Care Home: 37 Spenser Road

Similar services:

• Thorndene
• Insight - Eastchurch
• Southfields
• Magenta
• Seabourne House
• 33 St John`s Church Road
• Dovedale Court
• Lyncol House

What the care home does well Each person has an assessment and there is good information forming the basis of the individual support plan. The people living in the home and their families are supported very well to keep in touch with each other.Both homes are well organised and provide good space for the people living there. Bedrooms are personalised and the people have been involved in choosing what they want and what colour scheme. There is a good range of training provided to give staff the skills and confidence to support individuals effectively. What has improved since the last inspection? The assessments and plans are being changed to make them person centred. They have pictures and symbols and are set out to make it easier for people with learning disabilities to understand and for them to be involved. The staff have made a good start. The manager has applied to be the registered manager of the home and is studying the registered managers award. Since the inspection visit the manager has become registered. What the care home could do better: The person centred plans need to be continued so that they include the goals for each person. The skills that each person needs to develop to be as independent as possible need to be included so that they can have a better quality of life. Guidelines for how the staff are to support them to achieve this need to be written in the plan. The team leader has been looking at the activities that people participate in and how often they go out. This has changed since the service has increased. Some people are not going out very much. We talked to the team leader and staff about this. The activities that each person does are being reviewed as part of the new person centred planning. The team leader said they would make sure that everyone is occupied. Some visual aids are used in the home to support choices. Communication aids need to be designed for everyday use to increase individuals opportunities and enable people to say what they want. The team leader said that a referral has been made to the speech and language therapist for one of the people living in the home. She said she would make more referrals for advice and support to develop communication. The routines in the home need to be made more flexible and activities need to be available in the evenings and weekends. There are some restrictions to how and where people spend their time due to the way the staffing in the home is organised. There are not always enough staff for each person to stay in their own bungalow. A recommendation has been made to look at the staffing level and provide sufficient staff so that each person can spend their time where and doing what they would like.A fire risk assessment and emergency guidelines for staff need to be kept in each part of the home. This is because people are in two separate buildings. CARE HOME ADULTS 18-65 37 Spenser Road Herne Bay Kent CT6 5QP Lead Inspector Julie Sumner Unannounced Inspection 8th October 2008 10:30 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 37 Spenser Road Address Herne Bay Kent CT6 5QP Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01227 741114 viviennemoore@fchltd.co.uk fchltd.headoffice@virgin.net Family Care Homes Ltd Manager post vacant Care Home 13 Category(ies) of Learning disability (0) registration, with number of places 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Learning disability (LD). The maximum number of service users to be accommodated is 13. Date of last inspection 14th December 2006 Brief Description of the Service: 37 Spenser Road is a care home providing personal care and accommodation for adults with learning and physical disabilities. The main part of the home has been opened for more than 10 years and consists of an extended bungalow style house. Last year the registration was expanded to provide accommodation and support to thirteen people and includes another bungalow at the rear of the house. The home is located in a residential part of Herne Bay. There are some local amenities, including bus and train links, and the town centre and sea front are not far away. It is owned by Family Care Homes Limited who also own other homes in the area. The current fees for the service at the time of the visit range from £480.29 to £971.00. Information on the home’s services and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. The provider web address is included in the previous page with other contact details. 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This report is based on information received about 37 Spenser Road including an annual quality assurance assessment (AQAA) completed by the person in charge of the home and a visit to the home lasting around 7 hours. The visit was unannounced, which means that the people living in the home, staff and homeowners did not know that we (the commission for social care inspection CSCI) were calling. Since the last inspection visit the home has changed. The company have purchased another bungalow that they have renovated. It is situated at the rear of the main property facing onto Gordon rd. It has been included in the service registered at 37 Spenser rd. The whole service is now registered to provide accommodation and personal care for 13 people with learning and physical disabilities. Information was gathered for this inspection in a variety of ways throughout the year, since the last inspection visit and during the visit to the home. Surveys were sent to visiting professionals and easy read surveys were given to the people living in the home, who were helped by their families to complete them. The information in the surveys received have been included in this report. The visit included talking with people living in the home and members of the staff team. We spoke to the team leader who deputises for the manager when she is unavailable and the area manager who visited the home. General observations were made during the day of how people are supported. We walked round and looked at both buildings and various records were inspected. Requirements and recommendations made at the previous inspection visit have been acted on. One recommendation was made at this visit. What the service does well: Each person has an assessment and there is good information forming the basis of the individual support plan. The people living in the home and their families are supported very well to keep in touch with each other. 