Care Home: Castlerea House

Similar services:

• Sunny Bank (P.R.S.) Ltd
• Ashwood Court Unit 1
• Thornton Lodge
• Alfred House Residential Care Home
• Barkerhouse Road (123)
• Fernhaven
• Thames House
• Creative Support

What the care home does well People liked living in the home. One person said it was very nice, another that it was fantastic. Staff were kind, friendly and caring. The staff team was small and did not change very often. This meant people living in the home and staff all got to know each other very well. The home was clean, attractive and comfortable. What has improved since the last inspection? Due to the new owners, a wide range of positive changes were being made and the home was improving strongly. New people were now given useful information about the home. They were also getting special, individual help to visit and try out the home before making a decision about moving in. Time and effort was being spent on finding out what support a new person needed or wanted. This made sure the home was right for them and they would get the right help when they moved in. Staff had clearer and more helpful information about the help people living in the home wanted or needed. The health of people living in the home was taken very seriously, with any problems quickly sorted out, including referrals to specialists. People living in the home were being helped to try new social activities; take part in ordinary community life; and claim benefits they had been missing out on. Routines in the home were being looked at and were changing, with people living in the home having more control over their day to day lives. There had been a lot of unplanned building work to make sure the home was safe. Unsafe electrical wiring had been replaced; a bedroom ceiling had collapsed after a roof leak; and changes needed to meet fire safety rules. Some windows had also been replaced and better handwashing facilities provided. New staff were now being recruited properly, keeping people living in the home safe. New staff were also given a lot of help and time to settle in, with all staff being managed and supported more. This made sure they were getting the help needed to do their jobs well. What the care home could do better: Care records (including reviews) needed to show the above achievements being made. Improvements were needed in finance records to protect money belonging to people living in the home. Staff training records needed to be clearer to allow training needs to be checked. The owner/manager needed to think about the high hot water temperatures in the home (concerning the risk from scalding) and if kept high, record the decision about this and look at it again regularly. Key inspection report Care homes for adults (18-65 years) Name: Address: Castlerea House 18 Hope Street Higher Broughton Salford Gtr Manchester M7 2ES     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sarah Tomlinson     Date: 1 2 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.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: Castlerea House 18 Hope Street Higher Broughton Salford Gtr Manchester M7 2ES 01612780181 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: e.c.crossland@hotmail.com Mr Brian Charles Crossland,Mrs Indira Devi Crossland care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia - Code MD The maximum number of people who can be accommodated is: 10 Date of last inspection Brief description of the care home Castlerea House is a private care home, registered with us (the Care Quality Cimmission) to provide care for up to 10 adults with mental health needs. The building is a large, detached Victorian house in a residential area. There are 3 floors (a lower ground, ground and first), with 2 lounge/dining rooms on the ground floor and a third, small lounge on the lower ground floor. Smoking is permitted in bedrooms only, by agreement. There are 8 single bedrooms and 1 double bedroom. None are en-suite. There is 1 bedroom and a bathroom with a toilet on the lower Care Homes for Adults (18-65 years) Page 4 of 33 0 1 1 2 2 0 0 8 10 Over 65 0 Brief description of the care home ground floor. There are 2 bedrooms and a shower room with a toilet on the ground floor, with a further 6 bedrooms and a bathroom with a toilet on the first floor. The home has a hard standing, paved area at the front for parking, with planted borders and a mature tree. There is an unused enclosed area at the rear of the building. The current weekly fee is £345.00. A copy of latest inspection report is available from the home. 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: Our inspection visit, which the home was not told about beforehand, took place over 1 day (lasting 9.5 hours) and was done by 1 inspector. (References to we or our in this report mean the Care Quality Commission). During our visit we met everyone who lived in the home and spent time talking with 5 people. We also talked with two support staff and the owner/manager. We watched how staff supported people living in the home. We also looked around parts of the building and at some records. We have also used information from an Annual Quality Assurance Assessment form (AQAA). The home has to complete this each year. It includes information about what they think they do well, what they would like to do better and what they have improved upon since our last visit. Care Homes for Adults (18-65 years) Page 6 of 33 Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Care records (including reviews) needed to show the above achievements being made. Improvements were needed in finance records to protect money belonging to people living in the home. Staff training records needed to be clearer to allow training needs Care Homes for Adults (18-65 years) Page 8 of 33 to be checked. The owner/manager needed to think about the high hot water temperatures in the home (concerning the risk from scalding) and if kept high, record the decision about this and look at it again regularly. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.