Care Home: Adam House

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What the care home does well There was evidence that the manager and staff did understand the right of the resident to take control over their own life and make their own decisions and choices. Person centred care planning meant residents were cared for as they wanted and needed. Staff who provided written comments considered the service did well in `Promoting individual needs.` To ensure personal care and support was provided in a way, which maintained residents dignity and respected privacy and lifestyle, care plans took into account what residents wanted and what was important to them. Decision-making was encouraged and residents were given time to consider the individual choices they made. They had the benefit of planned one to one discussions with staff, and the option of weekly house meetings. Residents also benefited from additional specialist support where needed such as healthcare, and their care needs were reviewed regularly. Risk management was good and staff had enough information to know how to help keep people safe. Staff worked to a key worker system, and staff who provided written comments and those interviewed, considered they were given enough information to care for residents properly. Comments included `always receive up to date information about the needs of residents`. Residents right to confidentiality was respected. Residents lifestyle was centred on them and they did not have to conform to any institutional practice such as set times for getting up or going to bed. Daily living routines was also a personal choice and they enjoyed various activities such as shopping and socialising with friends. They went on holiday and they had kept good contact with relatives and friends. Meals provided met with residents tastes, needs and choice. Those residents spoken to during inspection said the food was `good`. They said they could have what they wanted. Records showed residents were helped to plan and prepare meals for themselves. Residents who were consulted, said they knew who to talk to if they were not happy. Staff working at the home had been trained in adult protection and knew their responsibility in this area. They were confident they would `report bad practice` if ever the need arose. The home was well maintained, safe, clean, and tidy, and provided a homely and pleasant environment for residents, visitors, and staff. Residents were satisfied with their bedrooms and living arrangements. The numbers of staff employed, training provided, and safe recruitment practices, meant residents should be protected, and their needs properly met. Staff working in the home were considered to be `very good`, and `helpful`. Staff interviewed said they loved their work and had job satisfaction and feltappreciated for their work and valued in the home. Written comments from staff included, the `Manager always arranges regular staff meetings, appraisals and supervision`. Communication was considered to be good and staff said they had the right knowledge and skills to care for residents with mental health care needs. Learning opportunities were relevant to the homes purpose. The managers skills had demonstrated the changes she had made to improve service delivery, the environment, and staffing was successful. The home was well managed and run in the best interests of the people living and working there. What has improved since the last inspection? Staff had been trained in caring for people with mental healthcare needs, which meant people considering staying in the home were assured their needs can be appropriately met. Residents care plans had improved to include all identified needs and provide clear detailed instructions for staff, on how to meet these needs. This provided residents with a more person centred approach to their care and personal development. Acceptable risk taking had been considered and risk management recorded better enabling staff to support residents safely. House rules had been revised to make sure they were appropriate for residents. To support staff deal with the event of a death at the home, they had a policy and procedure to follow. Staff had been given formal training in adult protection issues and had a clear procedure as to the homes stance on the use of `restraint`. All bedroom doors met with fire safety regulations to ensure residents were protected in the event of a fire. Master keys had been provided for staff to gain access when necessary. The recruitment process had improved and met with legislative requirements. The manager meets regularly with residents to ensure their is good resident and staff relationships. To support residents to receive a consistent approach to care the movement of staff between homes in the scheme is limited to emergency relief only. Staff training provided ensured residents individual and joint needs were met appropriately. This included induction that meets with general guidance of the National Minimum Standards. The manager has been registered with the Commission. The rotation of managers between homes had ceased therefore providing some stability for staff, and development of the service. Policies and procedures were kept up to date with current good practice. This supported staff to work effectively and safely. What the care home could do better: People should be consulted and their views considered before they move into the home. This will help to avoid any upset. Relationships building between between residents needs to be developed and managed where this need is identified. This will reduce the risk of conflict. Expressed concerns from any source should be dealt with using the complaints procedure. This will increase peoples confidence that their concerns are taken seriously. Residents` bedrooms should be fitted with more suitable locks, to allow residents the choice of locking their room safely from inside as they can only be currently locked when they leave their rooms. The manager should hold a recognised qualification in management and care. This will help to make sure she has the right knowledge and skills to support her role in managing the home. The manager should also have regular supervision that will provide day to day support. Quality assurance should be extended to seek the views of other people linked to the home such as social workers and community health workers. This will help to know if the service provided, the protection of residents, staff professionalism and management meets with peoples needs and expectations and help to develop the service. The registered provider must regularly visit the home unannounced and produce a report of the visit for the Commission. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Adam House 21 Ormerod Road Burnley Lancashire BB11 2RU     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: Marie Dickinson     Date: 1 3 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: Adam House 21 Ormerod Road Burnley Lancashire BB11 2RU 01282830215 01282414506 healycare@ntlworld.