Care Home: 79 Coriander Close

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What the care home does well The home has consistently demonstrated that it offers the people living there a very good service. The care plans for the people living in the home were very comprehensive and detailed how their needs were to be met by staff. The care plans also included very good detail of how individuals were to be enabled to meet their own care needs wherever possible. Risk assessments were in place for all the activities that the people living in the home took part in. There were also detailed behavioural guidelines in place that included what may be the triggers, any warning signs and how staff were to respond. There was a good range of activities available for the people living in the home both in the home and the community. Staff enabled them to experience new activities on a regular basis. There were good systems in place to enable staff to communicate with the people living in the home. The personal and health care needs of the people living in the home were met in ways that suited them. Care plans included detail of how staff would know if any of the people living in the home were unhappy or in any pain. Staff turnover at the home was quite low which was good for the continuity of care of the people living in the home. Staff were well trained and able to care for the people living in the home safely. Staff recruitment procedures were robust and ensured the people living in the home were safeguarded. The home is a small domestic dwelling and as such provides the people living there with a very homely atmosphere. What has improved since the last inspection? The requirements made following the last inspection had been addressed. These were in relation to staff recruitment, medication management, fire training and the replacement of some furnishings. The care planning system in the home had changed. Staff had had person centred planning training and the people living in the home had had person centred plans drawn up which detailed their dreams and aspirations. These included comprehensive details about the individuals in the home and how their needs were to be met. The sensory room had been further developed with the addition of further items and exploration objects.A new dining table and chairs had been purchased, new flooring had been fitted in some areas of the home and some new beds purchased. What the care home could do better: No requirements were made following this inspection but there were some recommendations. Staff should ensure that activity plans are updated as changes occur to ensure they cross reference to daily routines. The information in the daily routines should cross reference to the dietary needs where applicable. This will avoid any confusion when staff are referring to the documents. It was recommended that staff use either stones and pounds or kilograms to record weights so that they were easily able to recognise any weight gain or loss. Some general improvements were recommended for the medication system. For example, where it was necessary to hand write MAR (medication administration record) charts the details were checked and verified by two staff as being correct and that a system was put in place that made it easy for staff to audit the medication held in the home on an ongoing basis. Some areas in the home were identified as being in need of redecoration this should be addressed to ensure the accommodation is kept to an acceptable standard. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 79 Coriander Close 79 Coriander Close Northfield Birmingham West Midlands B45 0PB     The quality rating for this care home is:   three star excellent 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: Brenda ONeill     Date: 1 9 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 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 31 Information about the care home Name of care home: Address: 79 Coriander Close 79 Coriander Close Northfield Birmingham West Midlands B45 0PB 01214578257 01214578355 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Sense, The National Deafblind and Rubella Association Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability sensory impairment Additional conditions: The maximum number of service users who can be accommodated is: 3 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 (LD) 3 Sensory impairment (SI) 3 Date of last inspection Brief description of the care home 79 Coriander Close is a three bed roomed terraced house, situated in the middle of a housing estate in Northfield, Birmingham. It is registered for three people with learning disabilities and sensory impairment. Trident Housing owns the premises, and Sense in the Midlands are the care providers. The home consists of a downstairs toilet, kitchen with combined area for dining, lounge and sensory room. The laundry facilities are Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 0 3 3 Brief description of the care home housed within the kitchen area. On the first floor there are three bedrooms for the people living in the home, a bathroom and toilet and a small staff office. To the front of the house there is off road parking. There is a garden to the rear of the house. The home is not accessible to people who may use a wheelchair as there is no lift or aids and adaptations to assist people with impaired mobility. The service user guide did not include the range of fees charged at the home but did include a statement stating that due to the needs of the deaf blind being very complex fees were negotiated on an individual basis. Care Homes for Adults (18-65 years) Page 5 of 31 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: three star excellent 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 last key inspection at the home was carried out on January 25th 2007. Following this an Annual Service Review was done on January 15th 2007 when we sent some satisfaction surveys to the families of the people living in the home and the home sent us some information in the Annual Quality Assurance Assessment. From the information we received we decided the home had continued to provide a good service to the people living there and that we did not need to bring forward the next inspection. This key inspection was carried out by one inspector over one day in January 2009. During the course of the inspection the care for one of the people living in the home was tracked. This involved looking at the care plan, risk assessments and daily records Care Homes for Adults (18-65 years) Page 6 of 31 for the individual and observing the person in the home. We also looked at medication