Care Home: 38 Sandgate

What the care home does well The manger and staff work closely with the people living in the home, their relatives and other professionals to make sure detailed person centred assessments and care plans aredeveloped. They ensure people`s needs and preferences about how they like to live their lives are recorded enabling staff to provide a personalised service to them. Survey responses from family members and staff confirmed that the service is responsive to people`s changing needs as the following comments reflect. "Staff make life as meaningful as possible". "We meet people`s needs". "We respond to people`s requests and to changes in their needs and develop plans accordingly". "Sandgate is a happy placetowork and is well organised". Comprehensive information about how people communicate and make their needs known help staff to promote people`s independence and respect their choices in their daily life. Staff on duty staff encourage people to lead a fulfilling lifestyle and pursue their interests and hobbies. The home environment is safe, clean and hygienic with suitable aids and adaptations to meet peoples individual needs and promote their independence. There are good systems and procedures in place to safeguard people and makesure any concerns or allegations are reported an recorded appropriately. The home benefits from having a very stable group of care staff who work well as a team to provide a consistent and reliable service. They have developed good relationships with people and have a good understanding about what is important to them and their likes and dislikes. The manager and staff are very committed and are always willing to "go the extra mile" to make sure people receive a good quality service. The manager communicates a clear sense of direction and leadership with staff feelingvalued. She provides regular supervision making sure staff have the support and guidance they require. This is appreciated by staff who said they get "good support" from the manager and that she "always makes herself available even when she is not on shift". They also said "it is a well run home", and "we are a staff team who understand good team working and support each other in sometimes challenging situations".The manager ensures people living in the home and their Representatives are regularly consulted and their views are listened to and acted upon. What has improved since the last inspection? People`s care plans have been kept under review ensuring they contain relevant and current information and are easy to follow.The complaints procedure has been reviewed and improved making it easier to follow with shorter timescales for responding and resolving complaints.Staff have developed a better understanding about positive risk taking and have participated in relevant training to guide their practice.People`s personal routines have been adjusted in response to their changing needs, which has proved beneficial to them. What the care home could do better: The process for supporting people to go on Holiday must be reviewed, with a suitable advocate or representative available to the person concerned, to make sure theirPage 16 of 42Care Homes for Adults (18-65 years)views are represented. There has been an unacceptable eighteen month delay since a person expressed a wish to go abroad on holiday caused by the organisations policies and procedures. The medication stock recording system needs to be reviewed to make sure it is completed consistently and a clear accurate record is maintained that can be easily audited.Planned work to the exterior paintwork has been delayed. The home should notify the Commission immediately when the planned work is completed on the paintwork. The manager continues to experience difficulties in getting the landlord to complete routine maintenance in an appropriate timescale which can impact on the people living in the home. This was also commented on by staff and relatives. "Repair work to the home and updating are not adequate" and " The landlords are not attentive". The manager and organisation need to address this issue with the Landlord and make sure they are meeting their own responsibilities under the Care Home Regulations.The manager should now implement the training programme ensuring the training shortfalls identified are addressed and staff have up to date skills and knowledge.It is recommended fire tests and drills are planned ahead to take place at the recommended intervals ensuring all staff are suitably trained and aware of their responsibilities. Key inspection report Care homes for adults (18-65 years) Name: Address: 38 Sandgate 38 Sandgate Kendal Cumbria LA9 6HT The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ray Mowat Date: 1 8 0 3 2 0 1 0 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • Be safe • Have the right outcomes, including clinical outcomes • Be a good experience for the people that use it • Help prevent illness, and promote healthy, independent living • Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • 3 stars – excellent • 2 stars – good • 1 star – adequate • 0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 42 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 42 Information about the care home Name of care home: Address: 38 Sandgate 38 Sandgate Kendal Cumbria LA9 6HT 01539733465 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Lesley.watson@cumbriacc.gov.uk www.cumbriacare.org.uk Cumbria Care Name of registered manager (if applicable) Miss Lesley Jane Watson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 3 0 care home 3 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 3 Date of last inspection 3 0 0 4 2 0 0 9 Care Homes for Adults (18-65 years) Page 4 of 42 A bit about the care home 38 Sandgate is a registered care home for up to three people with learning disabilities. The home is owned by Impact Housing Association and operated and managed by Cumbria Care, an independent business unit within Cumbria County Council contract services group. There were two people living in the home at the time of this key inspection visit. This is due to one of the people living there