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Tina Louise Pounder Type of registration: Number of places registered: Mrs Bridget Mary Healy care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Adam House is a large garden fronted terraced property in what is mainly a residential area. It is very close to Burnley town centre, near to the College, library, main shopping area, churches and local parks. The home is owned by Mrs Healy and is registered to accommodate 6 adults under the age of 65 with a mental illness (excluding learning disability and dementia). The accommodation provided is domestic in style and consists of a lounge, dining kitchen and smoking area. There are two shared and two single bedrooms. Staff provides support 24 hours per day. Transport is available to enable service users to visit relatives, take short trips and outings within the community. Weekly charges for personal care and accommodation is £965 minimum. There were voluntary optional charges for entertainment and transport. Information about the services provided is usually available in the home. 6 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 31 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: 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: A key unannounced inspection was conducted in respect of Adam House on the 13th January 2009. An annual quality assurance assessment (AQAA) was sent to us by the manager prior to this inspection. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service, such as number of staff trained, and of essential maintenance to keep the home safe, being carried out as required. Written comments were also received prior to the inspection from staff employed at the home who gave their views as to how well the home performed in supporting them in Care Homes for Adults (18-65 years) Page 6 of 31 meeting needs of residents. There were no written comments from residents or relatives. Discussion took place with the manager, staff and residents during inspection. Documents including policies, procedures, and staff and residents records were looked at. The premises were inspected as part of the process. Areas that had been required to improve at the last key inspection were looked at to check for progress made. The home was assessed against the National Minimum Standards for Younger Adults. What the care home does well: There was evidence that the manager and staff did understand the right of the resident to take control over their own life and make their own decisions and choices. Person centred care planning meant residents were cared for as they wanted and needed. Staff who provided written comments considered the service did well in Promoting individual needs. To ensure personal care and support was provided in a way, which maintained residents dignity and respected privacy and lifestyle, care plans took into account what residents wanted and what was important to them. Decision-making was encouraged and residents were given time to consider the individual choices they made. They had the benefit of planned one to one discussions with staff, and the option of weekly house meetings. Residents also benefited from additional specialist support where needed such as healthcare, and their care needs were reviewed regularly. Risk management was good and staff had enough information to know how to help keep people safe. Staff worked to a key worker system, and staff who provided written comments and those interviewed, considered they were given enough information to care for residents properly. Comments included always receive up to date information about the needs of residents. Residents right to confidentiality was respected. Residents lifestyle was centred on them and they did not have to conform to any institutional practice such as set times for getting up or going to bed. Daily living routines was also a personal choice and they enjoyed various activities such as shopping and socialising with friends. They went on holiday and they had kept good contact with relatives and friends. Meals provided met with residents tastes, needs and choice. Those residents spoken to during inspection said the food was good. They said they could have what they wanted. Records showed residents were helped to plan and prepare meals for themselves. Residents who were consulted, said they knew who to talk to if they were not happy. Staff working at the home had been trained in adult protection and knew their responsibility in this area. They were confident they would report bad practice if ever the need arose. The home was well maintained, safe, clean, and tidy, and provided a homely and pleasant environment for residents, visitors, and staff. Residents were satisfied with their bedrooms and living arrangements. The numbers of staff employed, training provided, and safe recruitment practices, meant residents should be protected, and their needs properly met. Staff working in the home were considered to be very good, and helpful. Staff interviewed said they loved their work and had job satisfaction and felt Care Homes for Adults (18-65 years) Page 8 of 31 appreciated for their work and valued in the home. Written comments from staff included, the Manager always arranges regular staff meetings, appraisals and supervision. Communication was considered to be good and staff said they had the right knowledge and skills to care for residents with mental health care needs. Learning opportunities were relevant to the homes purpose. The managers skills had demonstrated the changes she had made to improve service delivery, the environment, and staffing was successful. The home was well managed and run in the best interests of the people living and working there. What has improved since the last inspection? Staff had been trained in caring for people with mental healthcare needs, which meant people considering staying in the home were assured their needs can be appropriately met. Residents care plans had improved to include all identified needs and provide clear detailed instructions for staff, on how to meet these needs. This provided residents with a more person centred approach to their care and personal development. Acceptable risk taking had been considered and risk management recorded better enabling staff to support residents safely. House rules had been revised to make sure they were appropriate for residents. To support staff deal with the event of a death at the home, they had a policy and procedure to follow. Staff had been given formal training in adult protection issues and had a clear procedure as to the homes stance on the use of restraint. All bedroom doors met with fire safety regulations to ensure residents were protected in the event of a fire. Master keys had been provided for staff to gain access when necessary. The recruitment process had improved