Care Home: Care Assist in Harrow

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What the care home does well The care home has a very welcoming atmosphere. Residents live in a homely environment, with quality furnishings, and decoration that is attractive, and meets their needs. The registered manager and the team leader are experienced, and motivated in ensuring that a quality service is provided to all the people using the service. There is close liaison with health care professionals, and other specialists as, and when required by the residents. People using the service were very positive about living in the home, comments included `I like it here`, `I like my bedroom`, and `I go to bed when I want`. Residents spoke positively of the staff, and knew the names of their key workers (key enablers). They also confirmed that they were listened to, and supported in making the choices that they want, and they told us that they participated in a number of activities that they enjoyed. People using the service have their views listened to, and respected. It was evident during the inspection that residents interacted with staff without hesitation, and that staff responded to them in a courteous and positive manner. The young people using the service are supported to have the contact that they wish with relatives and friends. They told us about family members visiting them and of the social arrangements that they had with their friends. Observation, records, and talking to staff indicated that staff were aware of each person`s needs, and cared about ensuring that these individual needs were met. It is evident that the home provides a quality service to young adults (18-30). What has improved since the last inspection? This is not applicable due to the care home being a new service, and this being the first key unannounced inspection. What the care home could do better: It is noted that this is the first key inspection since the care home was registered with us, and that people using the service have only recently been admitted to the home. With regard to this, it is evident that staff have worked hard to ensure that the home has the systems in place to provide a quality service to residents. Staff are aware that there are some improvements and development to the service that could be made, and have plans to put these in place. The format of some records, such as information about the service provided by the care home, could be in a more accessible format for people using the service who might have difficulty in reading. There could be a review of the hot water temperature systems in the home. It could be more evident from the care plan records that people using the service have participated in, and understood the content of their plan of care. People living in thehome could have their own copy of their care plan. Some aspects of the medication records could be better. This includes better recording of the individual guidance with regard to administering medication `as and when needed` (PRN medication), and of the recording of the `in house` training/assessment that staff receive prior to them administering medication to people using the service. Each staff member should have a recorded individual training and development plan. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Care Assist in Harrow 36 Park Drive Harrow Middlesex HA2 7LT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Judith Brindle     Date: 1 1 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Care Assist in Harrow 36 Park Drive Harrow Middlesex HA2 7LT 02089669004 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Care Assist Limited Name of registered manager (if applicable) Miss Caireen Piper Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Care Assist in Harrow (36 Park Drive) is a care home providing personal care, and accommodation for up to 6 people who have a learning disability or mental health needs. The home offers support to younger adults (18-30 years of age). The home was registered by the Commission for Social Care Inspection on the 4th September 2008. The registered provider of services at the home is Care Assist Limited. The home is located within a residential area of Rayners Lane, within the London Borough of Harrow. It is a few minutes walk from shops, pubs, parks, and bus and train public transport links. The home has a forecourt that can provide off street parking for two to three vehicles. Parking restrictions apply on the road outside the home. It is indistinguishable from local homes in the area. There are three bedrooms on the ground floor and three on the first floor. The homes Care Homes for Adults (18-65 years) Page 4 of 33 care home 6 Over 65 0 0 6 6 Brief description of the care home bedrooms are single, all fully-furnished to a high standard, and each have en-suite toilet and shower facilities. There is an additional toilet on the ground floor and second floor. Communal space comprises of a large kitchen/dining/living room with access to a back garden. The care home has a service user guide, and statement of purpose, (these provide information about the service). These, and information about the range of fees, which are based around the individual and their assessed needs, are available from the manager. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced inspection took place throughout a day in February 2009. This was the first key inspection of the care home since it was registered with the Commission for Social Care Inspection. The first resident was admitted to the care home in December 2008. There were three vacancies at the time of the inspection. We were pleased to meet and talk to all the people living in the home. The registered manager was present during a significant part of the inspection. A number of feedback surveys were supplied to the care home prior to the inspection. At the time of writing this report the Commission for Social Care Inspection had received one completed survey from a member of staff. Documentation inspected included, residents care plans, risk assessments, staff training records, and some Care Homes for Adults (18-65 years) Page 6 of 33 policies and procedures. The inspection included a tour of the premises. 