Care Home: 385 Torbay Road

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What the care home does well The care home has a very welcoming atmosphere. Residents live in a homely environment, with generally quality furnishings, and decoration that meets the needs of people using the service. The registered manager/owner is experienced, and motivated in continuing to ensure that a quality service is provided to all the people using the service. There is close liaison with health care professionals, and other specialists as and when required by the residents. People using the service were very positive about living in the home, comments included `I am happy here`. `I can get up and go to bed when I want`, and `I can choose what to eat`. People using the service have their views listened to, and respected. There are regular resident meetings, which they have the opportunity to attend. People using the service are supported to have the contact that they wish with relatives and friends. Holidays for residents are a regular feature of the care home. Observation, and talking to staff indicated that staff were aware of each person`s needs, and cared about ensuring that these needs were met. Interaction between staff, and residents was positive and respectful. What has improved since the last inspection? The three requirements and the recommendations from the previous unannounced inspection (8th and 10th May 2007) have been addressed. The home has improved the format of each resident`s care plan, which include the development of a more `person centred` ( the person being central to their plan of care) plan and includes a Health Action plan in picture and written format. The upstairs bathroom has been fully refurbished and decorated. The home records and acts upon (in line with the complaints procedure) any `concerns` communicated by people using the service What the care home could do better: The format of some documentation that is of interest to people using the service (such as the resident`s contract/terms and conditions) could be continued to be further developed to be more accessible to those who have difficulty in reading or of written English. The financial assessments of some people using the service could be developed. The staff induction training programme should meet the Skills for Care Common Induction standards. There should be evidence that staff have received `refresher` training, and that staff development and training plans are kept up to date. The recording of `in house` medication training could be better. The care home should ensure that all staff have knowledge and understanding of the Mental capacity Act/Deprivation of Liberty safeguards, and provide staff with training. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 385 Torbay Road 385 Torbay Road Harrow Middlesex HA2 9QB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Judith Brindle     Date: 2 6 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: 385 Torbay Road 385 Torbay Road Harrow Middlesex HA2 9QB 02089332625 01895638974 info@santacarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Santa Bapoo care home 4 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 4 The maximum number of service users who can be accommodated is: 4 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 Date of last inspection Brief description of the care home 385 Torbay Road is a care home providing personal care and accommodation for up to 4 adults who have a learning disability. Presently it is providing a service for Asian women. The owner and registered manager is Ms Santa Bapoo. The home opened in 1996. It is located in a quiet residential street in North Harrow. The care home is within a few minutes walk from a variety of shops, restaurants, library, banks and other amenities. Public bus and train facilities are accessible close to the home. The home is a semidetached house, which is in keeping with other houses in the locality. There is parking for 2-3 cars at the front of the house. All the homes bedrooms are single without ensuite facilities. There is one bedroom located on the ground floor. The home has an enclosed accessible maintained garden at the rear of the property. Care Homes for Adults (18-65 years) Page 4 of 33 Brief description of the care home Documentation/information about the care home is accessible to residents and visitors. Information with regard to fees can be obtained by contacting the registered manager/provider. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced inspection took place throughout part of two days in March 2009. There were no vacancies at the time of the inspection. We were pleased to meet and talk to all the people living in the home. The registered manager was present during part of the inspection. A number of feedback surveys were supplied to the care home prior to the inspection. At the time of writing this report we had received completed surveys from all the people using the service, and three from staff. Documentation inspected included, residents care plans, risk assessments, staff training records, and some policies and procedures. The inspection included a tour of the premises. Observation was also significant tool used in the inspection process. Care Homes for Adults (18-65 years) Page 6 of 33 Assessment as to whether the requirements, and the recommendations from the previous key inspection (8th and 10th May 2007) had been met, also took place during this key unannounced inspection. 28 National Minimum Standards for Adults, including Key Standards, were inspected during this inspection. Prior to this unannounced key inspection the registered manager/owner supplied us with a completed Annual Quality Assurance Assessment (AQAA) document. This record included required information about the quality of the service provided by the care home, and of any planned improvements. This document had been completed generally satisfactorily but there were some sections (policy information, and safety service checks, and medication sections) of the document that should have been completed. Reference to some aspects of this AQAA record is documented in this report. We thank the people living in the care home, staff, and the manager for their significant assistance in the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 8 of 33 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service have the information needed to choose a home that will meet their needs. Prospective residents have their needs assessed, with their participation (and/or family member/friend), prior to moving into the care home, which makes certain that the home knows about the person, and the support that they need. Evidence: The home has a statement of purpose, and an accessible service user guide written in English and in Gujarati. These documents include information about the service provided by the care home to people using the service. A copy of the service user guide was seen in the care plan folders of the residents care plans inspected by us. This service user guide is in written, and picture format. We were told that this information was up to date, and that the service user guide was given to prospective residents, and to others, such as the relatives of people planning to move into the care home. Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: There have been no admissions to the care home since the previous key unannounced inspection. All the residents have lived in the care home for several years. Previous inspection, records, and staff told us that there were procedures in place to ensure that prospective residents have their needs fully assessed (with their involvement) by the funding/purchasing Local Authority, and by care home senior staff, prior to moving in. We were told that this ensures that the service is as certain as they can be that it can meet the prospective residents needs. It was evident from records that the people using the service receive a contract of terms and conditions with the care home. This document could be developed into a more accessible format for people using the service, who might have difficulty reading, and/or who have English as a second language. Care Homes for Adults (18-65 years) Page 12 of 33 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. People using the service have an individual plan of their needs, which includes details of the care and support that they require from staff. People using the service are supported, and encouraged to make decisions and choices about their lives, and are supported to take risks as part of an independent lifestyle. There could be development with regard to residents financial risk assessments. Evidence: Each person using the service has a plan of care. All four care plans were looked at. These care plans are based upon assessment of the persons needs, and their changing needs. These include the persons health, behaviour/mental health, skills, abilities, emotional, social needs and aspirations. Care plans included information with regard to meeting residents equality and diversity needs, such as religious, cultural and language needs. The care plans include some written guidance to ensure that the persons assessed needs are met with staff support. It was evident that the care plans Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: had been significantly improved and developed since the previous key inspection. The information in these plans is more comprehensive, and includes evidence that each resident has participated in their plan of care. This includes signing their own care plan. These care plans each included a comprehensive summary profile of each person using the service, and had been reviewed, with the resident, (and family members), and staff approximately every six months. It was also evident that the care plans had also been reviewed by the care manager from the funding Local Authority. The care plans that were looked at included some evidence of risk assessment, which covered a range of possible risks (including behaviour, cooking, use the stairs, bathing and road safety) to the persons safety, and included guidance to minimise these risks, and to support the person using the service to lead a quality life as independently as the are able to. Residents spoke to us about the choices that they made. Examples of these included deciding when to go to bed, and when to get up in the morning. Other decisions that residents spoke of making included; choosing their own clothes, meals, and holidays. Staff were seen to offer residents a number of choices during the inspection, and to respect the decisions that each person made. The feedback surveys from people using the service also told us that they make decisions about what they want to do each day. Residents care plans include individual financial risk assessment. We were told that the manager stores some residents bank cards off the premises for security/safety reasons, and that residents have shared their bank card pass numbers only with the manager and one senior staff member (deputy manager). There needs to be evidence of a risk assessment with guidance for each person that has a bank card and bank Pin number that is held by the manager. To ensure that there is minimal risk of any financial abuse. Appropriate incoming and expenditure records are maintained. It was evident from records that residents spend their allowances on personal items, such as toiletries, clothes. A resident kindly showed me some clothes and a holiday souvenir that she had recently bought. Care Homes for Adults (18-65 years) Page 14 of 33 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 who use the service are able to make choices about their lifestyle, and are supported to develop their life skills. The people living in the care home have their rights respected, and their responsibilities are recognised in their daily lives. There needs to be some further assessment to ensure it is evident that residents freedom is not restricted, application of safeguards. Meals are varied, and wholesome, and meet the cultural and religious needs of people using the service. Evidence: People using the service told us of the activities that they participated in, and enjoyed. A resident spoke of working in two charity shops during the week. She told us about her role and responsibilities with regard to these jobs, and spoke of her plans to speak Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: to her care manager about spending a day a week at a day centre. Other activities that we were told about by the residents; included shopping locally for fresh food items that meet their cultural dietary needs, shopping for clothes, and other personal items, and going out for meals. A resident told us that she had seen two Asian films at the cinema