and met with legislative requirements. The manager meets regularly with residents to ensure their is good resident and staff relationships. To support residents to receive a consistent approach to care the movement of staff between homes in the scheme is limited to emergency relief only. Staff training provided ensured residents individual and joint needs were met appropriately. This included induction that meets with general guidance of the National Minimum Standards. The manager has been registered with the Commission. The rotation of managers between homes had ceased therefore providing some stability for staff, and development of the service. Policies and procedures were kept up to date with current good practice. This supported staff to work effectively and safely. Care Homes for Adults (18-65 years) Page 9 of 31 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 10 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 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission process ensured peoples needs were properly assessed, however a lack of discussion between individuals and or their representative meant it was unclear if moving into the home was the right decision to make. Evidence: There had been one new admission to the home since the last key inspection. Records made during admission showed how this was managed. The assessment had been completed by the manager and was brief. This was because the resident was being admitted from another home in the scheme. The records were clear that this move had not been talked about sufficiently with the resident or her family, and as a result had caused them some upset. The reason for the move was not sufficiently documented to support the admission being in the best interest of the resident. Residents written statement of terms and conditions, did not include the amount of fee that an individual paid. The specialist care residents require, and the skills, ability, and knowledge of staff that Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: will be caring for them had been considered. Training records showed staff were given training to help them to develop and know current good practice issues in mental health. Care Homes for Adults (18-65 years) Page 13 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good care planning meant residents were able to make good decisions and choices about their lives with the right support from staff who knew how to help them. Evidence: Information received at the Commission from the manager indicated the home did well as the residents had detailed assessments, care plans and risk assessments in place. And regular discussions are held to encourage new ideas from each person who are individually supported in their choices. One care plan was looked at in detail, and another briefly. These plans contained good information and linked very well to residents assessed needs. What was important to residents receiving care was recorded, for example taking pride in appearance and family contact. How identified needs were to be supported was clear and risk managed. The method for planning peoples care was very good. The introduction of short term goal setting meant residents knew they were improving in what they could Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: do for themselves with the help from staff. A recording system was in place to monitor this. Individual plans had been reviewed, and staff worked to a key worker system that allowed them to work on a one to one basis with people. As a result of this, mental health needs identified in assessment and very important to residents well being, were being dealt with properly. Staff who provided written comments for this inspection said they always receive up to date information about the needs of residents. Acceptable risk taking had been considered. Each care plan included risk assessments. These were reviewed. Where limitations were in place, residents knew about them and had been involved in deciding how these would be managed and had agreed it was in their interests. Guidance for staff in managing situations where people did not follow agreed action to minimise risk was recorded. This helped to make sure there was a consistent approach by all staff when dealing with risk. An example of a general risk found during inspection was smoking in bedrooms. Decision-making was said to be encouraged and residents were given time to consider the individual choices they made. They had the benefit of planned one to one discussions with staff, and records show the aim of these was to address and support individual needs. Residents also had the option of weekly house meetings. There are procedures in place to ensure that residents are informed of their rights to confidentiality. Written into individual records is an agreement for the sharing of information and confidentiality, informing them of circumstances when staff may have to share personal information. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were supported to be independent and given opportunity to take part in chosen activities, access community resources and keep in touch with families and friends. The meals provided were sufficient in providing for their tastes, choices, and diet. Evidence: People were out and about during the day when the inspection took place. The manager said residents were helped to develop skills that included social, emotional, communication, and independent living skills, and encouraged to use community resources. Records showed how residents were supported to identify their goals, and work to achieve them. This was done through care planning, and with key worker support. Part Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: of care planning was to help people identify what their own goals were, what they want and need to do. Short term goal planning helped them work towards meeting their needs and everyone involved knew what their role was. For example, making a meal. What needed to be done was recorded, and reviewed weekly. There was sufficient evidence to show residents had opportunity to develop and maintain important family relationships. Residents visited their family and went out for meals and shopping with them. Where residents were at risk or vulnerable in the community, this had been managed properly through discussions with residents to help them make good choices and give support, for example managing money. However relationship building between residents needs to be developed and managed where this need is identified. Weekly planners were used to help residents have some order in their lives. For example they knew when they cooked a meal, cleaned their bedroom, and what day they usually met with their relatives or friends. They decided what they wanted to do and completed their planner themselves. To get out and about residents could walk to town, visit the library, parks, pubs, and clubs. Public transport was used such