having a high level of assessed need requiring an additional sleep-in staff, who is using the third bedroom. The home is in a quiet residential area on the outskirts of Kendal town, it is close to a bus route and local amenities. The home is a semi-detached property with a small front garden and a paved patio area to the rear. All the rooms are single occupancy with the bathroom and communal areas of the home being shared, although the downstairs bedroom has a fully accessible en-suite bathroom with a high low bath and toilet. The fees charged are agreed individually according to a persons assessed needs. Information about the service is supplied to new and prospective residents in the service user guide, which is produced in an easy read format. Inspection reports are made available to people and or their representatives on request and are also displayed in the home. Care Homes for Adults (18-65 years) Page 5 of 42 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 42 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. During the visit we, The Care Quality Commission(CQC), met with people living in the home and spent time with the service manager. We also met with care staff individually and talked to them as they went about their duties. The Registered Manager completed a self assessment questionnaire called an Annual Page 7 of 42 Care Homes for Adults (18-65 years) Quality Assurance Assessment, AQAA and sent it to us before the inspection visit. This provided us with information about how the home is run and the managers views on what the home does well, where they have improved and plans for the future. There is also information about the people who live in the home and the staff working there. Surveys were sent out as part of this inspection to people living in the home, staff and other professionals with their views being used to formulate the judgements in this report. We also examined records relating to the running of the home that are required by Care Homes for Adults (18-65 years) Page 8 of 42 legislation, which included care plan files that guide staff in supporting people to achieve their goals and lead independent lives. We examined staff files and records relating to the maintenance and safety of the home. What the care home does well The manger and staff work closely with the people living in the home, their relatives and other professionals to make sure detailed person centred assessments and care plans are Care Homes for Adults (18-65 years) Page 9 of 42 developed. They ensure peoples needs and preferences about how they like to live their lives are recorded enabling staff to provide a personalised service to them. Survey responses from family members and staff confirmed that the service is responsive to peoples changing needs as the following comments reflect. Staff make life as meaningful as possible. We meet peoples needs. We respond to peoples requests and to changes in their needs and develop plans accordingly. Sandgate is a happy place Care Homes for Adults (18-65 years) Page 10 of 42 towork and is well organised. Comprehensive information about how people communicate and make their needs known help staff to promote peoples independence and respect their choices in their daily life. Staff on duty staff encourage people to lead a fulfilling lifestyle and pursue their interests and hobbies. The home environment is safe, clean and hygienic with suitable aids and adaptations to meet peoples individual needs and promote their independence. There are good systems and procedures in place to safeguard people and make Care Homes for Adults (18-65 years) Page 11 of 42 sure any concerns or allegations are reported an recorded appropriately. The home benefits from having a very stable group of care staff who work well as a team to provide a consistent and reliable service. They have developed good relationships with people and have a good understanding about what is important to them and their likes and dislikes. The manager and staff are very committed and are always willing to go the extra mile to make sure people receive a good quality service. The manager communicates a clear sense of direction and leadership with staff feeling Care Homes for Adults (18-65 years) Page 12 of 42 valued. She provides regular supervision making sure staff have the support and guidance they require. This is appreciated by staff who said they get good support from the manager and that she always makes herself available even when she is not on shift. They also said it is a well run home, and we are a staff team who understand good team working and support each other in sometimes challenging situations. Care Homes for Adults (18-65 years) Page 13 of 42 The manager ensures people living in the home and their Representatives are regularly consulted and their views are listened to and acted upon. What has got better from the last inspection Peoples care plans have been kept under review ensuring they contain relevant and current information and are easy to follow. Care Homes for Adults (18-65 years) Page 14 of 42 The complaints procedure has been reviewed and improved making it easier to follow with shorter timescales for responding and resolving complaints. Staff have developed a better understanding about positive risk taking and have participated in relevant training to guide their practice. Care Homes for Adults (18-65 years) Page 15 of 42 Peoples personal routines have been adjusted in response to their changing needs, which has proved beneficial to them. What the care home could do better The process for supporting people to go on Holiday must be reviewed, with a suitable advocate or representative available to the person concerned, to make sure their Page 16 of 42 Care Homes for Adults (18-65 years) views are represented. There has been an unacceptable eighteen month delay since a person expressed a wish to go abroad on holiday caused by the organisations policies and procedures. The medication stock recording system needs to be reviewed to make sure it is completed consistently and a clear accurate record is maintained that can be easily audited. Care Homes for Adults (18-65 years) Page 17 of 42 Planned work to the exterior paintwork has been delayed. The home should notify the Commission immediately when the planned work is completed on the paintwork. The manager continues to experience difficulties in getting the landlord to complete routine maintenance in an appropriate timescale which can impact on the people living in the home. This was also commented on by staff and relatives. Repair work to the home and updating are not adequate and The landlords are not attentive. The manager and organisation need to address this issue with the Landlord and make sure they are meeting their own responsibilities under the Care Home Regulations. Care Homes for Adults (18-65 years) Page 18 of 42 The manager should now implement the training programme ensuring the training shortfalls identified are addressed and staff have up to date skills and knowledge. It is recommended fire tests and drills are planned ahead to take place at the recommended intervals ensuring all staff are suitably trained and aware of their responsibilities. Care Homes for Adults (18-65 years) Page 19 of 42 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Ray Mowat CQC Northwest Citygate, Gallowgate Newcastle upon Tyne NE1 4PA 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 20 of 42 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 21 of 42 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. Peoples needs and preferences are assessed on an ongoing basis ensuring a responsive and consistent service. Evidence: There have been no new admissions to the home since the last inspection. People living in the home have a detailed person centred care plan in place that were developed from comprehensive care needs assessments. These are kept under review ensuring peoples changing needs are assessed and responded to appropriately. The manager and care staff work closely with family and other professionals to make sure all needs are assessed and reflected accurately in the care plan. The person centred care plans support and guide staff in providing a consistent and personalised service reflecting individual preferences about how people like to live their lives. These are proving very effective with the people living in the home enjoying a very settled period in their lives. There is a well trained and stable staff team who have developed a good understanding of peoples needs and what is important to them providing a responsive and reliable service. Page 22 of 42 Care Homes for Adults (18-65 years) Evidence: People have been issued with a tenancy agreement in conjunction with a contract of terms and conditions/residency agreement. These documents ensure people or their representatives are aware of their rights and the terms and conditions of their stay. The terms and conditions of residency has been written to ensure that the people living in the home have the protection of the care home regulations despite having a tenancy agreement with a social housing provider and a residency agreement that is called residency without board. These arrangements enable people to access different benefits than if they were living in traditional residential care, however they are then liable for paying rent to the Landlord and paying for utility bills, food and drinks, telephone calls and other personal expenses. Care Homes for Adults (18-65 years) Page 23 of 42 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. Comprehensive person centred care plans support staff in providing a personalised service. However one persons rights are being compromised by organisational policy constraints, which must be addressed. Evidence: Person centred care plans have been developed by the manager and staff who work closely with the person, their family and other professionals and agencies to make sure individual needs and preferences are assessed and an effective plan of care is agreed. The plans are easy to follow and informative giving staff a real insight about all aspects of a persons life and what is important to them. They also include detailed strategies that have been developed with multi disciplinary support, making sure staff understand peoples individual and sometimes complex and challenging needs and how to respond to them in an appropriate and consistent manner. Photographs have also been used to make information more accessible and meaningful to people. Survey responses from family members and staff confirmed that the service is responsive to peoples changing needs as the following comments reflect. Care Homes for Adults (18-65 years) Page 24 of 42 Evidence: Staff make life as meaningful as possible. We meet peoples needs. We respond to peoples requests and to changes in their needs and develop plans accordingly. It was evident from our observations and discussions that people have the autonomy to make decisions in their day to day lives, with staff supporting and encouraging them to lead an independent lifestyle. However one person who expressed a wish to go abroad for a holiday eighteen months ago still has not been able to go on the holiday. Staff said this was due to the organisation requiring health and safety information about the destination hotel over and above the information provided by the tour operator, which was proving difficult to obtain and causing this unacceptable delay. Despite this individual having capacity to make a clear choice and using a reputable high street holiday company, the constraints of the organisations policies and procedures are having a negative impact and are taking precedance over their personal choice. This situation must be reviewed with a suitable advocate or representative available to the person concerned, to make sure their views are represented. Based on our discussions and observations during this visit the people living in the home are involved in all aspects of home life. Daily records reflected how people are making daily choices such as what to wear, what to eat and where to go. Staff take on an enabling role encouraging people to make choices and take responsibility for for household chores such as sorting their laundry and shopping. One