Care Home: Carlene House

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What the care home does well The home is able to demonstrate that it is assessing and meeting the needs of service users admitted to the home. Prospective residents, their relatives and friends are able to visit and to assess the quality, facilities and suitability of the home. The health care needs of residents are being very well met. Residents are living in a safe, well-maintained environment, with access to safe, pleasant and comfortable facilities. Residents generally presented as well settled in their environment, and very satisfied with the communal and personal facilities provided. The home is being managed the home in an open, professional and competent manner. What has improved since the last inspection? At the last inspection a new Manager had just been appointed within a week of the inspection date. The new Manager has since settled well into the post and the home remains settled and the high standards of care achieved and commended in previous inspection reports continues. Specific improvements have been achieved with the 4 recommendations that were made at the last inspection: Environmental health have visited the home for an inspection and have commended the home to do with the standards they found in the kitchen. A system has now been devised that ensures that all the hot water taps/outlets have been checked at least once every month and full records made of these checks including details of what tap was checked when and what the temperature actually was recorded as being at the time of the check. The laundry room floor now has an impermeable floor laid down to prevent water ingress and ease cleaning. Regular 6 monthly tests have been carried out for emergency lighting. What the care home could do better: Improvements in the following areas are now needed. They are to do with: It is recommended that the Manager draws up an allegation of abuse record book that records any allegations of abuse made within the home and the actions taken to resolve them. It is recommended now that the communal areas such as the hall and the lounges are redecorated to ensure the same standard is maintained throughout the home. It is recommended that the bathroom floor on the 1st floor needs to be replaced andsealed all around the edges in order to ensure there may be no ingress of water under the floor covering. Some evidence of training qualifications was seen on the staffing files inspected however it is recommended that evidence for all staff training and other qualifications is routinely held on staff files. It is recommended that the Manager draws up a new staff training matrix that identifies future staff training needs and that logs training already undertaken by staff. This is a useful tool in that it will easily inform the Manager what training the staff team have received and where the gaps in training exist. Recording of areas of work discussed in supervision need to include more details that illustrate exactly what has been discussed and what actions have been agreed and by whom. It is recommended that where areas of development have been identified in the quality assurance process, the actions taken to address them are described and the results made known either in a news letter to the stakeholders or as a notice placed on the notice board. This would help stakeholders understand how their contributions are helping to improve the services provided at Carlene House. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Carlene House 17 Woodcote Valley Road Purley Surrey CR8 3AL     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: David Halliwell     Date: 1 3 1 0 2 0 0 8 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 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: Carlene House 17 Woodcote Valley Road Purley Surrey CR8 3AL 02086687676 02086604237 marcel@fircroftservices.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Alison Gilbert Type of registration: Number of places registered: Fircroft Services Limited care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 10 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home Carlene House is a detached care home for ten adults with learning disabilities, aged between 18 years and 65 years. Situated in a quiet residential area of Purley, the home is well placed to access local transport links, amenities and resources. The home consists of ten single bedrooms, a good-sized lounge and dining area with an activities room on the second floor. The kitchen is spacious and there is a laundry room on the ground floor. There are sufficient numbers of bathroom/shower and toilet facilities located throughout the home to meet the service users needs. The large landscaped garden is set out over two levels, with a raised lawn and patio area equipped with Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 10 Brief description of the care home tables and chairs and barbecue facility. All service users attend day services and employment and the home offers a varied and structured programme of activities and outings. The home does not provide its own transport but supports service users to fully access various public transport services.The Proprietor advised us that the price of a placement per week ranges from £600 - £999 where additional support is provided. 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key standards inspection was carried out on 27th March 2008. The stars quality rating for this service is excellent. This means that people who use these services experience excellent quality outcomes. They said that they like to be called residents. A completed AQAA was received prior to the inspection. No enforcement activity has occurred since the last inspection. This was an unannounced inspection visit and was carried out over 1 day. The Inspection covered all the key standards in the National Minimum Standards for Younger Adults. Care Homes for Adults (18-65 years) Page 6 of 33 The inspection involved a tour of the home, a review of all the homes records and formal interviews with 2 staff including the Manager. 