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. The sufficiency of information about the home had improved, helping new people decide whether to move in. In turn, information about the care and support needs of new people was being gathered in a proper and thorough manner. This will enable the owner/manager to make safe and informed admission decisons and ensure the staff team understand new peoples needs. Evidence: No new people had moved into the home since the new owners had taken over in July 2008. Currently, 9 people lived at Castlerea House, all on a long term basis. There was 1 vacancy as a person had recently moved out into their own flat. The owner/manager was currently assessing a referral for this vacancy. We looked at how he was finding out about the new persons health and support needs (in order to decide if the home could meet them and so be able to offer a place). Good practice was noted concerning the admission process, as the owner/manager had met with the person concerned and had obtained a range of comprehensive assessment information about them (and was now waiting for further, more recent updates). Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: Further good practice was noted, as the owner/manager was planning a personalised and flexible introduction to the home for the new person; one that was taking into account their specialised, personal needs. We discussed the need to ensure an initial care plan, discussed and agreed with the new person (detailing any relevant risk issues or restrictions), was in place to guide staff before the new person came for their first overnight stay. We looked at the information provided by the owner/manager to new people who were thinking about moving into the home. They received a brochure (a Service Users Guide). At our last inspection both this and the homes Statement of Purpose (a more technical document describing the service provided) had needed more information. Both documents had since been updated and now provided sufficient detail. The owner/manager planned further revisions to the brochure in the near future to make it more helpful and easier to read. Ways of making it as meaningful and interesting as possible should be considered (e.g. including photographs; input from people already living there). 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. The care needs and any associated risk factors of people who lived in the home were being well documented, ensuring staff were provided with accurate, up to date information to guide them in their work. Evidence: We looked at the care files of two people who lived in the home. Information had been re-organised into new folders. These were easy to use as old records had been archived into overflow files. There was a new helpful front sheet with personal details. We discussed the inclusion of Care Programme Approach (CPA) details (e.g. CPA care co-ordinator) as a quick, helpful reference guide for staff. The owner/manager was also introducing a new, comprehensive mental health assessment form to more clearly document the health and support needs and any accompanying risk factors of people living in the home. Files contained up to date care plans and risk assessments. These varied a little in quality. One persons had excellent personalised and helpful information, and clearly Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: reflected their involvement. Those for the second person were written in more generic language (and not reflect the in depth knowledge shown by the owner/manager). These documents for both people would benefit from having positive goals and risks included. These were being discussed and acted upon (e.g. possibility of voluntary work), but were not yet being routinely documented in care plans or review summaries (to recognise a persons achievements). We discussed the homes internal review process, as a brief monthly summary had been trialled but stopped. The key worker system had also temporarily stopped due to staffing changes and a need to review the responsbilities of the role. The owner/manager was aware both needed to re-start, with the homes reviews taking place at least every six months. We discussed how the key worker role could inform and support this process. We also discussed external reviews (with either the Community Mental Health Team or with Social Services). Good practice was noted, as the owner/manager was aware these needed to take place at least once a year and had recently organised external support for one person living in the home who had such input for over 5 years. We discussed other information in care files. Good practice was noted, as agreements between staff and the people who lived in the home to manage their money were now documented. There were also separate summaries of peoples abilities. The owner/manager needed to monitor how these were kept up to date, and if recommendations were included, how these linked to care plans and risk assessments. We discussed how known signs and symptoms of ill health, possibly indicating a relapse, could be recorded in files to be used as a reference point and support early intervention. Care Homes for Adults (18-65 years) Page 14 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home were being actively supported to try new activities and participate in the local community, helping them lead more meaningful and stimulating lives. Routines were also becoming more flexible, with people living in the home being supported to have more control over their day to day lives. Evidence: Whilst two people attended a day centre, most people living at Castlerea House led unstructured lives, spending their time around the home. However, since our last inspection the owner/manager had started to make a range of very positive changes, with the aim of helping people living in the home participate more in life both inside and outside the home. Two people had been supported to obtain concessionary bus passes and with staff support were now using them. One person had been supported to take up part-time Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: voluntary work, with a second person now considering similar work. Another person had been supported to be politically active and vote for the first time. Leisure activities had also taken