management, one staff file, training records, staff rotas and some health and safety documentation. A tour of the home was also undertaken. During the course of the inspection we spoke with the manager, area manager and three staff. Prior to the inspection the area manager had completed and returned to us the Annual Quality Assurance Assessment (AQAA) for the home which gave us some further information and is referred to in this report. No complaints or adult protection issues had been raised with us about the home since the last key inspection and none had been lodged directly with the home. What the care home does well: What has improved since the last inspection? The requirements made following the last inspection had been addressed. These were in relation to staff recruitment, medication management, fire training and the replacement of some furnishings. The care planning system in the home had changed. Staff had had person centred planning training and the people living in the home had had person centred plans drawn up which detailed their dreams and aspirations. These included comprehensive details about the individuals in the home and how their needs were to be met. The sensory room had been further developed with the addition of further items and exploration objects. Care Homes for Adults (18-65 years) Page 8 of 31 A new dining table and chairs had been purchased, new flooring had been fitted in some areas of the home and some new beds purchased. 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. 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 31 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 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems in the home ensured that the individual aspirations and needs of the people living in the home were assessed on an ongoing basis to ensure they could be met by the home. Evidence: There was a service user guide for the home which was available in different formats, for example, on disc. The document included all the necessary information to enable people moving into the home or their representatives to decide if the home would be able to meet the needs of the individual concerned. Each of the people living in the home had a personalised copy of the service user guide on their files. No new people had been admitted to the home for a number of years. Records in the home showed that the goals and aspirations of the people living in the home were regularly reviewed, for example, in statutory placement reviews and on an ongoing basis in monthly core meetings. The people living in the home had extensive person centred care plans that detailed their needs and how these were to be met. These Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: were updated when there were any changes to the needs of the people living in the home. Care Homes for Adults (18-65 years) Page 12 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home had comprehensive person centred care plans and risk assessments that detailed how all their needs were to be met and how any identified risks were to be minimised by staff. Evidence: The AQAA stated under what the home does well Person Centred Care Plans that contain an array of information to reflect the support needs and preferred lifestyle choices of individuals. The information is updated regularly by the manager, practice development worker and staff members. The information in each persons care plan is very informative and enables a consistent approach to the support given. The person centred plans had been drawn up since the last key inspection and one was sampled during this inspection. Staff are commended for the comprehensive details that are included in the plans. The Person Centred Plan (PCP) that was sampled was drawn up with input from all the Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: people who work with the individual and know them well, family and the organisations family liaison manager. The file included extensive information about what was important for the individual, their likes, dislikes and preferences in all areas of their lives and who was to support the person. The PCP included the dreams and aspirations of the individual and detailed what was possible. Pictures had been added throughout which made the PCP easy to understand and follow. There was an action plan with time scales detailing what was to be done as first steps, in the first 3 months and then six months. The PCP sampled included comprehensive details of how staff were to communicate with the person to enable them to make choices and complete tasks appropriately. For example, there was an object dictionary showing staff what objects were to be used to indicate outings and tasks. This included such things as wooden triangle for home , scissors meaning hairdresser, seat belt meaning the mini bus and so on. There were also details of the sign language that could be used to communicate with the individual. Staff were seen using both symbols and sign language when guiding the individual to make breakfast and a drink. Every task or activity the person was involved with was detailed in the PCP including all morning and evening routines. The abilities of the person were clearly detailed for example, likes a soak in the jacuzzi which he activates independently. There were details of the person removing his shoes and socks when in doors and his top. The person was seen to do this and staff were able to tell us this was normal for the person. The PCP also included details of what should be accessible to the individual including such things as a fan next to their chair, a box of tactile objects in the sensory room and a communication basket on the window sill in the kitchen which they would access independently. These items were all seen to be in place and the individual was seen to use the communication basket. Progress on the PCP was monitored via monthly core meetings which also included what has been done during that period and the general well being of the individual. There were also regular reviews being held. There were numerous risk assessments in place for the individuals in the home for such things as accessing areas of the home and any activities they took part in. There were also detailed behavioural guidelines in place. The guidelines included what may be the triggers, for example, being too hot, the early warning signs, for example vocalising or self injurious behaviour and how staff were to respond. Daily records clearly documented any presenting behaviours and how these had been managed by staff. All the people living in the home also had manual handling risk assessments and Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: had been assessed to identify if they were at risk of choking. If there was a risk a management plan was put in place. Care Homes for Adults (18-65 years) Page 15 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home were encouraged and enabled to have an independent lifestyle as far as was possible. Their rights and responsibilities were recognised by staff in their everyday lives. The catering arrangements at the home met the needs of the people living there. Evidence: The file for the person being case tracked included details of the choices they were able to make and this included activities, what to wear and what to eat. How staff were to undertake choice making sessions was very well detailed and informed staff what symbols were to be used to communicate with the individual to enable them to decide what they wanted to do. There was a weekly activity plan in place for the person whose care was being tracked. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: This indicated that the individual took part in activities both in the home and the wider community. Activities detailed on this included, snoozalem, swimming, massage, walking machine, aromatherapy. It was also evident that staff tried new activities, for example, a hot tub had been hired for the use of the people living in the home and we were told they enjoyed this very much. The person being case tracked had had a flight in a hot air balloon and we were told they had enjoyed this. Daily records included details of the activities taken part in and how people reacted to these. There were numerous pictures around the home and on care files showing people taking part in their planned activities and of their annual holiday. It was noted that the activity plan for the person being case tracked had not been updated when there had been a change in the time of day and frequency of use of the walking machine. The change had been clearly detailed in the individuals evening routine. Contact with families was enabled and encouraged by the staff in the home. Care files included information of when staff were to send birthday cards and so on to family members. All contact with families was detailed on personal files. Families were able to visit the home when they wished. The people living in the home had nutrition and dietary needs files that were kept in the kitchen. These detailed the likes, dislikes and preferences of the individuals and special dietary needs. Staff were able to tell us that the person being case tracked did not chew their food and therefore there were certain foods they could have and they needed to be supervised when eating. This was observed during the inspection when the individual was having breakfast. The individuals dietary needs plan stated they were to have a specific drink with their breakfast due to a minor health issue they were seen to be given this by staff. It was noted that in this persons daily routines the drink detailed was different to what was being given. This needed to be updated and cross reference to the dietary needs to ensure there was no confusion. The menus in the home were drawn up on a weekly basis and incorporated the likes, dislikes and preferences of the people living in the home. Records indicated the meals were varied and nutritious. Care Homes for Adults (18-65 years) Page 17 of 31 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 personal and health care needs of the people living in the home were met in ways that suited them. The medication system was generally well managed and ensured people received their medication as prescribed. Evidence: The people living in the home needed considerable support to meet their personal care needs. The care plan for the individual being case tracked was very detailed in relation to personal care. There were detailed morning and evening routines that showed what the individual could do for themselves and what staff needed to assist with. It detailed such things as to what extent the person could assist when in the bath and how long they could be safely left for, to what extent they could participate in dressing and how to ensure good oral hygiene. There were details to be followed for when the individual was going to the hairdressers and what preparations were needed. Clearly gender sensitive care had been considered and there was a statement on the file in relation to this. The people living in the home had health action plans in place. The one sampled during Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: the inspection included a lot of information about the health care needs of the individual including many pictures. It gave details of ongoing health concerns and also covered areas such as communication, vision, mobility, weight and healthy eating with detail of how often and when checks with health care professionals were undertaken. Records showed the appropriate checks had been carried out at the required intervals. The individual had attended appointments with the G.P. as necessary and medication was regularly reviewed. It was noted that the dentist had suggested sedation so that the individuals teeth could be fully examined. Staff were calling a multi disciplinary meeting to ensure that if this was done it was in the persons best interests. The individuals weight was being monitored and eating and drinking screenings were undertaken and any particular needs in relation to diet were detailed. There had been a period when the individual had not been weighed but this had been addressed. It was also noted staff had recorded one weight in stones and pounds and then another in kilograms. It was recommended that staff use either stones and pounds or kilograms to record weights so that they were easily able to recognise any weight gain or loss. The medication system in the home was generally well managed. Only staff that had been trained administered medication. The person being case tracked had very little medication and this was only taken on a PRN (as and when necessary) basis. There were protocols in place for staff to follow so that they knew when the medication was to be administered. It was noted that staff were entering a code on the MAR (medication administration record) for the PRN medication all the time indicating it had not been given. This is not necessary and it was recommended that staff only sign the MAR chart when the medication was administered. Medication coming into the home and any that had been returned to the pharmacist was recorded in books. To audit the medication in the home these books and previous MAR charts had to be referred to as balances were not always carried forward to the next MAR chart. It