recently, and had enjoyed them very much. Another resident spoke of going to the a local rural area for a visit. Records told us that people using the service have recently visited the local museum, been on walks, and had recently been away on holiday to Brighton. A person using the service told us that she enjoyed writing, and watching Asian programmes on television. Another resident spoke about her doing knitting and sewing as a hobby.Residents daily records told us that people using the service participate in a variety of activities. Most residents attend a day centre for several days during the week, including attending a resource centre, which particularly meets the needs of Asian people. We were told by the people using the service that they enjoyed spending time with friends at the various resource centres. Residents told us that they had enjoyed celebrating various festivals, including those of religious significance. A resident spoke of celebrating Diwali. Feedback from surveys from people using the service told us that residents can choose what activities that they wish to participate in. A resident confirmed that she could choose what to do and that if she didnt want to take part in a particularly planned activity, that decision was respected by staff. Annual Quality Assurance Assessment (AQAA) told us that the home supports people using the service to do meaningful occupations during the day. The visitors book confirmed that there are visitors to the care home. It was evident that the home supports residents to develop and to actively maintain relationships (if they wish) with family and friends. We were informed by staff and residents that people using the service have varied contact with relatives and or significant others. One resident spoke of receiving regular phone calls from a relative. A resident showed us her key to the front door. It was noted that the front door was locked during the inspection. Staff explained that this was needed to meet the safety needs of some residents. With regard to the Mental Capacity Act Deprivation of Liberty Safeguards, this needs to be assessed, to ensure that it is evident that people using the service have control over the decision with regard not being able to leave the home without agreement from staff. The manager told us that she had contacted the Local Authority about obtaining a representative/best interest assessor with regard to the residents concerned, with regard to possibly having a Special agreement Deprivation of Liberty Authorisation this issue. It needs to be recorded and agreed with the person using the service (if they have capacity) that the front door be locked (with staff having the key), and Deprivation of Liberty safeguards with regard to this, need Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: to apply if the person lacks capacity. AQAA and records told us that the residents meet with staff on a weekly basis and between them choose and plan the meals that they want to eat during the following week. Residents told us that they can choose what to eat and that they enjoyed the meals. It was evident from records and from speaking with people using the service that that meals provided in the care home meet their religious and cultural needs. The residents spoke of being very much involved in the preparation of their meals. During the inspection two residents participated in preparing their evening meal. The AQAA (Annual Quality Assurance Assessment) told us that the home had consulted a dietitian with regard to advise on specific dietary needs. A resident kindly offered and made us several cups of tea during the inspection. People using the service told us that they can make drinks and have snacks at any time. Residents told us that they had chosen what to eat for breakfast during the inspection. There were a variety of food items in the kitchen. These included dried foods such as pasta and rice, tinned foods, fresh vegetables and frozen items. A large variety of spices were also accessible. Care Homes for Adults (18-65 years) Page 17 of 33 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. The health and personal care that people receive is based on their individual needs,and the principles of respect, dignity, and privacy are put into practise. Systems are in place to ensure that medication is stored, and administered safely to people using the service. Records of staff medication training could be better. Evidence: It was evident from talking with staff, residents, and from general observation and from looking at records that staff have knowledge, and understanding of the importance of ensuring that the residents have their health care needs assessed and met. The care plans that were looked at, included Health Action Plans (which included pictures) for each person using the service, which include clear guidance on how each persons health needs are met by the home. Treatment and care for residents from health care professionals including the GP, dentist, chiropodist, psychiatrist, and optician, were recorded. Residents attendance at specialist clinics, and hospitals appointments were also documented. We were told that advice was sought from health care professionals as and when required by people using the service, and that referrals were made in accordance to residents needs, and their changing needs. Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: The home has a medication policy. We were told that all the people using the service require support with taking their prescribed medication. On the first day of the inspection medication was seen to be stored in a locked medication fridge. This was queried by us. We were told that the fridge had been supplied to the home following advice from a pharmacist, and that the home had been advised to that the medication should be stored in the fridge. During the process of inspection a senior staff member contacted the pharmacist, and a medication cabinet was supplied and secured in the home, and all medication transferred into it. Medication administration records were up to date. We were told that each person using the service has their medication reviewed regularly by the GP and/or psychiatrist, and that a pharmacist regularly inspects the medication storage, and administration systems in the care home. The AQAA told us that staff receive medication training, and that medication training is