place with day trips to Southport and Kendal. One person had received one to one support to enjoy a holiday in Spain. The owner/manager planned to continue such improvements (including encouraging physical activities). We discussed the key worker role in supporting this. For example, people living in the home could have regular 1 to 1 time with their key worker (inside and/or outside the home). This time could be protected and promoted by being identified on the staff rota. Shift patterns and staffing levels would permit this during the day. However, in the evenings, this would be difficult in the home and not possible out of the home as only 1 staff member worked after 6pm. The owner/manager was also reviewing routines to help people living in the home have more choice over their day to day lives (e.g. regarding bathing and showering) and to develop self care skills. One staff member welcomed opportunities to spend more time with the people who lived in the house as they felt their time was taken up with domestic jobs. Staff were responsible for both lunch and the main evening meal, plus all the cleaning. We discussed the culture of staff doing things for people rather than with them, and opportunities for increasing participation in domestic routines for the people who lived in the home. For example, staff could support people to make their own sandwich at lunchtime rather than doing it for them; and staff could clean bedrooms with people rather rather than doing it for them. Such an approach would also help people to develop, maintain or relearn practical life skills. With regard to food shopping, the owner/manager did this via the internet once a week, with individual requests sought and acted on (including buying better quality products). We discussed ways of further increasing the involvement of peole living in the house. For example, as noted, people could plan, shop, prepare and make their own lunch (with their key worker). Small, fresh items could be purchased with staff from local shops; and more people could be encouraged to have their own food cupboard in the kitchen. People living in the home spoke positively about meals, describing the food as good, with an alternative made if they did not like what was on the menu. To provide more variation, people living in the home had requested the previous two week menu was replaced by an informal system of just deciding on the day. Records were now being kept of this system, including alternatives provided. This helped staff avoid repetition Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: and allowed the owner/manager to check a healthy and balanced diet was being provided (including good quality vegetarian alternatives for two people). We advised this new system was reviewed from time to time to ensure everybody living in the home was involved in deciding the meals provided. Good practice was noted, as the owner/manager was considering ways of introducing new and unfamiliar dishes (e.g. having meals with a combined social and culinary theme, Mexican night). We also suggested reviewing the use of white bread with regard to better meeting peoples nutritional needs (e.g. trying fortified white bread). Fresh fruit and drinks were freely available. We discussed the practice of locking the kitchen overnight, with regard to documenting the reasons in the building health and safety risk assessment. We discussed seating arrangements, as there were not enough chairs for all ten people who lived in the home to eat at the same time. Currently this was not a problem as two people preferred to eat at different times and/or in their rooms. We also discussed about staff eating with the people who lived in the home, which they did not usually do. This would help make meals a more social, enjoyable event, particularly if the shopping/preparation had been shared (e.g. at lunch time). Food safety had improved as noted by the Environmental Health department, who had inspected the home earlier in the year. The owner/manager confirmed the 8 recommendations they had made had all been actioned. However, we found clearer staff training records were needed to confirm all staff involved in food preparation had up to date food hygiene training. People living in the home were actively supported to keep in touch with families and friends. We discussed about staff finding out about specialist support agencies that provided information and guidance about intimate relationships. We provided details of our In Focus bulletin regarding equality and diversity issues. 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. Improvements in the delivery of personal care; in responding to healthcare needs; and in medicines management meant the health of people living in the home had improved and they were receiving more flexible, respectful care. Evidence: Relationships between staff and the people who lived in the home were warm, friendly, caring and respectful. People who lived in the home spoke positively about staff. One person said they were very nice, another that they were fantastic. Although the owner/manager was male, the rest of the staff team were female. Consequently, where needed, intimate personal care or prompts about such care could not always be provided by a staff member of the same gender. We were impressed with how the owner/manager was critically reviewing previous routines, with the aim of maximising the privacy, dignity, independence and control the people who lived in the home had over their daily lives. As a result, one persons personal hygiene routine had changed and staff were also prompting rather than providing such care. Another person was now taking care of their own personal Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: hygiene after previously having staff support. The physical and mental health of people living in the home was well maintained and promoted. The owner/manager had taken action to address and improve specific long standing health issues for three people living in the home. Specialist assessments and support had been arranged, with subsequent marked improvements in peoples health. We discussed better recording would more clearly