was strongly recommended that a system was put in place that made it easy for staff to audit the medication held in the home on an ongoing basis. It appeared that one of the PRN medicines that was audited had a shortfall in the number of tablets remaining in the home however the tablets in question were recorded in the returns book as having gone back to the pharmacist. It was noted that some of the MAR charts had been hand written rather than printed by the pharmacist. It was strongly recommended that where this was necessary the details were checked by two staff who signed to say the information was correct. Care Homes for Adults (18-65 years) Page 19 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The policies, procedures and systems in place in the home along with the training staff received ensured the people living in there were safeguarded. Evidence: There had been no complaints lodged with us about the home since the last inspection and none had been logged at the home. There had been one incident in the home when it was felt people had not been fully safeguarded when staff left them unattended for a very brief period of time. We were notified about this by the former manager. The incident had been regarded as very serious and had been acted on immediately by the organisation. The complaints procedure for the home was not viewed at this inspection. Previous inspections have shown us that the procedure is appropriate and that it is available in different formats, for example, pictures and compact disc. The AQAA indicated that the procedure remains the same and that the organisation has a number of ways in which complaints can be raised. The care plans for the people living in the home detailed their abilities in relation to raising concerns. There was also detail of how staff would know if any of the people living in the home were unhappy. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: The organisation had clear guidelines in place in relation to challenging behaviours to ensure the people living in the home were safeguarded. The AQAA detailed the training staff had in relation to managing challenging behaviours where they learned safe and non harmful control and restraint techniques. If restraint had to be used it was as a last resort and for the minimum duration. The staff at the home also had the support of a behaviour management team that advised them on how to manage any presenting behaviours. The home notify us when physical intervention has been necessary with a full explanation of why and the technique used. The systems in place for the safekeeping of money on behalf of the people living in the home were robust. All had bank accounts that their personal and mobility allowances were paid into. Withdrawals from the accounts were only allowed by managers and all were clearly documented and cross referenced to bank statements. Small amounts of cash were accessible to the staff in the home for use on behalf of the people living in the home. All expenditure was documented and signed for with receipts available. The cash balance checked at the time of the inspection was correct. The training matrix for the home indicated that all but two staff had had training in adult protection issues. Both were spoken with and confirmed they had recently had this training. The AQAA indicated that this was also followed up with them in supervision and that they were given protection questionnaires to refresh their knowledge and understanding of the subject if formal training was not due. Staff recruitment procedures were robust and safeguarded the people living in the home. Care Homes for Adults (18-65 years) Page 21 of 31 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 home provided the people living there with a comfortable, safe and homely environment in which to live. Evidence: The home is a small domestic dwelling and as such provides the people living there with a very homely atmosphere. The home was safe, comfortable and generally well maintained. Some areas were in need of redecoration, for example, the stairs , hallway and one bedroom. However the manager had already planned for the bedroom to be decorated. It was noted that some of the drawer fronts on the kitchen units were in need of replacing. Communal space consisted of a well furnished lounge,dining kitchen and well equipped sensory room. Further items and exploration objects had been purchased for the sensory room since the last inspection. This room was frequently used by the people living in the home. The were symbols, calendar boards and communication boxes around the home enabling individuals to access objects of reference easily. The people living in the Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: home were able to find their way around the home either independently or with some guidance from staff. The kitchen was clean and tidy. All opened foods in the fridge had been dated on opening. Laundry facilities were located in the kitchen but due to the layout of the home there was no alternative space for this. All the bedrooms were of single occupancy and located on the first floor of the home. They were appropriately indiviualised to reflect the personalities of the occupants. All the people living in the home had double beds. There had been some new flooring and new furniture purchased for some of the bedrooms. The home has one bathroom and toilet located on the first floor with a shower over the bath. This gave the people living in the home the choice of either having a bath or shower. There was also an additional toilet on the ground floor. The home had a large well maintained garden with seating and swing available for the use of the people living in the home. The manager spoke to us about her plans to improve the garden to make it more of a sensory garden for the people living in the home. Care Homes for Adults (18-65 years) Page 23 of 31 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. Appropriate staffing levels were being maintained by a well trained staff team that could meet the needs of the people living in the home. The recruitment procedures were robust and ensured the people living in the home were safeguarded. Evidence: There was relatively low staff turnover at the home and some of the staff had worked there for a number of years. This was good for the continuity of care of the people living in the home and very important due to their complex needs. There were two staff on duty when we arrived at the home. Both were able to tell us about the needs of the people living in the home and what was planned for the day. Observations made showed that staff followed the care plans in place and used all the appropriate communication systems available to them to ensure the people living in the home were able to make their own decisions wherever possible. Rotas indicated there were always a minimum of two staff on duty through the waking day and one waking night staff. These levels were appropriate for the needs of the people living in the home at the time. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: We spoke to a member of staff who was still on their probationary period at the home. They were able to tell us about the extensive training they had had including, medication, working with the deaf blind, manual handling, and adult protection. They were very impressed with the range of training available. The individual told us that the most challenging issue had been communicating with the people living in the home due to their complex needs. However they had shadowed the first week and spent this watching experienced staff work with the people living in the home and had learned a lot. We were told that the other staff in the home had been very supportive and the team worked well together. The individual was able to tell us that if they needed information about the people living in the home they looked at the files. They had clearly learned a lot about the needs of the people living in the home and was able to tell us about these, for example, dietary needs. Although the new staff member was able to tell us in some detail about the extensive induction training there were no records of this on site. We were told this was because the individual had their own training pack until it was complete. It was recommended that some records were kept on site during the induction period. The training matrix for the home indicated staff had undertaken training in numerous topics including manual handling, health and safety, first aid, food hygiene, care of medicines, infection control, protection and fire safety. Refresher dates were also indicated and only a very small number of these were overdue. Staff also undertook training in topics specifically related to the people they were caring for including such things as communication, challenging behaviour and working with deaf blind people. The training matrix indicated that five of the nine staff employed at the home had either NVQ level 3 or 4. The recruitment documentation for the new employee who was spoken with was sampled. All the required documentation was on site and this showed that all the appropriate checks had been undertaken before the person had started work at the home. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was running smoothly. The quality monitoring system that was place ensured the service was run in the best interests of the people living in the home and that it was continuously improved. Evidence: The registered manager had left the home since the last inspection. However the home have what is termed by the organisation as an unregistered care manager in post who was being supported by the area manager. Both were present throughout virtually all of the inspection. The area manager told us that he had interviewed and appointed a new manager who was to be put forward for registration with us but the person had refused the post at the last minute so he was now having to advertise again. The unregistered manager had been in post since October and was very positive about the amount of training and support she had received since taking up the post. She was very receptive to the comments made during the inspection. She had learned a lot about the needs of the people living in the home and was ensuring the home was run Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: in their best interests. It was evident throughout the inspection that staff were well aware of their roles and responsibilities and that they had a good knowledge of the needs of the people living in the home. Some very good practices were observed throughout the day. As at the last inspection there was a quality monitoring system in place at the home. The manager of the home undertook a comprehensive audit of the home on an annual basis this involved feed back from staff, the relatives of the people living in the home and any professionals involved in their care. The outcome of the audit resulted in an action plan being drawn up. The outcome of the annual audits and the action plan were overseen and agreed with senior management. The area manager undertook regular unannounced visits to the home to oversee the conduct of the home. The health and safety of the people living in the home and the staff were well managed. Staff had received all the required training in safe working practices and were seen to work safely with the people living in the home. The AQAA indicated that all the equipment in the home had been serviced as required. The in house checks on the fire system were sampled. These were all up to date and showed that fire drills were undertaken as required and the outcomes were recorded. The home continue to notify us appropriately of any incidents or accidents in the home. Care Homes for Adults (18-65 years) Page 27 of 31 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 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 14 Staff should ensure that activity plans are updated as changes occur to ensure they cross reference to daily routines. The information in the daily routines should cross reference to the dietary needs where applicable to avoid any confusion. It is recommended that staff use either stones and pounds or kilograms to record weights so that they are easily able to recognise any weight gain or loss. It is strongly recommended that a system is put in place that makes it easy for staff to audit the medication held in the home on an ongoing basis. It is recommended that staff only sign the MAR chart when PRN medication is administered and do not enter a code when it is not admisistered. It is strongly recommended that where it is necessary to hand write MAR charts the details are checked and verified by two staff as being correct. The fronts of the kitchen units that are wearing should be replaced to ensure the accommodation is kept to an acceptable standard. 2 17 3 19 4 20 5 20 6 20 7 28 Care Homes for Adults (18-65 years) Page 29 of 31 8 28 Areas identified during the inspection that are in need of redecoration should be addressed to ensure the accommodation is kept to an acceptable standard. Is is recommended that some records of the induction training completed by new staff is kept in site during the induction period. 9 35 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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