included in the staff induction programme. It was not evident in the training records looked at by us of what the content was of the medication training that staff received during their induction and following it. A senior staff member told us about the process of medication training/induction that was carried out by the home to ensure that all staff who administer medication to people using the service, are competent to do so. We were told that this includes shadowing new staff and informing them of the specific medication needs of each person using the service. There needs to be a record of this in house medication training, which includes individual assessment and confirmation of staff competency to administer medication to residents. This record needs to include evidence of staff having knowledge of how medicines are used and how to recognise and deal with problems in its use, and also the principles behind all aspects of the homes policy on medicines handling and records. We were told that previous inspection requirements with regard to medication had been met by the home. Care Homes for Adults (18-65 years) Page 19 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service, have access to an effective, robust complaints procedure, and are protected from abuse, and have their rights protected. It should be evident from records that staff receive refresher safeguarding adults training. Evidence: The care home has a complaints procedure, a summary of which is recorded in the service user guide. The complaints procedure includes timescales with regard to responding to a complaint. Following the key unannounced inspection, we were supplied with a copy of the complaints procedure which was in picture and written format. AQAA told us that we listen with a view to do something about a complaint or suggestion, and we encourage expressions of opinions individually and through representatives. We looked at records that told us that residents concerns are recorded and listened to, and that action is taken to resolve issues of concern. There has been one recent complaint which we were notified about. The home responded appropriately in line with their complaints procedure. AQAA told us about the steps taken by the home to develop and improve communication with relatives of residents, and to encourage them to speak to staff when they have a concern/complaint. AQAA told us that the home has regular contact with our service users, relatives and advocates to share ideas and opinions about the running of the home. From talking to staff, and information from staff feedback surveys, it is evident that the service recognises the value and importance that complaints/concerns bear in driving the Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: service forward and in protecting individuals. The home has clear and robust policies and procedures with regard to the protection of people using the service. Staff, and records told us that staff had received training in safeguarding adults, and we were told that that safeguarding adults training is included in the staff induction programme, and in the National Vocational Qualifications (NVQ) in care that staff have achieved or are in the process of completing. It was not clear from records that staff receive refresher safeguarding adults training. This should be evident in the staff training records. The home informs us as required about notifiable events. Care Homes for Adults (18-65 years) Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The layout of the home enables residents to live in a safe, well maintained, and comfortable environment, which supports and encourages their independence. Residents bedrooms, meet their individual needs, and are individually personalised. Evidence: The care home is located in Rayners Lane in the London Borough of Harrow. There are a variety of shops and other amenities within a short walking distance from the home. Bus and train facilities are accessible near to the home. A person using the service spoke of accessing public transport, and of going to local shops with staff, to buy herself personal items, and various food items. The inspection included a tour of the premises. The care home is well maintained, homely, clean and airy. The feedback surveys from a people using the service confirmed that they thought that the home was fresh and clean. The living environment is homely, with furnishings of reasonable quality. Ornaments, photographs, pictures, a large television are located in the communal sitting room. There is also a quiet sitting/prayer room which residents, and others can access if they wish. Since the previous inspection the bathroom has been refurbished and is more of an attractive facility. AQAA told us that the home had also replaced the gas boiler, and that fire door fittings/closers have been replaced. We were Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: told of plans to redecorate the whole premises within the next twelve months. This is positive, as there are areas of the home that could do with being freshened up to improve the attractiveness of the environment for people using the service. Comments from a staff surveys included the service users are provided with a good environment. The home has an enclosed garden, which was generally well maintained. A resident told us that in warmer weather she sometimes spends time in the garden. A bedroom was looked at, and seen to be individually personalised. People using the service told us that they were happy with their bedrooms. The laundry facilities are located away from food storage, and food preparation areas. A senior member of staff and records told us that staff receive food and hygiene training (some staff received food and hygiene training on the first day of this inspection), and that staff also receive infection control training during their induction programme and during the NVQ (National Vocational Qualification) care course. We were told that people using the service are supported to be as fully involved (as they are able to be) in the laundering of their clothes. A person using the service told us that she tends to launder her clothes on a particular day of the week. Care staff carry out cleaning duties in the home. Care Homes for Adults (18-65 years) Page 23 of 33 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. Staff in the home are trained, skilled and are in