document such work and allow issues to be more easily monitored. A central health record, with all the details of a persons appointments/check ups (including the reason for attendance and the outcome) would enable issues and medical conditions to be tracked over time (informing the review process regarding a persons health). We discussed where a person managed their own health care (e.g. arranging their own annual check ups), this should be recorded in their file and confirmed at reviews. We also discussed as part of the owner/manager reviewing previous practices, whenever possible people should be supported to access health services outside the home (improving community participation and helping them lead an ordinary life), rather than organising health services to visit the home. We discussed the monitoring of peoples weight. We agreed this was necessary only if a medical or health reason required it, or the person themself wished support to lose/gain weight. We discussed where there was an identified need, the frequency and subsequent recording needed to match the care plan (e.g. an agreement for monthly weighing should be reflected with a monthly record). We looked at accident records. These were appropriately completed and were now being kept properly (in accordance with data protection legislation). We discussed any serious injury (e.g. resulting in a visit to A&E) or any serious illness must be notified to us (under Regulation 37 of the Care Homes Regulations 2001). First aid boxes were kept in the lower ground floor office and in the kitchen. We discussed the latter should be kept unlocked to promote quick and easy access in an emergency. With regard to medicines management, improvements identified at our last inspection had been acted on. There was now a clear audit trail of medicines entering the home; handwritten entries on medicine administration record sheets (MARs) were now being signed and countersigned (reducing the risk of error); and photographs were now in place to clearly identify anyone in receipt of medication. To support an audit trail for medicines returned to the pharmacist, the returns book Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: needed to be completed more consistently, as the name of the person whose medicines were being returned was not always recorded. We also discussed care files should show consent to medication, where applicable (e.g. with a signed consent form). An up to date list of their medicines should also be kept. We discussed a change in the legislation regarding medicines storage in care homes. This now meant all care homes must have a Controlled Drugs cupboard and the owner/manager needed to install one to be compliant. Care Homes for Adults (18-65 years) Page 20 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. Arrangements were in place to protect people who lived in the home from abuse or harm and for taking their concerns seriously. Evidence: Information about how to make a complaint was in the homes brochure. This was in a helpful and clear format. We discussed two minor changes needed - the inclusion of a timescale to which a complaint would be responded to; and an amendment to the wording to explain a complainant can contact us or Social Services at any time (they did not need to wait until they had tried to resolve the issue with the home). The complaints procedure was not displayed in the home. The owner/manager had discussed it with everybody who lived in the home on an individual basis earlier in the year (with a signed record kept). We discussed the idea of a noticeboard for people who lived in the home, which the owner/manager planned to raise at the next group meeting. The people we spoke to who lived in the home knew who they would talk to if they were unhappy or had any concerns. We discussed about staff finding out about local independent advocacy schemes. No complaints had been received by either us or the owner/manager since our last inspection. As we had requested at this visit, a system for recording complaints had now been introduced. Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: No safeguarding alerts had been made since our last inspection. Good practice was noted, as the owner/manager had since attended abuse awareness and reporting training, and was arranging for the staff team to update their training. With regard to acting in the best interests of the people who lived in the home, we were impressed the owner/manager had identified and supported three people to claim benefits they were entitled to but had not been receiving. Several people who lived in the home had some of their money looked after by staff. This was being held safely and as noted, agreements about the arrangement were now held in care files. At our last inspection we had been concerned the accompanying records were insufficient. Although some improvements had since been made, at this inspection we again found gaps in record keeping. Whilst one record was clear and in good order, a second did not correctly show all previous balances, nor clearly account for all transactions made. We discussed having a transaction details column on the record sheet would help identify and track money going in and out (e.g. holiday money; clothes money). We checked two cash balances. One was incorrect (by £20.00). We discussed the recent introduction (from 1st April 2009) of the Deprivation of Liberty Safeguards (DOLs), which include a new legal role and responsibilities for care home managers. Good practice was noted, as the owner/manager had attended training about this. He was able to confirm no person living in the home was currently being deprived of their liberty. Care Homes for Adults (18-65 years) Page 22 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. Extensive, unplanned maintenance work had greatly improved the safety of people living and working in the home. Evidence: Castlerea House was bright, welcoming and comfortable, with domestic style furniture, fittings and decor. Since our last inspection, a significant amount of unplanned building and maintenance work had taken place. A bedroom ceiling had collapsed due to a roof leak, resulting