4 residents were spoken with formally and more informal interviews were conducted with 2 other residents as a part of the tour of the home. 6 staff and 4 residents files were inspected as was the policies and procedures manual for the home. No new requirements have been made as a result of this inspection however 7 new recommendations have been made. Feedback on the recommendations was given verbally to the Manager at the end of the inspection visit. The residents and staff were very helpful and they are to be thanked for their assistance over the course of this inspection visit. The agencies Registration Certificate with the Commission for Social Care Inspection was seen displayed appropriately in the hall just outside the main office. There have not been any changes in the ownership or management of Carlene House since the last inspection. What the care home does well: What has improved since the last inspection? What they could do better: Improvements in the following areas are now needed. They are to do with: It is recommended that the Manager draws up an allegation of abuse record book that records any allegations of abuse made within the home and the actions taken to resolve them. It is recommended now that the communal areas such as the hall and the lounges are redecorated to ensure the same standard is maintained throughout the home. It is recommended that the bathroom floor on the 1st floor needs to be replaced and Care Homes for Adults (18-65 years) Page 8 of 33 sealed all around the edges in order to ensure there may be no ingress of water under the floor covering. Some evidence of training qualifications was seen on the staffing files inspected however it is recommended that evidence for all staff training and other qualifications is routinely held on staff files. It is recommended that the Manager draws up a new staff training matrix that identifies future staff training needs and that logs training already undertaken by staff. This is a useful tool in that it will easily inform the Manager what training the staff team have received and where the gaps in training exist. Recording of areas of work discussed in supervision need to include more details that illustrate exactly what has been discussed and what actions have been agreed and by whom. It is recommended that where areas of development have been identified in the quality assurance process, the actions taken to address them are described and the results made known either in a news letter to the stakeholders or as a notice placed on the notice board. This would help stakeholders understand how their contributions are helping to improve the services provided at Carlene House. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users may be fully assured that their needs are assessed and that their individual aspirations and wishes will be taken into account in the assessment process. Evidence: Standard 2 - Since the last inspection in 2006 no new residents have been admitted and the home is now full with a total of 10 residents. We reviewed the files of 4 of the residents and found that all had received a full and comprehensive pre-admission needs assessment that was carried out with skill and sensitivity by the staff with regards to the needs of the people concerned. We also spoke to four residents formally and two others informally. The Manager told us that they would ensure a needs assessment and care plan is obtained from the referring authorities for any new resident placed at Carlene House. Evidence of this was seen by us on the residents files. Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: The completed AQAA also confirms this and it says, that all residents have a residents assessment plan, detailed individual care and development plans and health action plans. The combined information from these sources form a comprehensive information base for each resident from which accurate and relevant care plans can be drawn up. The Manager explained to us that the needs assessment process is about ensuring that staff can meet the identified needs of the prospective resident in that they have the appropriate skills, training and knowledge to enable them to do so. Before agreeing any admission the Manager allocates a key worker to each resident who will work with them on developing the homes care plan and making sure it meets the identified needs. Both the Manager and information in the AQAA confirmed that a key worker is allocated to each resident. Residents were seen by us to have been involved in the assessment process having had the opportunity to express their wishes and preferences and to comment on their identified needs. Signatures of the residents and dates were seen on the assessment paperwork confirming their involvement in the process. Family and close relationship needs of the residents files inspected had been included in the assessment and care planning processes. When we spoke with one of the residents it was clear from what she told us that she had been and is still fully involved in the process and that she is very satisfied with the outcomes of her care package at Carlene House as a result. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents may be assured that their assessed and changing needs and personal goals will be reflected in their care plans. They may also be assured that they will be able to make decisions about their daily lives and be enabled to take risks as part of developing a more independent lifestyle with support, as they need it. Evidence: Standard 6 - All of the residents have a plan of care that reflects their identified needs. Records on the residents files sampled, indicated that they are fully involved in their individual planning meetings and supported to achieve their personal goals and aspirations. It is clear that staff work closely with each individual, their family and significant others, such as the day service, to ensure their preferences are responded to appropriately and the people important to them are involved with their planning of care. Daily records are also kept which highlight progress; achievements and any Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: activities participated in. Residents care plans were seen to have been reviewed on a six monthly basis, and provide detailed information relating to their support needs and short-term goals throughout the year. Person centred planning continues to progress further and resident has a health action plan booklet. Pictures, symbols and photos are included to make them more accessible to those residents who have limited verbal communication. This is good practice, making the care plan more meaningful to them and valuing their input to it. Records show that staff encourage and promote independence in all aspects of peoples lives. Standard 7 - Over the course of this inspection we saw that staff asked residents what they wanted to do and to