sufficient numbers to support the people using the service, and to support the smooth running of the service. There could be better recording of the training received by staff. People using the service are supported and protected by the care homes recruitment policy and procedure. Evidence: The staff rota was available for inspection. We looked at several weeks of this rota. It was evident from this record that there is generally one staff member on duty in the care home. Staff and records told us that there are periods during each day when there are two staff on duty, which ensures that people using the service have the opportunity to access community facilities as and when they wish. We were told that the staff rota is flexible and is adjusted to meet the needs of the people using the service, and that there were sufficient staff on duty at all times to ensure that the varied needs of people using the service are met. We discussed with the senior staff member the need to ensure that the home has a staff lone working policy due to there often being only one staff on duty in the home, particularly at night. Following the inspection, we were supplied with a copy of a working alone policy, which the Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: manager had completed. Staff feedback surveys told us that staff had received a staff induction when they started working in the home. Comments included the service provides essential training for staff. The manager spoke of being in the process of recruiting staff, due to staff members having recently left employment in the home. She confirmed that despite a lack of permanent care workers employed in the home, the staffing in the home was meeting the needs of residents, particularly as all staff working in the home (some of whom work in another of the organisations homes) know the residents well. People using the service spoke of liking the staff, and confirmed that they were approachable. A resident said that the staff are nice. Following the inspection the manager told us that she had recruited a staff member and was continuing to recruit other staff. Staff feedback surveys told us that staff had received a staff induction when they started working in the home. We looked at a staff induction record, this indicated that the induction was basic , and there was minimal detail in the record, with regard to what was covered in the induction. The staff induction should meet specification with regard to the Skills for Care Common Induction Standards (CIS). This was discussed with the manager and a senior staff member. The 12-week CIS induction period will enable care workers to give high quality care and support, and it also provides recognition for their work,and prepares them for entry onto NVQ health and social care programmes. The care home should also look into staff having the opportunity to achieve the Learning Disability Induction Award. Following the inspection the manager spoke of developing and improving the staff induction programme. Records told us that staff receive appropriate training that provides care staff with the skills to carry out their roles and responsibilities. This training includes health and safety training, 1st Aid, food & hygiene,and manual handling training, and some specialist training such as prevention of falls, continence and break away training. Training certificates looked at, did not always include the content of the training that staff had received. Records did not indicate that staff had received refresher training as the last recorded training that most staff had received was recorded as 2006. A recently employed staff had records of having had up to date training. Following the inspection the manager told us that staff had received a variety of training since 2006 and that she was in the process updating staff training records. Each staff member should have an up to date training and development plan with a record of all training that they have received. AQAA told us that 100 of our staff were NVQ trained until one of them left. We were told that the home has a policy of enrolling all untrained staff on NVQ level 2 (in care) after six months service. We were told that the NVQ training in care that staff receive, includes many areas of training including health and safety, moving and handling and food and hygiene training. We were told that a senior member of staff had recently completed the Registered managers Award/NVQ level 4 in management and care. Staff should receive training Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: with regard to the Mental Capacity Act Deprivation of Liberty Safeguards. This was discussed with a senior staff member. The home has a staff recruitment and selection procedure. Four staff personnel records (including a recently employed member of staff) were looked at. These records included required information including confirmation that an enhanced Criminal Records Bureau (CRB) check (a check to gain information as to whether a person has a criminal record) had been carried out. Staff job descriptions were seen. Staff personnel files could be in better order, it was not easy to locate some information from some of them. The manager spoke of improving the staff files. Records, and staff told us that staff generally receive regular 1-1 staff supervision (approximately 2 monthly), to ensure that staff are supported in their role, and have the opportunity to develop and achieve goals in regard to carrying out their duties in caring and supporting people using the service. Staff feedback surveys told us that they received supervision often. A senior member of staff told us that she ensures that staff receive supervision regularly. Records told us that a staff member had recently received a staff appraisal. Care Homes for Adults (18-65 years) Page 26 of 33 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 management, and administration of the home is based on openness, and respect, has effective quality assurance systems, which ensures that a quality service is provided to people using the service. So far as reasonably practicable the health, safety and welfare of people using the service is promoted and protected. The fire risk assessment could be further developed. Evidence: The registered manager also owns the home. She has supported and cared for people with a learning disability for a significant number