as bus and taxi. As part of the basic contract price, residents had the option of a minimum seven-day holiday outside the home they helped to choose. One resident said she had a good holiday last year and was hoping to go on holiday this year. Another resident used a taxi to visit her relative every day. Family links were encouraged and residents could have visitors at any reasonable time. The home was managed in a manner to avoid any institutional routines. Observations of staff at work showed they treated individuals with respect. Staff who provided written comments for this inspection thought the home did well as they respected peoples wishes with thought and understanding. Residents preferred name was recorded on their plan. Residents had house rules they had agreed to follow. All bedrooms had locks on their doors and residents managed their own keys. Residents had access to a portable telephone. Residents planned their own menus, went shopping, and staff helped them with meal preparation and cooking as agreed in care planning. Mealtimes were flexible. 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. Residents preferred method of support allowed them to enjoy personal care in a non institutional and dignified way. Their healthcare needs were sufficiently monitored which supported them maintain their general well being. Medication policies, procedures and staff training promoted good practice. Evidence: Records showed residents living in the home were registered with a General Practitioner and that appointments had been made and kept. Appointments had also been kept with care coordinators, consultants, and community health services as required. Healthcare was recorded and written with short term and long term planning, such as dental visits and routine medical checkups. Health action plans were being written. Help with personal care was given according to need and individuals wishes. Comments from residents living in the home indicated staff treated them well. Care planning was person centred and informed staff what residents could and could not do. For example, can shower and bathe independently, needs support to use the right Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: bathing products such as shampoo and shower gel. Guidelines were written for staff on how support was to be given, such as prompting and assisting. Residents were encouraged to be independent and take responsibility for their personal care needs as much as possible. Residents in the home said staff did listen to them and helped them where needed, however they said they did not need any help as they managed very well. Staff had been trained in mental health care, to ensure they provided the right approach to care for people with mental health problems. They also had guidance on dealing with a death in the home. The home operated with a monitored dosage system for medication. Records of individuals medication was kept, and included information about the medication, and what staff should be aware of if someone was not well. Those staff responsible for administering medication had been trained. Individuals are given support to self medicate following an assessment to make sure this would be safe, however no resident in the home managed this. Medication storage was secure, and required records were up to date. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure supported residents to raise any issue of concern they may have. There were policies and procedures, and appropriate training for staff in professional conduct and adult protection issues to support residents rights, safety, and welfare being promoted. Evidence: Information received at the Commission for this inspection regarding the complaints procedure stated All resident in the home know how to make a complaint. And Offer a non judgemental service and encourage people to use the procedure if and when they need to. The complaints procedure was displayed in the home and a copy had been given to residents. Those residents spoken to during inspection said they had no complaints. Care records did show however, one concern from a relative had not been dealt with using the procedure. Staff who provided written comments said they knew what to do if residents or other people had any concern. Information was passed on well. They said the home did well as it Cares for each individual service users care protection. The manager said that they have a book for verbal complaints as residents do not always feel comfortable putting their concerns in writing. Records showed four complaints had been received and dealt with properly. There had been no complaints received at the Commission. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: Policies and procedures for safeguarding adults were available for staff to follow. Records showed staff training in Protection Of Vulnerable Adults (POVA) was provided and also covered in induction of new staff. Staff interviewed during inspection were clear of their responsibility and obligation to follow correct procedures in reporting under POVA should this be necessary. Records showed the manager had acted responsibly in dealing with protection issues. Staff had formal agreements to abide by the homes code of conduct and practice that included protection issues such as financial protection. 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 a clean, well-maintained, comfortable environment for residents living there. Evidence: The home is ideally located for the town, near to all main shopping facilities and recreation. Parking is in a controlled parking area. The home does have daily parking permits for visitors who must remember to request them. There are two parking spaces at the back of the home. Improvements to the home had continued. The manager said she was given extra money to purchase items for the home by the the provider. They had purchased bedding, curtains, and carpets where needed. Residents had been involved in this. Following a tour of the home the following observations were made. The lounge for residents was homely and furnished and fitted to a very good standard. Residents said it was nice. The kitchen had been upgraded. The smoking lounge adjacent was in the process of having a shower and toilet added and a bedroom on the ground floor was having an en Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: suite room built. Bedrooms seen were comfortable, personalised and furnished and fitted to a good standard. Some rooms had new carpets. Bedroom door locks were not entirely suitable in giving residents a choice of whether or not to keep the door locked when they were in their room. The locks fitted were a standard Yale lock that had been disabled to prevent residents locking themselves in and allow staff to gain access in an emergency situation. The manager had a set of master keys available for staff to use when needed. The home was very clean, tidy, well lit, and smelt fresh. 