person also likes to get involved with preparing meals and will make their packed lunch or a meal with staff support and guidance. Despite one person having very limited verbal communication staff are skilled at providing choices to them in different ways by using gestures, prompts and communication aids. A good range of individual risk assessments have been developed to support and safeguard people in pursuing an independent lifestyle both in the home and in the local community. These are kept under review with evidence of changes being recorded to make sure they are up to date and relevant. Learning logs are used to record what works well and what has not worked when supporting people with activities, enabling effective strategies to be developed. Communication needs are very well documented with staff developing communication profiles and communication passports based on previous experience that record how people communicate and make their needs known. They include a list of utterances, sounds and gestures and an explanation of what they mean and how staff should respond. All the personal and confidential records we examined were securely stored. Staff were Care Homes for Adults (18-65 years) Page 25 of 42 Evidence: aware of their responsibilities in relation to the handling and sharing of confidential information in line with Data protection guidelines and the organisations policies and procedures. Care Homes for Adults (18-65 years) Page 26 of 42 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy participating in a range of activities with staff supporting them to pursue individual hobbies and interests. Evidence: People living in the home are attending different day services five days each week, Monday to Friday. This provides them with opportunities to socialise with their peers and participate a in a number of educational, vocational and leisure activities. Based on our discussions with them and the staff that support them they benefit from and enjoy this arrangement. Staff from the home work closely with day service staff to monitor peoples needs and make sure they receive consistent and appropriate support and independent lifestyles are encouraged. Through the support of day service staff, volunteers and staff from the home people are involved in both in house activities and community activities and events. One person is a member of a sailing club and in the summer months enjoys regular sailing trips. They Care Homes for Adults (18-65 years) Page 27 of 42 Evidence: also enjoy the company of a volunteer who will support them to visit the local pub quiz. One person has a car through motorbility, which is registered in their name meaning that they must be using the car to enable the other person to access it. This in addition to a limited consumable income can sometimes restrict the opportunities for people to go out independently of each other. Staff have a good understanding about peoples personal preferences and idiosyncrasies enabling them to respond sensitively to them and support them with leisure activities of their choice. One person particularly likes music and sensory activities that they find stimulating and relaxing. This is well documented within the care plan ensuring staff offer it appropriately and consistently. Through attending day service and attending community groups and social activities people are being supported to maintain and develop relationships outside the home environment. Staff also support people to maintain contact with family and friends, which is important to them. There was records of family visiting the home as well as staff supporting people to visit their relatives. Relationships that are important to people were recorded within the care plan as well as significant family information. Despite staff being aware of the importance of promoting and supporting people to lead an independent lifestyle, as described earlier organisational policy and staffing levels are at times restricting peoples lifestyles. One person is able to use a key and has a key to their own room and the front door of the home. Staff were attentive to peoples needs and there was a relaxed and friendly atmosphere during our visit with staff respecting peoples rights and opinions. The menu is very flexible due to the small scale of the home with people involved in choosing and shopping for food. Nutritional needs and special dietary requirements have been assessed and recorded enabling staff to provide appropriate choices. The meal time we observed was a relaxed social occasion with staff providing unobtrusive support and promoting independence. Care Homes for Adults (18-65 years) Page 28 of 42 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. Personal and healthcare needs are well documented making sure people receive appropriate support and have access to relevant services. Monitoring of medication records must be strengthened to quickly identify discrepancies. Evidence: Although some people have very limited verbal communication staff are skilled at communicating with them and understanding their needs. Detailed person centred plans contain communication assessments and comprehensive strategies and guidance for staff to enable them to communicate effectively. Working with other professionals and specialist services, strategies and useful tools have been developed to aid communication and understanding. Based on our observations and discussions staff are aware of individual needs and preferences about how people like to be supported and cared for. Staff are attentive and respectful as they go about their duties and make sure they promote peoples independence and choice in the lives when providing personal care and support. Health action plans have been completed as part of the care plan that record all health interventions including routine healthcare check ups and specialist support. These detailed records help staff to provide consistent support and make sure peoples needs Care Homes for Adults (18-65 years) Page 29 of 42 Evidence: are be responded to in an appropriate and timely manner. The manager works closely with key workers to make sure records