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