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 6 Both homes are well organised and provide good space for the people living there. Bedrooms are personalised and the people have been involved in choosing what they want and what colour scheme. There is a good range of training provided to give staff the skills and confidence to support individuals effectively. What has improved since the last inspection? What they could do better: The person centred plans need to be continued so that they include the goals for each person. The skills that each person needs to develop to be as independent as possible need to be included so that they can have a better quality of life. Guidelines for how the staff are to support them to achieve this need to be written in the plan. The team leader has been looking at the activities that people participate in and how often they go out. This has changed since the service has increased. Some people are not going out very much. We talked to the team leader and staff about this. The activities that each person does are being reviewed as part of the new person centred planning. The team leader said they would make sure that everyone is occupied. Some visual aids are used in the home to support choices. Communication aids need to be designed for everyday use to increase individuals opportunities and enable people to say what they want. The team leader said that a referral has been made to the speech and language therapist for one of the people living in the home. She said she would make more referrals for advice and support to develop communication. The routines in the home need to be made more flexible and activities need to be available in the evenings and weekends. There are some restrictions to how and where people spend their time due to the way the staffing in the home is organised. There are not always enough staff for each person to stay in their own bungalow. A recommendation has been made to look at the staffing level and provide sufficient staff so that each person can spend their time where and doing what they would like. 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 7 A fire risk assessment and emergency guidelines for staff need to be kept in each part of the home. This is because people are in two separate buildings. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been carried out. EVIDENCE: Since the last inspection the registration has changed to accommodate the new bungalow at the rear of the property. The service is now registered for thirteen people. The statement of purpose was updated in June 2008. Two assessments were looked at which were for the two newest people that have moved in. They contained clear information that formed the basis of the support plan. Joint assessments with health and social services were also seen. The assessment is completed in consultation with the person concerned. As appropriate, members of their family and social workers are involved. 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is some good information to support personal care. People are helped to stay safe carrying out their day to day activities. EVIDENCE: All the people in the home have a care plan. The company has recently introduced a new person centred style plan. Two of the new style plans that have been started were looked at. The assessment part of the person centred plan has been completed but goals have not yet been set. The assessment says whether individuals can carry out a task independently or whether they need support. The guidelines for how staff need to do this effectively are to be included. Additional information about how people’s needs are being supported was looked at in the other folders as some of the guidelines are still in the original plan. The team leader explained some of the ways they support each person. Staff have got to know individuals well and responded to changes in need. There 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 11 was a discussion with the team leader about developing individual skills and goal setting for each person and she is going to take this forward. In the person centred plan there is a communication assessment with clear descriptions of how people communicate when they are frightened, sad, happy, unwell and so on. There are indications in the plan about facial expressions, some noises and gestures and what they mean. The staff team have produced picture aids to help some of the people living in the home to make some decisions like bedroom décor. A simplified risk assessment called ‘My understanding of health and safety’ is also included in the person centred plan. This identified the areas of risk, like if the person has awareness of road safety. Risk assessments were also seen in the main care plan file where they have guidelines for minimising risk. These ranged from every day personal care and occupational activities both in and out of the house. For example having a bath, getting in and out of a vehicle and going horse riding. Risk assessments and guidelines need to be designed alongside the planning of goals in the person centred plan. And the deputy manager acknowledged this. There was a discussion about communal records that are currently kept in the home. These are going to be changed and incorporated into the individual daily records. This means that individual support can still be monitored overall but will be in line with legislation about confidentiality of records. 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Most people in the home lead active lifestyles and staff are developing the activities further to benefit less able people. People are helped to keep in touch with their families. Good quality meals are served. EVIDENCE: A range of occupational activities are organised for the people living in the home. Some of these are in the home and some out in the community. People were occupied in different ways during the day of the visit. One person had an album of pictures cut out of catalogues of things she likes which she was looking at. This was a useful tool to help us have a conversation with her. Another person spoke about what she likes to do. The day before the visit three people went bowling and had lunch at the bowling alley. On the day of the visit three people were at the day activities centre owned by Family Care Homes and another person was at a day 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 13 activities centre in Canterbury. Two people went out for lunch. Other people went out for walks or were occupied in the home. At the end of the visit it was observed that some people were getting into night attire after the evening meal. This was also commented on in a survey received, indicating that this may be usual practice. This needs to be reviewed with the activities provided because some people might like to go out in the evening. Comments in surveys also stated that they would like an increase in the activities during the weekend like going for walks and to the pub. The home keeps records of activities that individuals have participated in. Some records were looked at. It was noticed that some people have less opportunities to go out and there were entries about having personal care or eating lunch as the activities for the day. This was discussed with the team