are up to date and accurate and appropriate referrals are made when needs arise. We examined the contents of the medication cabinet against the records held, which on the whole were up to date and accurate. However a stock record of a recent short term medication was checked and found to be inaccurate and had not been completed consistently causing confusion. How this recording system is completed needs to be reviewed to make sure a clear accurate record is maintained that can be easily audited. The majority of medication was stored in a monitored dosage system with other medications recorded separately. Staff receive appropriate training with the manager monitoring staff competence on a regular basis. Care Homes for Adults (18-65 years) Page 30 of 42 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 clear policies and procedures in place to make sure peoples voices are heard and they are protected from abuse or harm. Evidence: Since the last inspection the complaints policy and procedure has been reviewed and updated simplifying the procedure and clearly setting out new time frames for responding to complaints. These are issued to people and made available in the home. In addition to the formal complaints procedure staff liaise with people informally on a day to day basis and through their key work responsibilities to check out their satisfaction with the service and note any concerns. Survey responses from relatives and staff said they were aware of how to raise a concern or complaint. There were no complaints or concerns recorded since the last inspection. There are clear policies and procedures in place in relation to safeguarding vulnerable adults, including a whistle blowing procedure, which are in line with local authority procedures and current good practice. All staff receive relevant training as part of their induction training in addition to the manager checking out peoples understanding of policy and procedures at staff meetings and through regular supervision meetings. There have been no safeguarding referrals made in relation to the people living and working in the home. Care staff have completed relevant training in physical intervention techniques specific to Care Homes for Adults (18-65 years) Page 31 of 42 Evidence: people living in the home who need be protected from self-harming behaviours. The home have sound systems in place to manage peoples finances effectively whilst whilst promoting independence and choice. In addition to the manager monitoring financial matters, records are also monitored by the court of protection. Care Homes for Adults (18-65 years) Page 32 of 42 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home environment is improving with further work planned to the exterior of the home. Evidence: The refurbishment of the upstairs bathroom has now been completed to a good standard providing a suitable environment. The painting of the outside of the house has not yet been completed but a visiting service manager confirmed the work is planned for the summer months when the weather improves. The manager must ensure this work takes place as planned and must notify us when the work is completed. The manager continues to experience difficulties in getting the landlord to complete routine maintenance in an appropriate timescale which can impact on the people living in the home. This was also commented on by staff and relatives. Repair work to the home and updating are not adequate and The landlords are not attentive. The manager and organisation need to address this issue with the Landlord and make sure they are meeting their own responsibilities under the Care Home Regulations. All areas of the home were clean and hygienic and free from hazards. Infection control policies and procedures are in line with good practice and staff have received or have planned relevant training in relation to food hygiene, infection control and health and safety. Staff have access to appropriate protective equipment and cleaning materials and are aware of procedures relating to handling soiled linen. Care Homes for Adults (18-65 years) Page 33 of 42 Evidence: Suitable aids and adaptations are in place to promote peoples independence including grab rails, high /low bath and a specialised toilet seat. Other equipment has been purchased such as the large screen television which also help to improve peoples quality of life. The home is personalised throughout with photographs and other personal items and people are involved in choosing colour schemes and soft furnishings. Bedrooms also reflect personal taste with furniture and peoples personal belongings making the home feel homely and comfortable. Care Homes for Adults (18-65 years) Page 34 of 42 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. The home has a stable and skilled staff team who have developed good relationships with the people they support. Evidence: The organisation has sound recruitment systems and procedures in place that are in line with good practice guidelines and ensure all new staff are safe and suitable for the role. Suitable job descriptions have been developed identifying their key responsibilities, however the manager is still awaiting a job description and contract. The home benefits from having a stable staff team who have developed a good understanding and relationship with the People living in the home, enabling them to provide a personalised service. Survey responses from staff reflected this, We have a stable workforce who have worked in the home for a number of years and have got to know and understand the people living there. Over 75 of staff have completed their National Vocational Qualification (NVQ) giving them appropriate skills and knowledge. Staff we met said that induction training was very good and gave them all the information they needed. We looked at individual training records and a training programme compiled by the manager. The manager had completed a training gap analysis to identify training shortfalls. It was evident from the records we examined that staff had completed relevant training in the past but in some Care Homes for Adults (18-65 years) Page 