28 National Minimum Standards for Adults, including Key Standards, were inspected during the inspection. Prior to this unannounced key inspection the registered manager supplied the Commission for Social Care Inspection (CSCI), with a comprehensively completed Annual Quality Assurance Assessment (AQAA) document. This record includes required information from the registered manager (and/or owner) about the quality of the service provided by the care home, and of any planned improvements. Reference to some aspects of this AQAA record is documented in this report. We thank the people living in the care home, staff, and the manager for their significant assistance in the process of inspection. What the care home does well: What has improved since the last inspection? What they could do better: It is noted that this is the first key inspection since the care home was registered with us, and that people using the service have only recently been admitted to the home. With regard to this, it is evident that staff have worked hard to ensure that the home has the systems in place to provide a quality service to residents. Staff are aware that there are some improvements and development to the service that could be made, and have plans to put these in place. The format of some records, such as information about the service provided by the care home, could be in a more accessible format for people using the service who might have difficulty in reading. There could be a review of the hot water temperature systems in the home. It could be more evident from the care plan records that people using the service have participated in, and understood the content of their plan of care. People living in the Care Homes for Adults (18-65 years) Page 8 of 33 home could have their own copy of their care plan. Some aspects of the medication records could be better. This includes better recording of the individual guidance with regard to administering medication as and when needed (PRN medication), and of the recording of the in house training/assessment that staff receive prior to them administering medication to people using the service. Each staff member should have a recorded individual training and development plan. 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 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service have the information they need to make an informed choice about the home as to whether it will meet their needs. Prospective residents have their needs assessed with their participation prior to moving into the care home which makes certain that the home knows about the person and the support that they need. Each person using the service has an individual written contract with the home. Evidence: The home has a service user guide, and statement of purpose, which include information about the service provided to residents by the care home. The manager told us that she was in the process of developing the service user guide into a more accessible DVD format that would be supplied to the people living in the home. We were supplied with an up to date copy of the statement of purpose and the service user guide. Both included comprehensive information about the care home. The care home has an admission policy/procedure. We were told of the process of Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: referral to the admission of a prospective resident. As this is a newly registered service, all three people living in the home have been recently admitted. All the care plans were looked at, and all included evidence that comprehensive assessment of the residents needs had been carried out. The manager told us that she and another senior member of staff carry out an initial assessment of the persons needs with full involvement from the prospective resident. Records told us that residents had completed an Individual Application Form, which is in written and picture format. This indicated that they had answered a number of questions about their needs, and preferences. Staff told us of the importance of listening to prospective residents and of gaining information from them about themselves and their wishes. There was significant assessment information from the funding Local Authority also in the care plans. We were told that the referral and transition process, of a person moving into the home, is flexible in accordance and with respect to the needs, and wishes of the prospective resident, and that the number and kind of visits to the care home are discussed and agreed with the person. A resident told us that she had visited the care home before moving into it. It was evident that there was close liaison with previous placements, advocates, and health and social care professionals during the process of transition and admission. Records told us that a resident had visited the home several times prior to moving in. People using the service receive a contract in written and picture format, of terms and conditions with the care home. The terms and conditions/contracts that were looked at had been signed by the person using the service. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have an individual plan of their needs, which includes details of the care and support that they require from staff. People using the service are supported, and encouraged to make decisions and choices about their lives, and are supported to take risks as part of an independent lifestyle. Evidence: Each person using the service has a plan of care, and support. All the care plans were looked at. These care plans are based upon assessment of the persons needs. This assessment includes persons health, behaviour needs, skills, abilities, emotional, social needs and aspirations, and their plans and goals. Each care plan included significant comprehensive guidance for staff to inform them of how to support each resident to meet their needs and to achieve their goals. AQAA told us how the equality and diversity (race, gender identity, disability, sexual orientation, age, religion and belief) needs of people using the service are met, and that staff receive training with regard to understanding and respecting these needs. Records of each persons daily Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: needs, activities, and progress are maintained. A staff feedback survey told us that they always receive up to date information about the needs of the people they support, and that they aim to empower the people using the service, to fulfil their potential in order to maximise their independence. It was evident that the care plans were up to date, but it was not always clear from the records, when it was planned to review each persons needs and goals, and whether the resident knew of the content of their plan of care, including the guidance to meet their varied needs. But there were some parts of the care plans that were signed by the resident. People using the service should have a copy of their plan of care (or summary of it). Senior staff spoke of developing systems to ensure that it is evident that each person using the service knew the content of their care plan, and we were told that they would have the opportunity to keep their own copy of their plan. People using the service spoke positively about the staff. All the residents told us the name of their key enabler (key worker). They confirmed that their key enabler actively provides one to one support, and assisted residents with meeting their needs, including shopping for personal items. The team leader told us about the process of allocating a key enabler to a person using the service. This includes looking at the skills and needs of the staff member and resident. Key Enabler action plans with regard to their role and responsibilities were seen. A staff member spoke of her role as a key enabler. We were told that two people using the service have an advocate. A staff member told us that there were plans to provide residents with the opportunity to participate in regular resident meetings. This is positive. The care plans that were looked at included evidence of comprehensive general risk assessment, which covered a range of possible risks (including behaviour, access to the community, nutrition, manual handling and road safety) to the persons safety. There was recorded guidance to minimise these risks, and to support the person using the service to lead a quality life as independently as they can. Each risk assessment has a signing sheet attached to the risk assessment. These included sections for feedback from the resident about their risk assessment. These documents had not always been completed, so it was not always clear as to whether the resident knew about these risk assessments. Residents spoke to us about the choices that they made. Examples of these included deciding when to go to bed, and when to get up in the morning. A person using the service commented that she had chosen to go to bed at 11pm on the night before the Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: inspection. Other decisions that residents spoke of making included; choosing their own clothes, meals, and when to go out and visit friends and family members. People using the service made many choices during the inspection. It was evident that they felt confident and comfortable to inform staff of their individual needs and preferences. Staff were observed to respect the decisions that the residents made. Residents were seen to have their own key to their bedroom. Care plans told us that each resident receives an individual financial risk assessment. The team leader told us that each person using the service manages their own benefit allowances, and is provided with a weekly sum of money to enable them to purchase their own food items for their meals. People using the service should have the opportunity to sign the records as and when they receive their money for purchasing food items. This was discussed with the team leader. Appropriate records and receipts of these finances were available. The care plans included assessment of each persons financial needs. Care Homes for Adults (18-65 years) Page 15 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their lifestyle, and are supported to develop their life skills. The people living in the care home have their rights respected, and their responsibilities are recognised in their daily lives. Meals are varied, and wholesome, and meet the cultural religious and nutritional needs of people using the service. Evidence: People using the service told us of the activities that they participated in. These activities included taking part in a variety educational college courses as well as a variety of leisure pursuits. A person using the service told us that she was continuing the college course that she had started prior to moving into the care home. Residents spoke of enjoying meeting friends and others, on a regular basis. They spoke of the activities that they enjoyed doing. These included shopping for clothes, getting their Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: hair and nails done, buying their toiletries, cooking, watching soaps on television, using the computer, and listening to music. A person using the service told us that they had enjoyed the recent Christmas, and New Year festivities, and had received a number of gifts that they liked. Staff told us that activities, and leisure pursuits are flexible, and chosen by the people using the service, and that residents participate in the community, by accessing amenities, and facilities. We were told by people using the service that they participated in carrying out a variety of household tasks including laundering their own clothes, and doing their own washing up and cooking. They were observed to carry out a number of these activities during the inspection. Care plans included information such as Annual Plan toward independence, in which goals with regard to this are agreed, and skills needing to be learnt and/or developed by people using the service are recorded. AQAA told us that the care