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. The level of staffing, training provided and good recruitment practice meant residents were cared for by qualified and competent staff. Evidence: Rotas seen for the previous weeks and day of inspection showed the numbers of staff on duty at any given time was sufficient to cover essential duties such as keeping the home clean and give residents one to one support. No staff worked alone during the day, although staff worked long shifts of twelve hours. One carer was on night duty covering waking watch. The manager said staffing levels in the home allowed for staff to meet the needs of the residents, and supported a person centred approach to care. Two new staff had been recruited. Their records showed recruitment checks to be complete. Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) register check had been applied for, prior to employment which helped make sure staff employed were suitable. Interview notes were taken to show that the home operated as an equal opportunity employer. On appointment staff were issued with a job description and usually a contract of terms and conditions of employment. Staff who provided written comments for the inspection said they had proper checks Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: done prior to appointment. And induction training had everything they needed to know. Records of induction given had covered essential training in basic principles of care, and safe working practice issues. Staff also stated they were given training relevant to their role as carer for example approaches to mental health. They said the manager met with them regularly to give them support. Training records showed the percentage of care staff trained to a National Vocational Qualification in care level 2 or above was very good. Equality of opportunity was demonstrated with training, and learning opportunities were right for the homes purpose. Staff interviewed during inspection said they loved their work and had job satisfaction within a good team. Staff felt they were appreciated for their work and valued in 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 managed and run in the best interests of the residents. Evidence: The registered manager had been in post at Adam House for over one year. She had completed level 3 National Vocational Qualification in care and attended other training such as approaches to mental health. Plans were currently been made for her to enroll on a National Vocational Qualification in Care level 4 and The Registered Managers Award as required. Her responsibilities included for example overall responsibility for staff employment, policies and procedures, health and safety, provisions, standards, resident welfare, appraisal of all staff, supervision of staff, and staff training. Arrangements were in place for emergency contact evenings and weekends. This was displayed in the office. The manager had worked under the direct supervision of another manager within the scheme during her induction, however formal supervision should be arranged better to support her in her role. There was no evidence Mrs Healey Registered Provider visited the home to conduct an unannounced monitoring visit on a regular basis. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: The manager was able to demonstrate changes she had made to improve how people were cared for, the environment, and staffing issues as required following the last inspection. She said a budget was provided for the running of the home for which she had control over. Other requests for improvements made had been dealt with as and when they were requested. The budget allocated covered general needs as required to manage the home efficiently, for example provisions and cleaning products. An Annual Quality Assurance Assessment was completed by the manager for this inspection. Overall the assessment indicated the conduct and management of the home ensured it was run in the interests of the residents, respecting individuals rights and ensured residents best interests were safe guarded. This was achieved by enabling residents to have their say for example in care planning, one to one chats and an option of weekly residents meetings. Quality assurance however needs to be extended to seek the views of other people linked to the home such as social workers and community health workers. Staff interviewed during inspection and those who provided written comments said they had regular supervision and appraisals. They considered communication was good and records of staff meetings showed they were consulted about good practice issues. The frequency of these meetings should be increased. Insurance cover was in place to meet any loss or legal liabilities. Residents were supported to manage their own finances and proper records were kept and audited at regular intervals. Record keeping was generally good, and confidential records were stored securely. Staff were made aware of the requirements of the Data Protection Act, and compliance was included in their terms and conditions of employment. Safe working practices in the home were evidenced. Residents had fire drills and each person was risk assessed to make sure they were kept safe in the event of a fire. The home had a good range of policies and procedures and good practice aimed at keeping everyone safe. Staff were given essential health and safety training in topics such as first aid and fire prevention. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 5 5(b)(c) People using the service 31/03/2008 must be informed of the fees they are charged. 12/09/07 Mrs Healey Registered 29/02/2008 Provider must visit the home once a month and make a report of the visit, forwarding a copy of the report made to the Commission. 2 43 26 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 1 37 9 The manager must hold a recognised qualification in management and care. This is a legal requirement to make sure the manager has the right knowledge and skills to support her role in managing the home. 29/01/2010 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 2 2 15 People should be consulted and their views considered before they move into the home Relationships building between between residents needs to be developed and managed where this need is identified. All expressed concerns should be dealt with using the complaints procedure. Residents bedrooms should be fitted with more suitable locks, that will allow them the choice to lock their doors when in their rooms. The manager should have regular supervision to support her in her role in managing the home. 3 4 22 26 5 37 Care Homes for Adults (18-65 years) Page 29 of 31 6 39 Quality assurance should be extended to seek the views of other people linked to the home such as social workers an community health workers. 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). 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