leader. The team leader did explain that staff do not always write what they do if they have been occupied in the home. This was being addressed in the next staff meeting. The team leader has obtained free bus permits from the council for some of the people living in the home. They also have companion passes so the staff go free with them. The deputy manager is planning to obtain bus passes for all the people living in the home who would benefit from one. The team leader has been looking into the activities with the physiotherapist who has been to the home. They have discussed floor equipment, including mats, that would enable one of the people to maintain his mobility whilst being occupied and this is being ordered. Staff said they have got to know the people who are not able speak really well and can anticipate their needs and interpret what they are saying. We discussed further developing communication aids so that they might be able to interact with other people too. People do not have communication aids that are used for day to day choices and activities. Relatives commented, in surveys, on the good support they receive from the home with transport assistance to keep in contact with their son or daughter. Some people go home to parents regularly. There are contact details in each person’s folder. Relatives said they always feel welcome and they are very happy with the home. There are menus with alternatives and records of food kept. People said the food is good. They all choose where they want to sit to eat. Lunchtime is a casual meal and often some of the people eat out. The evening meal is the main meal of the day. This was seen on the day of the visit and looked attractively presented with everyone looking like they were enjoying it. Staff spoke about the support they give one person who has all food liquidised and drinks specially thickened due to swallowing difficulties. They have a new liquidiser and separate each part of the meal. 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Personal and healthcare support is responsive to the varied and individual needs and preferences of the people living in the home. EVIDENCE: Staff have got to know individuals’ preferred way of being supported. Some people are able to say how they would like to be supported. There is written information in each person’s folder. Referrals have been made to the speech and language therapist and developing communication support further was discussed with the deputy manager who said she would take this forward. One person is visually impaired and has support from the Kent Association for the Blind (KAB). She said she likes to know the time and has a talking watch. The home has also had support from the community physiotherapist, occupational therapist, dietician and continence advisor. People are supported to access health care services. Health action plans have been designed for each person. Two of these were looked at. Ok health checklists have also been completed for some of the people living in the home. People are supported to attend the GP, dental services and any other health 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 15 care specialist as required. One person returned from the health centre having had some dental treatment on the day of the visit. Medication is stored in a clinical room which is cool. There is a control drug cupboard. The Boots monitored dosage system is used to administer medication. At present none of the people living in the home administer their own medication. The manager audits medication. The team leader is doing this while the manager is on holiday. The area manager also carries out an audit during the monthly visits and additionally if she feels there is a need. There are clear instructions and clear information about medication in the administration folder. There are large photos as dividers for each person’s medication administration sheets in the folder. The team leader has also made up a folder with information about all the medication prescribed so that staff can read about the side effects contraindications and what the medication is for. 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that is clearly written and easy to understand. Staff have got to know the facial expressions and non verbal behaviour of individuals to respond to their needs. EVIDENCE: Staff spoke about how they support people with communication difficulties to express themselves if they might have a problem. Staff said they had got to know individuals really well and could recognise what behaviours and facial expressions mean. There was further discussion about how this could be supported so that the people are not totally reliant on the interpretation of the staff. At present not all the people living in the home have communication aids. The home has made referrals for speech and language therapy and this needs to be extended to other people to increase the development of communication support for each person. Staff were spoken to about safeguarding vulnerable adults procedures. They have had training in safeguarding and abuse awareness. They felt confident that they would report to the person in charge of the shift. They said they have good communication in the team. The company have produced a new flow chart to assist staff with what to do if they suspect abuse and who to report to and this goes up the line through the organisation to the directors. Staff said they have the additional support of the operations manager who is still fairly new in post. 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 17 One safeguarding alert was raised in May 2008 regarding alleged poor practice following an accident. There is an ongoing multi-agency investigation that had not reached its conclusion at the time of the visit. 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. EVIDENCE: There have been some changes to the layout of the home since the last inspection visit. The service has been extended to include a bungalow situated at the rear of 37 Spenser road. The staff referred to the bungalow as Gordon road as its front door is on this road. Two people live in Gordon road. It has a fitted kitchen, dining room, lounge, bathroom with assisted bath and individual bedrooms with en-suite one with flush floor shower. There is a washing machine in the kitchen. The bungalow was clean and clear of clutter. The people living there spend time in both homes. 