make decisions about their daily lives. One resident told us, I like living here, staff ask me what I want to do most days. Another resident said, Staff are kind and my key worker helps me where I need it. The Manager told us that residents do have their own residents meetings on a regular basis every 4 - 6 weeks and that meetings are minuted. The minutes of these meetings were shown to us by the Manager. The records show that meetings are held as described, they indicate who has attended the meetings and what issues have arisen and discussed. This means that residents are enabled to make decisions about their lives with assistance as needed. Standard 9 - The care planning process includes the use of risk assessments that were seen and inspected on each of the 4 residents files. They are evidently used as a preadmission assessment tool and following admission, being used to assist residents to be appropriately supported to take risks as a part of developing a more independent lifestyle wherever possible. Any identified risks are managed positively to help the residents lead the sort of lives they aspire to as much as is realistically possible. These risk assessments are agreed with the resident and the relevant professionals who both sign the risk assessment form. This all helps residents to be assured that they will be supported to take risks as part of developing a more independent lifestyle wherever this is possible. Care Homes for Adults (18-65 years) Page 14 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users may be assured that they will be able to take part in appropriate activities, some of which will be based in the local community. That they will be supported to maintain appropriate personal relationships with family and friends; and that their rights will be respected and their responsibilities recognised in helping them to construct an appropriate programme of activities in their daily lives.Residents were seen to be offered a healthy, nutritious and varied diet according to their needs. Evidence: Standard 12 - Carlene House places a strong emphasis on community presence and involvement for the service users for which the home is again commended. Records and observation showed that service users are offered choices of activities and supported to engage in their preferred interests and hobbies. Activity plans are flexible so that daily programmes can alter if service users wish to do something different. The Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: home does not have its own transport but service users regularly use public transport services including bus, tram and train. This year all the residents at Carlene house went on a foreign holiday in the sun, residents who we asked said: I loved the holiday in Corfu, especially the water park. I went to Lanzarote, staff were really helpful, the food was good but it was too hot on the beach. Standard 13 - Community activities include swimming, social clubs, Rangers group, bingo, horse riding, trips to local pubs and restaurants. The home offers a wide range of in house entertainment facilities such as television, videos, music system, art and craft activities and jigsaws, computer and board games. As already stated meetings are held regularly for the residents and minutes showed that there are opportunities for discussing and planning activities. Residents spoke favourably about these events and it was clear that their views have an influence on the way the activities are organised and the way the home is run. Several residents returned from their respective colleges and day centres during the course of the inspection. On arrival, staff supported individuals to follow their chosen interests and routines. In view of the extensive activities provided and concise standard of record keeping, standards 12 and 13 have again been assessed as exceeded on this occasion. Standard 15 - The Manager told us that residents do keep in regular contact with their families and friends. Staff encourage the residents to keep and maintain contacts with family and friends so that they do benefit from having appropriate relationships. There is a visitors room in the house that can be used by visitors who wish to see their relatives in the house. Standard 16 - Policies seen by us to be established within the unit ensure that residents rights to privacy, respect and dignity are respected. Residents who were interviewed also confirmed that they felt staff respected these rights. Residents said that their mail is unopened, their preferred form of address is used by staff and staff do knock on their doors before entering. We observed staff to be interacting with residents in a friendly and respectful manner. Standard 17 - Food menus shown to us indicate that menus are well balanced, nutritional and cater for the varying cultural and dietary needs of the residents. Menu choices are provided and the Manager told us that some residents assist in the drafting of the food menus. A rolling programme is used within the home. No complaints about the meals arose during the inspection in fact those residents Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: interviewed said that they like the food provided. One resident said, I love the food here, another told us, the food is good and we can choose what we want to eat. It was noted that a wide range of meals were listed which cater for the multicultural needs and wishes of the residents. We asked the Manager if a dietician is used to advice on the menu planning in order to ensure that the food provided is always healthy and nutritious. The Manager said that a dietician is used in some cases where there is a specific need and that training is also offered to staff and residents on menu planning. The Manager showed us a detailed food record that is kept for each resident and that is useful to help ensure that the residents maintain an appropriate diet that is healthy and nutritious. This was seen to be linked in with the residents care plan objectives and their weight record. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users may be assured that they will receive personal support in the way they prefer and require, they may also be assured that their physical and healthcare needs will be appropriately met. Service users are protected by the homes policies and procedures for dealing with medicines. Evidence: Standard 18 - 4 residents who were interviewed at this inspection confirmed that they receive their care in the way they prefer. They said that they are able to decide themselves about their daily routines and this was backed up by care staff who were also interviewed by us. Staff ensure that care support at Carlene House is person led, flexible, consistent and is able to meet the needs of the residents. It was confirmed by the staff and the residents that they are able to choose when they get up, when they go to bed, when they have a bath, what they wear and what they will do during the day. A member of staff interviewed explained how when drawing up Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: the weekly activities chart, which is based on the care plan, they always sit down with the resident and go through the programme in order to gain the residents approval and to understand their choices. Standard 19 - Records examined confirmed that arrangements are in place for meeting healthcare needs. Residents are supported to access a range of NHS facilities e.g. GP, consultant, dental, chiropodist, optician and physiotherapy services. Health action plan record books are in place for each resident. The Manager told us that the residents are registered with dentists, opticians, chiropodists and community nurses in order to maintain their all round good health. Residents interviewed were able to confirm this. Information in their case files also evidences it by the recording of their contact with these services. Information seen in the residents casefiles confirmed that annual healthcare checks are routinely carried out by GPs. Standard 20 - The homes policies and procedures manual contains appropriate policies for the control of medication. We reviewed the records for the administration of medication to residents (MAR sheets) and these were seen to be appropriately completed and in line with the homes policies and procedures. Photographs of the residents were attached to the MAR sheets, which helps to ensure that staff administer medications to the right resident. We did a spot audit check on the stock control system and this proved satisfactory with the levels of medications being as stated on the control sheets. A check on the storage facilities for the medication was seen to be appropriate. Boots the chemists provides training in medication; the Manager informed us that this is mandatory training for all staff. The staff interviewed said they had received this training. At present residents are unable to administer their own medication. The home actively supports service users who wish to self medicate and appropriate facilities (e.g. lockable cabinets bolted to the walls) have been installed in each bedroom. 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. Service users may be assured that their views will be listened to and that they will be protected from abuse, neglect and self-harm. Evidence: Standard 22 - The Manager told us that the complaints procedure has recently been updated in pictorial form so as to ease access to it by all residents. This is a good improvement and should assist residents when necessary. The policy contains all of the relevant and necessary information and is readily available to the people who live there, their relatives and other visitors. A log of complaints is kept in a book but no complaints had been made about the home since the last inspection. Residents interviewed said they are aware of who to go to if they feel unhappy and are provided with the necessary support to air their views or concerns. Standard 23 - The home has an adult protection policy that links directly into the L.B.Croydons adult protection policy. The Manager informed us that all staff have undergone appropriate POVA training in the last 3 years. Inspection of the training information held in staff files inspected made it clear that this was the case and that staff had received this training in the last 3 years. It is thought as good practice that all staff should undertake POVA refresher training at least once every 2 - 3 years on an authorised training course preferably offered by L.B.Croydon. Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: 2 members of staff interviewed confirmed that they know what to do if an allegation of abuse is made and they showed awareness of the procedures to be followed. This means that these staff are aware of what abuse is and the safeguards in place for the protection of the residents should they need them. Access to external agencies is actively promoted by the staff at Carlene House. We asked the Manager to see the allegation of abuse record, we were told that the home does not have such a record however the Manager also said that no allegations had been made since the last inspection. The Manager confirmed that they would draw up a proper record book for this purpose. This is recommended. The policies and procedures manual for the home includes a whistle blowing policy and a policy on dealing with violence and aggression. Understanding the policies and procedures is a part of the staff induction process and evidence of this was seen on file, staff are asked to sign to say that they have read and understood the policies and procedures for the home. 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. Service users at Carlene House are able to live in a homely, comfortable and safe environment. The home is also clean and hygienic and well looked after by staff. Evidence: Standard 24 - A tour of the premises was undertaken as a part of this inspection and the home was seen to be clean and tidy in all areas. All areas of the home are accessible to the residents. The general condition of the home and the facilities is good; communal areas and bedrooms are kept clean and odour-free. Staff provide a homely touch through supplementary decoration and ornaments / flower decorations and pictures hanging on all the walls. A number of the residents bedrooms have been redecorated since the last inspection and the decorative standard of these rooms is high. It is recommended now that the communal areas such as the hall and the lounges are redecorated to ensure the same standard is maintained throughout the home. It is also recommended that the bathroom floor on the 1st floor also needs to be Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: replaced and sealed all around the edges in order to ensure there may be no ingress of water under the floor covering. The Manager showed us the fire records for the home and the last fire risk assessment was carried out satisfactorily in July 2008. At the last inspection environmental health had not visited this home as recommended. However the Manager informed us that an environmental health officer has since visited on 18.4.07 and the report was seen and inspected. The comments made by environmental health were very positive saying that Carlene House exceeds the standards in the kitchen areas. Standard 30 - The Manager showed the Inspector the homes infection control procedure, which seems to be effective. At the last inspection it was recommended that the laundry room floor needed to have an impermeable floor laid down to prevent water ingress and easy cleaning. This recommendation has now been met. 