home supports and encourages people using the service to maintain their independence. Residents were seen cooking their own meals and carrying out household duties, during the unannounced inspection. The visitors book confirmed that there are visitors to the care home. It was evident that the home supports residents to develop and actively maintain relationships (if they wish, and in accordance to risk) with family and friends. We were informed by staff and residents that people using the service have varied contact with relatives and or significant others. A person using the service told us that she had recently visited a relative. The social needs and support required to meet those needs are documented in each persons care plan. The menu was displayed in the kitchen. We were told that each resident plans and chooses their own preferred meals for the week. Each persons meals were recorded on the menu. It was evident from talking to residents and from looking at records that the meals met their cultural and nutritional needs. The residents spoke of choosing what they liked to eat, and of shopping for their food items, then cooking their own meals. Residents were seen preparing meals during the inspection. Food eaten by residents is recorded. The kitchen included storage of a variety of fresh, frozen, dried and canned food items. Each person using the service has their own separate food storage areas. One person has her own fridge in her bedroom. Staff told us that residents had a choice of snacks when they wished. Care Homes for Adults (18-65 years) Page 17 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs, and the principles of respect, dignity, and privacy are put into practise. Systems are in place to ensure that medication is stored, and administered safely to people using the service. There are some developments and improvements that could be made with regard to some aspects of recording. Evidence: It was evident from talking with staff, residents, and looking at records that staff have knowledge, and understanding of the importance of ensuring that the residents have their health care needs assessed and met. The care plans that were looked at, included up to date records of health and social care appointments with the GP, chiropodist, optician, psychiatrist, and social workers. Attendance at specialist clinics, and hospital appointments were also documented. A resident told us that she had recently attended a hospital appointment. We were told that advice was sought as and when required from health care professionals, and that referrals were made in accordance to residents needs, and their changing needs. Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: The care home has a medication policy/procedure. We were told that a local pharmacist dispenses the residents medication. The home needs to ensure that it has a system in place where a pharmacist regularly checks the medication storage and administration systems in the home. Records told us that each resident has an individual profile of their medication needs. The use of each medication and the side effects of it were recorded. Medication is stored securely in a locked medication cabinet in each persons bedroom. The medication storage, and administration systems were inspected. Medication administration records were up to date. The team leader told us about the guidance followed by staff with regard to the administration of medication prescribed for as and when it is needed by people using the service (PRN medication). This needs to be clearly documented with regard to each PRN medication for each person using the service. We were told that all staff receive comprehensive medication training when they start their job. The team leader told us that she ensures that prior to staff administering medication to people using the service they receive in house training and assessment to ensure that they are competent to carry out this task. This assessment should be recorded, and staff should have the opportunity to attend further medication training given by a pharmacist or other person trained to give medication training. Care Homes for Adults (18-65 years) Page 19 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service, have access to an effective, robust complaints procedure, and are protected from abuse, and have their rights protected. It could be more evident from records that residents are fully supported to express any concerns that they may have. Evidence: The care home has a complaints procedure, which is accessible. This is documented in the service user guide. AQAA (Annual Quality Assurance Assessment) information told us that the complaints procedure is clear, and details who is to get involved at what stages. There are systems in place for recording complaints, and with regard to the action taken in response to a complaint. There were no complaints recorded. We discussed with the team leader the issue of residents reporting concerns. Management staff told us that they listen to people using the service and respond to all concerns communicated by people using the service. These should be recorded. The care home has a safeguarding adults policy/procedure. AQAA told us that this works alongside Harrow Borough Councils policy. Records confirmed that incidents and accidents are recorded, and that action taken in response to these is documented. Records and staff told us that staff receive safeguarding adults training during their induction programme, and during National Vocational Qualification health and social Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: care courses, and that it is also discussed during staff supervision meetings. A staff member confirmed that they had knowledge and understanding of how to respond appropriately to complaints and/or any suspicion or allegation of abuse. We were told that the home is planning further safeguarding adults training (through accessing Local Authority safeguarding adults training) for staff. This is positive. The home has a whistle blowing policy. Care Homes for Adults (18-65 years) Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment of the home is safe, homely, clean, and comfortable. The premises are suitable for the care homes stated purpose, and residents bedrooms are individually personalised and meet their needs. Evidence: The care home is located in a quiet residential road in North Harrow close to shops and transport links at Rayners Lane. There is off street parking for two to three vehicles on the homes forecourt. The premises are indistinguishable from local homes in the area. The home has had a complete refurbishment to a high standard prior to being registered with the Commission for Social Care Inspection. The inspection included a tour of the premises. Communal space comprises of a large kitchen/dining/living room with access to a private enclosed garden. Dining and living room furniture is of quality. All six bedrooms has their own en-suite toilet and shower facilities. Two people using the service kindly showed us their bedrooms. These included a number of personal items including ornaments, music systems and a television. Both residents told us that they liked their bedroom. The laundry facilities are located away from food storage and food preparation areas. Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: Residents told us that they were fully involved in the laundering of their clothes, and that the laundry facilities were suitable and satisfactory with regard to meeting their needs. AQAA told us that the home meets requirements from the Environmental Health Department and ensures that staff and people using the service have knowledge and understanding of good practise with regards to hygiene. AQAA told us that three staff have received training in the prevention and control of infection. Care Homes for Adults (18-65 years) Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff receive appropriate induction, and support from their manager to ensure that they have the skills and knowledge to carry out their roles and responsibilities in meeting the varied care and support needs of people using the service. Staff training should be further developed and be more evident of being individually planned for each staff member. Sufficient numbers and skill mix of staff are employed to ensure that there are enough competent staff on duty to meet the needs and changing needs of people using the service. People using the service are supported and protected by the care homes recruitment policy and procedure. Evidence: There were two staff on duty during the inspection. The manager was also working in the home during most of the inspection. The staff rota was inspected. This confirmed that there are at least two staff on duty in the home during the day, and one staff member who carries out a sleep in duty at night. All three residents were aware of their key enabler (key worker), and spoke positively of the staff. People using the service were seen to approach all staff with ease and to interact with them in a positive manner. Staff were observed to talk with residents in a sensitive manner Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: during the inspection. We were told that one care staff vacancy was in the process of being filled, and that the home was awaiting the result of the enhanced Criminal Record Bureau (CRB) check (a check carried out to find out if the possible potential staff member has a criminal record) for this person. Three staff recruitment files of care staff member were looked at. All checks that are required to ensure people are protected from harm had been carried out. These included protection of vulnerable adult (POVA) first checks. AQAA and management staff told us that staff are carefully selected, and that there is a six month probation period for each member of staff. A staff feedback form told us that appropriate recruitment checks were carried out before they started work. It was evident from records that staff receive a comprehensive induction programme, and certificates of the training that staff had received prior to their recruitment were available for inspection. We were told that the care homes staff induction is linked to the Skills for Care induction standards, and is carried out during a period of three months. A staff feedback form told us that the staff member found that their induction covered everything that they needed to know to do the job when they started. We were shown a partially completed staff induction programme that had been signed by the staff member and senior staff member. A care staff member spoke with us told us that they had received a comprehensive induction (that meets Skills for Care standards) in regard to the care home and of their roles and responsibilities. A senior staff member told us that she had plans to ensure that all the newly recruited staff had an individual training plan, and that a training programme would be put in place. We were told that all staff have their own record/file of the policies and procedures with regard to the home, and that these are discussed during staff supervision sessions. A staff feedback form told us that they had received relevant training, and that they were aware of planned training. We were told that there were plans to ensure that staff have the opportunity to achieve NVQ (National Vocational Qualification) level 2 and 3 in health and social care. A member of staff told us that she had obtained an NVQ qualification prior to her employment in the home. A care staff member told us that they receive regular one to one formal and informal staff supervision. A senior member of staff spoke of the importance of staff supervision in ensuring that staff understand and are supported to meet the needs of people using the service. She told us that staff supervision is carried out on a weekly basis over three months then on a monthly basis, but is flexible with regard to the needs of the member of staff. Care Homes for Adults (18-65 years) Page 25 of 33 Care Homes for Adults (18-65 years) Page 26 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager is qualified, competent and experienced to run