of years, and has managed Torbay Road since it was registered in 1996. The manager has completed a National Vocational Qualification level 4 management course. She spoke of ensuring that her skills are updated, by undertaking periodic training. Records, staff, residents and contact with the home since the previous key inspection, told us that there are clear lines of accountability within the care home. During the inspection, residents were Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: seen to approach the manager without hesitation, and spoke positively about her. The care home has a quality assurance policy/procedure, to ensure that systems to monitor the quality of the service that is provided by the home are in place. Following the inspection we were supplied with an up to date business plan of the service, and were told that an annual development plan with regard to the service was being completed. Senior staff told us that they were planning to update the annual quality assurance assessment (supplied by us) throughout the year and use it as part of the homes monitoring system. A senior staff member told us that questionnaires to obtain feedback from those using the service and those that have other contact (such as relatives, and care managers) with the home are supplied to them on an annual basis. AQAA told us how residents are involved in the decision making of the home. These include decisions about activities, and meals. We were also told that informal consultations with relatives happen all the time, and service users are consulted throughout the day individually. AQAA also told us that the home plans to hold one or two informal evenings in the home with relatives and service users, about their wishes and to meet with (the manager) and other staff to exchange views and suggestions. It was evident that care plans had been reviewed and that other documentation within the home was generally kept up to date. Records told us that staff and also resident meetings take place regularly. Certificates of worthiness in regard to the servicing of electrical and gas systems were up to date. Records told us that health and safety checks are carried out regularly in the home. These include hot water temperature checks. The home has a fire risk assessment, and regular unannounced fire drills take place. The front door being locked, needs to be included in the fire risk assessment and needs to include details and assessment of who has access to the key. We discussed with a senior staff member that there should be a recorded emergency plan in the home, that covers the action needed to be taken in an emergency such as gas and/or electrical safety, and flu pandemic concerns. Following the inspection the manager told us that she was in the process of completing this plan. The home has an accident reporting policy. Records told us that incidents and accidents are recorded. The employers liability insurance certificate that was displayed was just out of date. A senior staff member told us that the manager had received the new certificate and had told her that this would be displayed promptly. Following the inspection, the manager confirmed this had been carried out. Care Homes for Adults (18-65 years) Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 There needs to be evidence that each person using the service has their financial risk assessment developed. To include clear guidance which demonstrates that there are systems in place with regard to staff storing residents (with their agreement)bank cash cards and their bank Pin numbers. To ensure that there is minimal risk of any person using the service being financially abused. 01/07/2009 2 16 13 It needs to be recorded in 01/07/2009 the care plan, and agreed with the person using the service (if they have Capacity) that the front door be locked (with staff having the key), and Deprivation of Liberty safeguards with regard to this need to apply if the person lacks Capacity. To ensure that no person Care Homes for Adults (18-65 years) Page 30 of 33 using the service is subject to a restriction to their freedom unless there is a Special agreement Deprivation of Liberty Authorisation. 3 20 13 There needs to be a record of in house/and other medication training which includes evidence of staff having knowledge of how medicines are used, and how to recognise and deal with problems in its use, and also the principles behind all aspects of the homes policy on medicines handling and records. To ensure that medication is administered safely to people using the service. 4 35 18 It needs to be evident that all staff have received up to date training appropriate to the work that they are to perform. To ensure that all staff have the knowledge and skills to carry out their role and responsibilities 5 42 23 The front door being locked, needs to be included in the fire risk assessment and needs to include details and assessment of who has access at all times to a front door key. To ensure that people using the service, staff and others are not at risk of harm. 01/07/2009 01/08/2009 01/07/2009 Care Homes for Adults (18-65 years) Page 31 of 33 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 5 The contract/terms and conditions between the home and the resident could be developed into a more accessible format for people using the service, who might have difficulty reading, or who have English as their second language. It should be evident from records that staff receive refresher safeguarding adults training to ensure that they receive up to date knowledge and information with regard to responding to a suspicion or allegation of abuse. Staff should receive training with regard to the Mental Capacity Act Deprivation of Liberty Safeguards 2005. Certificates of staff training should always include details of the content of the training provided to staff. Each staff member should have an up to date training and development plan with a record of all training that they have received. The staff induction should meet specification with regard to the Skills for Care Common Induction Standards. There should be a recorded emergency plan in the home, that covers the action needed to be taken in an emergency such as gas and/or electrical safety, and flu pandemic concerns. 2 23 3 4 35 35 5 6 35 42 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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