35 of 42 Evidence: cases they were in need of refresher training to make sure their knowledge was up to date and in line with current good practice. The manager should now implement the training programme ensuring these shortfalls are addressed. We examined staff rotas, which confirmed that two staff are on duty each day, including evenings and weekends, when people are at home. This level of staffing is appears to be adequate when both people are in the house. As described previously peoples consumable income can sometimes limit their opportunities to go out independently. Staff comments also confirmed this saying, If we had more funding for staffing we could provide a higher level of individual and one to one activities for people. Subsequent to the inspection visit the registered manager Lesley Watson confirmed people have opportunities in the evening and weekends to go out independently dependent on their personal finances. The manager ensures all staff receive regular formal supervision, which is good practice and a testament to her commitment taking into account the managers contracted hours. This is appreciated by staff who said they get good support from the manager and that she always makes herself available even when she is not on shift. They also said it is a well run home, and we are a staff team who understand good team working and support each other in sometimes challenging situations. Staff meetings are also used effectively to share information with staff and make sure they are aware of relevant policies and procedures and peoples changing needs or significant events that affect them. Care Homes for Adults (18-65 years) Page 36 of 42 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 manager communicates a clear sense of direction and leadership ensuring the service is responsive to peoples changing needs. Evidence: Requirements have been made at previous inspections relating to the low number of management and supervisory hours allocated to the home. The organisation has now responded to clarify the management support arrangements for the home, as a result of the last requirement made on 30th April 2009. The responsible individual has confirmed that the Registered Manager has been approved to work overtime in response to service demands and to provide extra support when required. In addition a new line management arrangement is in place with the new line manager being available to support staff in the managers absence as well as there being an on call operations manager available twenty four hours a day and seven days each week for support and guidance. The Commission will continue to monitor the management arrangements in the home to make sure they are sufficient for the effective and efficient management of the home. The manager is waiting to be issued with a contract and job description clarifying her role and responsibilities. Care Homes for Adults (18-65 years) Page 37 of 42 Evidence: The staff we met and received survey responses from said they feel valued and able to contribute to the smooth running of the home. Through regular supervision and staff meetings in addition to more informal contact, the manager ensures there is an open, positive and inclusive atmosphere in the home. Staff are confident in their role and responsibilities and the reporting procedures of the organisation. Formal consultation takes place with people living in the home and other people with an interest in the home ensuring their views are valued and responded to. The manager and staff also work closely with other professionals, health agencies and family members to make sure the service is responsive to peoples changing needs. The organisation have a comprehensive range of policies and procedures that are kept under review and ensure that staff are aware of and follow current good practice guidelines and legislation. Relevant risk assessments have been completed to safeguard both the people living in the home and the staff that support them. Routine maintenance and servicing of equipment has taken place at the prescribed intervals ensuring it is safe and fit for purpose. Health and safety checklists on the whole were up to date however in the fire log the record of some tests and drills reflected some inconsistencies and long gaps between fire drills, however recent checks and drills had been recorded. It is recommended fire tests and drills are planned ahead to make sure they take place at the recommended intervals. Care Homes for Adults (18-65 years) Page 38 of 42 Are there any outstanding requirements from the last inspection? Yes No Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 39 of 42 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 20 13 01/05/2010 The medication stock recording system must be reviewed to make sure it is completed consistently and a clear accurate record is maintained that can be easily audited. Stock records we examined were inaccurate and completed inconsistently making it difficult to follow and keep an accurate record of medication held in the home. 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 7 The process for supporting people to go on hoilday should be reviewed, with a suitable advocate or representative Page 40 of 42 Care Homes for Adults (18-65 years) 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 available to the person concerned, to make sure their views are represented and not compromised by the policy and procedures of the organisation. 2 3 24 24 The home should notify the Commission immediately when the planned work is completed on the exterior paintwork. The manager and the organisation need to ensure they are meeting their responsibilities under the Care Home Regulations and all routine maintenance is completed as required. The manager should now implement the training programme ensuring the training shortfalls identified are addressed. It is recommended fire tests and drills are planned ahead to take place at the recommended intervals. 4 35 5 42 Care Homes for Adults (18-65 years) Page 41 of 42 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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