the care home appropriately. Effective quality assurance, and quality-monitoring systems are in place to monitor, develop and improve the quality of the service provided to people using the service. So far as reasonably practicable the health, safety and welfare of people using the service is promoted and protected. The hot water systems could be reviewed. Evidence: The care home is a new service. It was evident from the AQAA, records and from talking to the registered manager that she is competent, and experienced to manage the home. The team leader has a significant role in managing the home and supervising staff. Feedback from people using the service spoke of being happy living in the home, and that they felt well supported by management and care staff. Residents spoke very highly of all staff including the senior staff. They approached all staff without hesitation when they had questions, and or wanted support. A staff feedback form told us that they felt that the manager was very helpful all of the time, Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: and gives lots of support. The home has up to date policies and procedures that are needed to ensure that residents rights and best interests are safeguarded. We were told that there were plans for the organisation to carry out an annual development plan for the service in 2009, and that the registered manager will also carry out an in house audit following information received from feedback questionnaires completed by people using the service and from other stakeholders. The manager spoke of her plans to continue to improve and develop the accessibility of the format of some documentation of particularly relevance or interest to people using the service. We were told that regular staff meetings had recently started to take place. Records told us that there are policies and procedures and significant guidance in place to ensure that the health and safety needs of people using the service, and others are identified and met. Required checks of the electrical and gas systems, and other health and safety checks are carried out. Certificates and service records for appliances and equipment used in the home were noted to be in order and up to date. Household cleaning items are stored safely. The manager told us that there is a thermostatic digital system in place which ensures that hot water in the home is at a safe temperature, but there was concern that if this system becomes faulty it could lead to the temperature of some hot water outlets being unsafe. When vulnerable people access to hot water, baths or showers, the Health and Safety Executive strongly advises the fitting of thermostatic mixing valves that prevent water being discharged at more than 43C. Valves should be fitted according to manufacturers instructions and will need regular maintenance. The manager told us that risks of scalding had been considered and that appropriate risk assessment was in place to minimise any risk of burns. Records told us that close monitoring of the water temperature from water outlets in the home is carried out. There were a number of temperatures that were recorded as being above 50oc, for example on the 27/01/09 with regard to the wash basin hot water outlet in bedroom 2, a temperature of 54.2 oc was recorded (also bedroom 3 on the 28/01/09 a temperature of 51.8oc, and the kitchen hot water outlet on 09/02/09 recorded a temperature of 53.4oc). The home needs to review the system in place for ensuring that the hot water temperature in the care home is always at a safe temperature, and put systems in place if required, to meet this need. The care home has an up to date fire risk assessment. There was a detailed record of all fire safety and other regular checks carried out in the home. Accidents and incidents are recorded. Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: The employers liability insurance certificate was displayed and up to date. Care Homes for Adults (18-65 years) Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Guidance needs to be clearly 03/06/2009 documented with regard to the storage and administration of each PRN(prescribed medication administered as and when needed to people using the service) medication that is prescribed for each resident. To ensure that it is evident that all medication is administered to people using the service, safely. 2 20 13 The home needs to ensure that it has a system in place where a pharmacist regularly checks/audits the medication storage and administration systems in the care home. To ensure that the systems for administering medication to people using the service are robust and safe. 03/06/2009 Care Homes for Adults (18-65 years) Page 31 of 33 3 42 13 The home needs to review the system in place for ensuring that the hot water temperature in the care home is always at a safe temperature, and to put systems in place if required, to meet the need to minimise any risk of scalding. It needs to be evident that residents and others are not at any risk of being scalded from the temperature of the hot water in the home. 06/03/2009 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 3 6 7 7 People using the service should have a copy of their plan of care (or summary of it). People using the service should have the opportunity to participate in regular resident meetings. People using the service should have the opportunity to sign the records as and when they receive their money for purchasing their food items. The in house staff medication assessment should be recorded and staff should have the opportunity to attend further medication training given by a pharmacist or other person competent/trained to give medication training. There should be recorded evidence that the home supports and encourages residents and others to communicate any concerns that they might have. The home should ensure that all the newly recruited staff have an individual training plan, and that a training programme is put in place. 4 20 5 22 6 35 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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