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 19 In the main house there has been some refurbishment and the kitchen is open plan with surrounding breakfast bar and tables in two areas. The sitting room is small and staff said it is seldom used. There is some comfortable seating in part of the dining room and this whole area is where the majority of people spend their time. There is fitted cushioned seating around the wall and bay window in the sitting room. A flat screen TV is situated above one of the dining room tables next to the kitchen. People can also listen to music in this area of the home as well as in their bedrooms. One person said she likes pink and her bedroom was decorated in pink. A new bed has recently been purchased for one of the people living in the home. Some of the bedrooms also contain sensory equipment. The deputy manager said that some individuals are getting new comfortable furniture for their rooms. One person is getting measured for a chair to be made for him. The home is recruiting a cleaner as the current cleaner has recently resigned. It is part of the key workers responsibility to keep individual bedrooms clean and tidy for the person they are key worker to. The main laundry is located in an outhouse adjoining the home. It has working equipment and the features needed to maintain good hygiene. Staff have attended infection control training and staff spoke of also attending health and hygiene training. 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home have confidence in the staff that care for them. People who use the service may have to move from one part of the home to another depending on the staffing at the time. EVIDENCE: The company have a recruitment procedure which includes all safety and identity checks required by law for care homes. Two staff files were looked at to check this. New staff have induction training that includes the Skills for Care common induction standards. Staff do not work alone and unsupervised until their criminal records bureau check has been processed and they have had essential training for health and safety. The staff team works across both buildings. Usually meals are eaten in Spenser rd and the majority of staff are based there. One member of staff has been employed to provide one-to-one support for one of the people living in Gordon rd. Another member of staff comes over from Spenser rd and then the two people living there stay in Gordon rd. There is a night staff over there and 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 21 one in Spenser rd. Sometimes one of the people who lives in Spenser rd goes over to Gordon rd to watch a film with the people living there. It is a recommendation from this inspection visit that the people living in Gordon rd have staff based there and the people in Spenser rd have staff based there. So that the two homes can function independently giving a better service to the people living in each home. It is also a recommendation to make sure there are enough staff in the evening so that activities can continue if individuals wish. The home have a key worker system. Staff are responsive to individuals and when a person seems to naturally respond to a member of staff this is taken into consideration when key workers are chosen. Staff said they had had two staff meetings this year. The area manager said that she was planning the next staff meeting because they realised they had not had one for a while but did not realise that there had also been a gap of 6 months from the last one. The staff said that they felt they had good communication between the team. Staff said they have supervision and during this they have requested training that they feel would benefit them and the people living in the home. They said they had attended training in epilepsy, first aid, dementia awareness and also recently, a course about Downs Syndrome, which they had found really valuable. The company provide National Vocational Qualification (NVQ) training to all staff. The training matrix was on the wall near the office and illustrated ongoing training in all essential areas needed. Some of the certificates and the training file were also looked at. 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager has the required experience and qualifications and is competent to run the home. EVIDENCE: This inspection visit was conducted by the team leader who is the manager’s deputy in her absence. The manager made an application to become the registered manager during the summer. The registration team approved this shortly after this visit. The manager has been in post for over two years. She has completed the national vocational qualification to level 4 for management and has also completed assessors course for the NVQs. She is currently studying the registered managers award. 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 23 The home has a quality monitoring system. They give out questionnaires to the families of people living in the home. The team leader said they would extend this to other people like care managers who visit the service. All the comments received were positive and relatives are enjoying a good rapport with the home. The area manager calls to the home regularly to see how things are going and to check the home is running properly. She says if improvements need to be made and writes a report each month about what she finds. She also compares the services in other homes in the company and passes on good practice. The manager has produced a development plan for the home to list the goals for improvements for this year, which focuses on supporting the people in the home to adjust to the changes in the building, developing the new person centred plans and developing a new staff training matrix. The fire risk assessment is a standard Cared 4 one and is kept in the main part of the home in Spenser rd. There was no risk assessment in the Gordon rd part of the home as this was included in the one in the main house. The fire safety officer is booked to visit the home for training this week and the team leader said she would ask him to review the risk assessment and would make sure there is a relevant copy in each home. There is a grab file to use in emergencies. It is clearly marked and designed to grab in the event of an emergency so that they can easily access all necessary information. This includes the plan and guidelines for full evacuation in emergency including fire, next of kin contact numbers and contact numbers for directors and other homes. There is ongoing training for staff in areas of health and safety. Each home manager is reviewing one policy each a month so that all the company policies get reviewed. This is being organised at the managers meetings. We talked about making sure that all necessary documentation and policies/procedures are also kept in the Gordon rd part of home because they might be slightly different and staff need to have access to them. 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 2 13 3 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA16 Good Practice Recommendations Make sure that the routines in the home do not restrict people’s choices of activity and quality of lifestyle. And provide sufficient staff so that each person can stay in their own part of the home when they wish to. 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 37 Spenser Road DS0000023268.V372755.R01.S.doc Version 5.2 Page 27 - 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!