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. Service users benefit from the clarity of staffing roles and responsibilities and they can be assured that they are supported by competent, appropriately trained, qualified and supervised staff. The homes recruitment policy and procedures helps protect the residents. Evidence: Standard 32 - We saw staff working with residents at Carlene House to be approachable and to take time to deal with their questions appropriately and patiently. The Manager said that there is a training programme for staff provided both in house by staff and also external agency training. This covers all the essential training required by the staff to do their jobs well and efficiently. The provision of funding for training is also said to be good and the Manager told us that if a training need is identified then a training course could be provided. The Manager informed us that 5/8 of the staff have achieved their NVQ level 2 or 3 awards and 2 of the others are enrolled to undertake their NVQ awards, with 1 member of staff still to gain their level 2 award. Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: Some evidence of these qualifications was seen on the 4 staffing files inspected however it is recommended that evidence for all staff training and other qualifications is routinely held on staff files. The impression was gained over the course of this inspection that all the staff are committed to ensuring that their skills and knowledge is continually being developed by appropriate levels of training so that they can best meet the needs of the residents. Training records were examined by us and it could be seen that staff had completed the following training courses: Induction 1st aid Fire safety Moving and handling Food hygene POVA Health & safety Infection control Communication skills Epilepsy Safe handling of medication Standard 34 - The Manager told us that the home does have a recruitment policy and procedure and that all staffing posts are filled by application and interview. Evidence of these processes being used was seen by us on the staffing files. The Manager said that she or the Deputy and the Proprietor usually constitute the interview panel. Review of 6 of the staffing files evidenced that suitable application forms are completed, that 2 references are obtained including one from the last employer. All staff files reviewed evidenced that proper CRB checks have been carried out for staff employed within this unit. The Manager told us that in all cases enhanced criminal record bureau (CRB) checks are carried out by the agency for all new staff. Documentary evidence was made available at this inspection. A new matrix for CRBs held for all staff on the staffing files was shown to us. This information certifies that the appropriate checks have been completed. It is good practice to renew all staff CRBs every 3 years. All other documentary evidence required (under Standard 34) for staff was seen to be held on the staff files reviewed. The result of this is that there is at Carlene House a staff team that has a balance of the skills, knowledge and experience to meet the needs of the residents. Staff interviewed confirmed that they understand their terms and conditions as well as their roles and responsibilities within the home. Standard 35 - As already indicated earlier in this report the Manager has said that there is an overall training and development plan and budget for the home. The Manager said that a structured induction programme is offered to new staff and documentary evidence of this was seen and supported in interview with staff. It Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: includes: Safe working practices The workers role Meeting the needs of service users The homes policies and procedures. The Homes management prioritise training and facilitate staff members to undertake training beyond the basic requirements. Internal training that is provided within the home by the Manager and other staff compliments the formal training offered to staff and enables the specific needs of the residents to be met in a person centred way. Training certificates were seen in most cases confirming that staff had attended the stated courses. However it has been recommended that certificates are gained for all staff training and held on file. This is valuable for the staff member in that it provides documentary evidence of the training input they have received and helps to document their CVs. It is also recommended that the Manager draws up a new staff training matrix that identifies future staff training needs and that logs training already undertaken by staff. This is a useful tool in that it will easily inform the Manager what training the staff team have received and where the gaps in training exist. Standard 36 - The Manager told us that there is a properly structured staff supervision policy and procedure. Records were inspected and both the policy and the supervision tools cover the areas that are required in order to implement a reasonable supervision process. However whilst recording in the supervision records that are held on staffing files showed that staff have received regular and formal supervision, areas of recorded discussion need to include more details that illustrate exactly what has been discussed and what actions have been agreed and by whom. This should specifically relate to residents issues; the key working process and the monthly reports on progress made by key workers with care plans. This is a recommendation. These detailed notes should also cover these areas: Daily activities and outings for residents Employment and training needs Holidays and leave Work performance issues. Once this has been achieved it will mean that all the key and important areas for the review and monitoring of the work being done in the home to meet the needs of both the residents and the staff groups should be properly met. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can be confident that they benefit from a well run home. The quality assurance system helps to ensure that their views underpin monitoring and review of the homes developments. Service users may also be confident that their rights and best interests are safeguarded by the homes record keeping policies and procedures. Evidence: Standard 37 - The Manager has now had 18 months experience of management experience at Carlene House. She has recently achieved the registered managers award at NVQ level 4, as has the Deputy Manager who has also completed the train the trainer training. The Manager has demonstrated a high level of competence in the management and running of Carlene House since she has been in the post. The systems that are in place to ensure that the home is fit for purpose and meets the required standards are efficient and effective. This reflects very positively on the Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: Manager and also on the staff team all of whom have developed and managed these processes well. The residents spoken to by us felt that the home is being well run and evidence seen supports this view. The homes records and administration systems were seen to be in very good order and overall the impression was extremely positive. Interviews with staff reflected a positive and caring approach towards the residents. Residents can therefore be assured that they are benefiting from a well run home. Standard 39 - The Manager told us that monitoring of this agencys quality assurance is through formal and informal consultation with residents and from visiting relatives and professionals. Feedback forms are issued and questions asked focus on the key principles of the service e.g. privacy, dignity, independence, choice, rights and fulfilment. The information and feedback gathered from these sources is then analysed and forms the basis of the annual development plan that includes implementation targets, with dates as milestones that can be measured and monitored. Staff are allocated areas of responsibility and the management team monitors the progress being made. Residents are provided with information about all aspects of this process via residents meetings and newsletters. It is recommended that where areas of development have been identified the actions taken to address them are described and the results made known either in a news letter to the stakeholders or as a notice placed on the notice board. This would help stakeholders understand how their contributions are helping to improve the services provided at Carlene House. The Manager explained the quality assurance processes being used within the home to ensure that residents views underpin all self-monitoring review and development by the home. The Manager said that there is an annual management audit undertaken that reviews all health and safety issues, statutory and legal issues, the effective implementation of the homes policies and procedures, the environment and the building, staff and employment issues and training issues. With the implementation of the quality assurance tool it means that there is in place a very effective method of maintaining high quality standards in the home. Standard 42 - We were shown information to do with relevant Health and Safety legislation. Policies and procedures were also seen for Health and Safety, risk assessment, moving and handling and fire. The Manager informed us that all staff receive training in moving and handling, fire safety, first aid, food hygiene, and Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: infection control. This was supported by staff interviewed that confirmed that they had received training in these areas. Up to date certificates were seen for: Boiler & Gas 15.5.08 Fire alarms 10.7.08 Emergency lights 10.7.08 Fire extinguishers 7.7.08 Portable electric appliances September 2008 Water tests 30.4.08 All food was seen to be stored appropriately and properly labelled with dates of opening and expiry. Records were seen that confirmed regular tests had been carried out for the: Fire alarm - weekly Fire extinguishers - weekly Emergency lighting - monthly Fridge and freezer temperatures records were checked and records indicate that they came within the acceptable ranges. Accident records were checked - 2 records were noted to do with residents in 2008 and these were dealt with appropriately. Hot water temperatures were also checked and records indicated that they also came within the acceptable range. At the time of this inspection no fire doors were seen to be wedged open and the building appeared to be secure. The Manager showed us a recently completed risk assessment for the building and another for the risk of fire. These are welcomed as it should assist in the prevention of accidents, raise awareness of the fire risks and what to do if a fire should arise and will inform the maintenance programme for the building. 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 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 23 It is recommended that the Manager draws up an allegation of abuse record book that records any allegations of abuse made within the home and the actions taken to resolve them. It is recommended that the communal areas such as the hall and the lounges are redecorated to ensure the same standards are maintained throughout the home. It is recommended that the bathroom floor on the 1st floor needs to be replaced and sealed all around the edges in order to ensure there may be no ingress of water under the floor covering. Some evidence of training qualifications was seen on the staffing files inspected however it is recommended that evidence for all staff training and other qualifications is routinely held on staff files. It is recommended that the Manager draws up a new staff training matrix that identifies future staff training needs and that logs training already undertaken by staff. Recording of areas of work discussed in supervision need to include more details that illustrate exactly what has been discussed and what actions have been agreed and by whom. 2 24 3 30 4 31 5 35 6 36 Care Homes for Adults (18-65 years) Page 31 of 33 7 39 It is recommended that where areas of development have been identified in the quality assurance process, the actions taken to address them are described and the results made known. Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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