in the person whose room it was sleeping in a nearby hotel for 7 weeks. Further external work was still needed to resolve this problem. Faulty electrical wiring had been replaced in the lower ground floor. The owner/manager had also requested a safety inspection from Greater Manchester Fire Authoirty, which had resulted in further work. The two ground floor bay windows and a bedroom window had also been replaced, plus the carpet in the double bedroom. The owner/manager was aware other areas of the home now needed attention and planned to prioritise these in the coming year. This included the first floor bathroom (as wallpaper was starting to come away from the ceiling; tiles had fallen off the bath panel; there was no light shade; a brighter bulb was needed; and the decor and Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: fittings were very dated), and the occupied ground floor bedroom. A replacement for the scratched dining table in the main lounge was also planned. We also discussed some of the sealed double glazing window units needed attention due to excessive amounts of condesation, which obscured the view (e.g. in the empty ground floor bedroom). We discussed future improvements to the outside space. There was no easily accessible or currently useable rear garden. There was an enclosed rear yard that was accessed from the lower ground floor only. The front garden consisted of hard standing area for parking. It had planted borders and a large, mature tree. There was no seating (apparently, previous benches/seats had been stolen). The front door area was used for smoking. The owner/manager had replaced the previous unsightly bin used for cigarette butts with a more attractive garden pot (helping the building stand out less as a care home). Unfortunately, this had since been broken. We found the home smelt fresh and was clean and tidy. Following an Environmental Health inspection earlier in the year improvements had been made in hand hygiene, with liquid soap and paper towels now in all communal hand washing areas (bathrooms/toilets/kitchen). Care Homes for Adults (18-65 years) Page 24 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. Improvements in recruitment and supervision meant people living in the home were safer and were receiving care from better managed staff. Evidence: During our inspection, enough staff were on duty to meet the needs of people living in the home. We looked at a random sample of rotas from earlier in the year. At our last inspection we had been concerned these did not contain enough information. Rotas had now improved; providing a clear record of who was working, for what hours and confirmed staffing levels were maintained. Good practice was noted, as the staff team was small and generally stable, with little change. This meant staff and the people living in the home got to know each other well. Staff usually worked regular set shifts. The team consisted of the owner/manager (who worked both day and night shifts) and 7 support workers. Two staff were on duty during the day (7 days a week). One staff member worked during the evening (from 6pm), completing an overnight sleep-in shift. Communication within the staff team was supported by formal team meetings, plus extended informal handovers when the owner/manager was on duty. We discussed the need to increase the former or formalise the latter to meet our standard of team meetings taking place at least 6 times a year. We also discussed shift patterns, regarding introducing a brief overlap Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: when the owner/manager was not on duty (e.g. of 15 minutes). This would support staff communication by ensuring a formal handover took place. Two new staff had been employed since our last inspection, when we had been concerned recuitment had not been robust enough, putting people living at the home at risk. At this inspection, considerable improvements had been made - with an interview record; references; proof of identity and copies of any relevant qualifications or training all now in place. Appropriate criminal record checks were also evident. We confirmed these (CRB disclosures) should now be destroyed (to comply with data protection legislation), with reference numbers and issue dates kept on staff files. We also confirmed those from staff employed after this inspection must be until our next visit. The owner/manager had confirmed in the pre-inspection self assessment form (AQAA) employment contracts were now issued. We discussed the need to ensure staff photographs were recent and any discussions at interview (e.g. regarding sickness) were recorded. Also, as references from agencies often only confirmed an applicants employment, the owner/manager needed to ensure he obtained full and satisfactory information to confirm an applicants suitability (e.g. a further reference from a service where the applicant had actually been placed by the agency). The owner/manager was aware of the new forthcoming additonal legal requirement for staff to be registered with the Independent Safeguarding Authority. We were impressed with the time and effort the owners were providing to support new staff. The owner was working alongside one new starter each Sunday night for a three month induction period. We discussed adapting the Skills for Care common induction standards workbook that was being used or creating an additional record to recognise and guide this excellent shadowing programme (e.g. regarding tasks/approaches demonstrated and observed). Both the staff we spoke with felt they were well looked after and supported. Since our last inspection the owner/manager had introduced formal supervision, with records being kept. The owner/manager was aware these needed to take place at least six times a year and be supported by annual appraisals. We looked at training for existing staff. At our last inspection, training records were unclear. At this inspection, although staff had been undertaking a range of courses, it was still unclear who had up to date food hygiene and medication training. We again discussed a staff matrix would help the owner/manager identify when staff had completed mandatory, basic safety courses; when these were due for renewal; plus show any other training received. Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: We discussed the use of informal training provided by the owner/manager, which he was keen to introduce to provide staff with better mental health knowledge and understanding. As noted, the owner/manager had already encouraged staff to review how they worked with people living in the home; supporting them to have more control over their lives and improve their self care skills. The owner/manager had a formal teaching qualification obtained when working as a nurse. We discussed recording informal training on staff records and also keeping information for staff to refer back to. With regard to NVQ training, the AQAA confirmed 5 of the 7 staff had attained an NVQ level 2 care award. Care Homes for Adults (18-65 years) Page 27 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. People living in the home and the staff team were benefiting from positive, proactive leadership, with a home that was safer and well run. Evidence: The owners, Mr Brian and Mrs Indira Crossland, were husband and wife. Mr Crossland was a qualified mental health nurse and worked in the home on a daily basis as the manager. Mr Crossland was in the process of completing a qualification in managing care services (the Leadership and Management award (NVQ level 4)). Mrs Crossland was a qualified general nurse and worked in the home on an occasional basis (currently once a week to support and induct a new staff member). Mr and Mrs Crossland had now owned the home for 16 months. People living in the home thought highly of the new owners. One person said they were nice people, another person said they were very happy with them. As noted, staff also felt well supported and they were learning new ways of working (helping people living in the home to make more choices; to improve their self care skills; and to participate more in life outside the home). Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: We discussed ensuring records reflected these improvements, as although generally in better order (e.g. recruitment files), some records did not reflect the excellent work being done (e.g. review and care records). Some records also still needed improvement (e.g. staff training and finance records). The owner/manager had improved record storage, with confidential staff files now kept securely in a locked cupboard. The owner/manager was about to appoint a manager. Mr Crossland intended to remain fully involved in the running of the home and continue working there on a daily basis. The aim of employing a manager was to create more time to continue with the improvements started and to ensure the completion of supporting documents. The changes in care practices and community participation were part of a very positive new approach Mr and Mrs Crossland were bringing to the home. There was a warm, open and positive atmosphere. Practical steps were taken to support a respectful and fair culture. For example, issues raised in group meetings were listened to and acted on (e.g. a request book was being tried so everyone living in the home got the chance to watch their favourite television programmes). We discussed other practical ways of promoting an open and inclusive culture, e.g. reducing the number of keys on the bunch carried by staff (minimising this symbol of authority); reviewing the practice of having a locked mail box (as only staff had access to letters received). In addition to group meetings, the owner/manager was aware of the need to introduce other quality assurance mechansims (in order to gain feedback about the changes being made) such as surveys with relatives and stakeholders (e.g. community mental health nurse; social workers), as well as with the people living in the home. These were planned for the coming year. With regard to safe working practices, the owner/manager had provided details in the AQAA showing all safety and maintenance checks were up to date. During our inspection we looked at records for electrical wiring (NICEIC) and gas and fire safety. These were in order. At our last inspection we had been concerned about fire safety. As noted, the owner/manager had subsequently requested the involvement of Greater Manchester Fire Safety Authority, who had issued a safety order that the owner/manager had since met. There was one outstanding issue of the kitchen door, which was still being incorrectly held open. The battery operated door guard had been replaced 3 times since our last inspection and after receiving confirmation from Greater Manchester Fire Safety Authority the door itself was acceptable, the owner/manager was now awaiting feedback about an acceptable automatic door Care Homes for Adults (18-65 years) Page 29 of 33 Evidence: closer. Maintenance checks were now taking place on fire safety equipment; weekly fire safety checks were being carried out (including the checking of escape routes and the sounding of the fire alarm panel plus different alarm points in rotation); and fire drills were taking place (although the need to keep legible details of who took part was discussed). We also discussed water temperatures, as the hot water was very hot. Thermostatic mixer valves that could be set to control water temperatures were not fitted. The risk of having hot water well above 43 degrees (e.g. for a bath) needed to be formally reviewed (taking into account the capabilities and needs of the people living in the home). Care Homes for Adults (18-65 years) Page 30 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 31 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 42 13 Hot water temperatures must be close to 43C. To ensure nobody living in the home was at risk of scalding. 07/01/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 23 To safeguard any money held on behalf of people living in the home, the system for recording and auditing it should be reviewed. The system for recording staff training should be reviewed to provide clearer information about training achievements and training needs. 2 35 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!