Care Home: Chataway Nursing Home

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What the care home does well People referred to the home have a thorough assessments of their needs and were given the opportunity to visit the home before they decided if it would be the right place for them to live. Plans of care were drawn up from information recorded in the assessments and these told staff what they needed to do in order to meet each person`s needs. People living in this home were asked their views about how the home should be run. This meant that people could influence decisions on activities, meals and the employment of new staff. One person described how the chef came to ask them about the meals and, `we talk about meals and socials at meetings`. Staff were also good at listening to and dealing with concerns and see these as opportunities to make further improvements to the way the service is provided. Good systems were used to safeguard people from harm and when accidents or incidents occurred, action was taken to prevent the same thing happening again. People living in the home were very positive when describing staff and the support they gave them. One person said that, `the staff will listen to you and if I ask they will go out with me when I need to.` Staff assisted people to take responsibility for their own health care and will accompany them to health care check-ups and appointments when necessary. Staff told us about the training they had received in the last twelve months and they agreed that they received good support from the manager. One member of staff said that the manager was `fantastic` and was always there to help. Each member of staff had regular opportunities to discuss the care they provided at team meetings and in one-to-one discussions with a senior member of staff. This allowed the quality of care and support provided to be monitored so that the home was run in the best interests of the people living there. What has improved since the last inspection? This was the home`s first key inspection since re-registering with the commission. What the care home could do better: No requirements were made where the home had to take action to make improvements. Key inspection report Care homes for adults (18-65 years) Name: Address: Chataway Nursing Home 19-21 Chataway Road Manchester Lancs M8 5UU     The quality rating for this care home is:   three star excellent 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: Steve OConnor     Date: 0 7 0 7 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 30 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 30 Information about the care home Name of care home: Address: Chataway Nursing Home 19-21 Chataway Road Manchester Lancs M8 5UU . Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): D R Price Associates Ltd T/As Chataway Nursing Home Name of registered manager (if applicable) Miss Lyn Asprey Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to people of the following gender: Either whose primary care needs on admission to the home are within the following category: Mental disorder, excluding learning disability or dementia 2. The maximum number of people who can be accommodated is: 26 Date of last inspection Brief description of the care home 26 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 30 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 inspection report is based on information and evidence gathered by the Care Quality Commission (CQC) since the service was registered in January 2009. The home was previously registered with the CQC under the same owner but a change in circumstances meant that they had decided to re-register. This was the first key inspection of the newly registered service but the home had been inspected just before the change. Information from that key and other previous inspections and information gathered about the service was used in this key inspection. Information included the manager completing a self-assessment form called an Annual Quality Assurance and Assessment (AQAA) describing how they feel they have met the National Minimum Standards (NMS). Care Homes for Adults (18-65 years) Page 5 of 30 Additional information that would be used included any incidents notified to us and information provided through other people and agencies, including any concerns and complaints. During the visit time was spent talking to people who live at the home, the manager, the activities coordinator and other members of staff. Documents and files relating to how the service was run were also seen. Fees were charged at around six hundred pounds per week. Information about the service and previous inspection reports can be gained direct from the manager. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 7 of 30 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 8 of 30 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. People can be confident that they will receive the right kind of information to help them decide if the home will be the right place for them to live and that their needs will be identified so that they receive the support to help them. Evidence: The manager described the referral and introduction process for prospective people to come and live at the home. We also reviewed three peoples files to assess the documentation and records of the referral and introduction. All referrals came through either local authority or health services and evidence was seen of the different assessments of need that they had provided that gave a detailed description of the prospective person and their support needs. Depending on the persons wishes they either visited the home or a member of the management team visited them to carry out an initial assessment of their needs and to provide them with information about the home and service. People were encouraged to visit the home to meet other people and staff and could even to spend Care Homes for Adults (18-65 years) Page 9 of 30 Evidence: an over-night stay to help them decide whether it was the right move for them. Several examples of these initial assessments were seen and found to be detailed and descriptive about the person, their personal circumstances as well as their support needs in areas such as their emotional and physical health and social needs. The manager stated that all referrals were discussed with members of the staff team to gain their views and to look at issues such as compatibility with the other people who live there. At this stage they would identify a keyworker and named support worker who would work closely with the person. Whilst the home did not accept emergency referrals they could provide a more rapid response to urgent referrals that still gathered the information required for them to be able to meet a persons support needs. Care Homes for Adults (18-65 years) Page 10 of 30 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. People using this service are consulted about the way the home is run and are empowered to make decisions that are important to them. Evidence: The manager described how when people first arrived a temporary initial care plan was developed so that staff knew how to support a person. Staff would be expected to have read the relevant assessments and care plans from the local authority or health service. It was the responsibility of the keyworker, who was a registered mental health nurse (RMN) and named care worker to work with the person to carry out further assessments such as moving and handling, nutrition and skin integrity and to develop a personal mental and physical health care plan. The activity coordinator also worked with the person and other key staff to find out how a person wanted to spend their time and to develop a social care plan. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: The manager stated that people were always encouraged to take a full and active part in the assessment and care planning but this would depend on their own wishes. Four peoples care plans were sampled and found that they covered all areas of a persons life and contained some detailed and person focused information that told the reader about the person and their life. Included in the care plan was information about peoples preferences and wishes about the support they received and the life they wanted to lead. Peoples support was reviewed by the keyworker at least every two months to make sure that changes were being reflected in the plans. People also took part in reviews organised by the local or health authority. Evidence was seen that the manager audited the care plans on a regular basis to make sure that they were being completed and to a good standard. It was found that a lot of the information written in the reviews was at times repetitive and lacked any real detail or description of peoples progress or otherwise. Also, at times, the plans of care were generalised in terms of the actual support people needed and how it was to be given and was not always written in a way that described how the person wanted to be supported. The manager recognised that care plans and reviews could be improved even further and that keyworkers could benefit from more person centred planning training. Daily records provided details on what care had been provided and what action was being taken to make sure that people were protected from the risk of harm. To support people to take an active part in decisions about their own life and the direction of the overall service they were encouraged to take part on an elected residents committee and attend regular residents meetings. Records of these meetings showed that people were being kept informed of changes to the service and were asked their views about such issues as the meals and activity planning. As part of the initial assessments, hazards and risks that may impact on peoples safety and welfare were identified and if needed a fuller more detailed risk assessment and staff guidance was developed. This was especially detailed in the area around peoples emotional and mental health with guidance on how to respond to the triggers that show that people may be becoming unwell. In addition, specific risk assessments were carried out in relation to self-care, diet, vulnerability and finances. Due to the nature of peoples illness it was necessary at times to place restrictions on their choices especially in the areas of smoking, drinking alcohol and access to Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: personal monies. Were a risk had been identified the staff had worked with people to come to an agreement on access to cigarettes, alcohol or money and this agreement had been recorded and signed by the person. Care Homes for Adults (18-65 years) Page 13 of 30 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. Peoples choices and opportunities for social activities and meals provide daily variation and fulfillment for people living in the home. Evidence: The management and staff team devoted a lot of time and resources to working with people to find out and support how they wished to live their lives and offered and supported them in taking part in activities that they enjoyed and also in new experiences. The home employed a dedicated activity coordinator whose role was to work with people and staff to identify their social needs and to develop a support plan that allowed them the opportunity to take up those activities they wish. The assessments and care plans included a lot of information about peoples preferences and interests and goals that they wanted to achieve. Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: Evidence was seen of how individuals and groups of people had been encouraged and supported to enjoy social events and activities both in the home and in the community. Several people mentioned the day trips and holiday that they had experienced and enjoyed. One person was being supported to continue their interest in gardening and another in gaining further educational qualifications and skills. The management and staff understood the importance of people being able to continue and experience their individual culture and religious choices and people were either supported to attend the place of worship of their choice or services were even held at the home. Records were being maintained that described the activities that people took part in on a daily basis. As an example, for one person this included working on arts and crafts projects, shopping, visiting local pubs and restaurants and the records showed that they had been supported to vote in the recent European elections. Staff worked hard to ensure that people were able to influence decisions in relation to meals, daily routines and the social and leisure activities. This had been achieved by electing a residents committee and undertaking consultations with people individually and at monthly meetings. Ultimately people decided for themselves their own daily routines but within the structure of regular mealtimes, health appointments and other treatments needed to maintain their health. Several people attended specialist mental health services such as drop-ins and day services. Where people had families they were encouraged and supported to maintain contact and friends and family could visit at any reasonable time. One person explained how his visitors could come when ever they wanted and they spent time either in the garden or in their room. Several people commented on the quality and range of the meals they had. One person described how, if they did not like what was on the menu, they just went and spoke to the chef and were given other choices. The chef had a good understanding of each persons dietary needs. They attended monthly meetings with people to discuss and agree menus. People were encouraged to share mealtimes together to prevent isolation and spend time with other people. However, people did have the choice of taking meals privately Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: and who they sat with at the dinner table. Care Homes for Adults (18-65 years) Page 16 of 30 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. Peoples personal and health care needs were being met so that they can remain healthy and active. Evidence: Peoples care plans identified the personal and general health care support they needed. The manager confirmed that most people needed prompting and encouragement to maintain their personal care but some people did need hands on support. People also had individual mental health care plans that related to how their illness affects them and how staff needed to support people to maintain their mental health and when/if they become ill. There was evidence of people being supported to access general, specialist and mental health services to maintain their health. Clear records were maintained and updated of any changes to peoples support. Most people were on the Care Programme Approach (CPA) and had regular contact with community mental health services and psychiatrists. Evidence was seen of CPA reviews and assessments involving the staff Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: team and mental health services. The importance and priority given by the management and staff team to the positive affect of maintaining peoples health was reflected through the time and resources given to encouraging people to take part in regular gentle exercise sessions and accessing community health programmes. At the time of the visit people were being encouraged to take part in a series of summer olympics events to become more active and enjoy exercises. Whilst the care plans for both physical and mental health did outline what actions staff needed to take, at times these could be lacking in personal detail and did not fully reflect the actual level of interventions and all the work that staff did to support a person. For example one persons plan stated that staff were to discuss with the them the coping strategies to try to reduce the impact of visual and auditory hallucinations. However, there was no record found of what these strategies were. The manager confirmed that this knowledge was often past on between staff verbally and through hands-on experience. It was also found that personal care support was often written in general terms such as give support rather than person focused and descriptive in the way that the person wanted to be helped. It is recommended that care plans relating to personal and health care be more individually person focused and reflect the actual support given to maintain their health and wellbeing. We looked at how medication was being managed on behalf of four people. All medicines were kept secure and the records for administration of medication were accurate and up to date. Regular checks had been made by staff to ensure that people were receiving their medication as directed. The manager informed us of an incident involving medication that had gone missing and the additional security and recording measures they had put in place to prevent this happening again. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can confidently express their concerns and staff have the knowledge and skills needed to safeguard them from harm. Evidence: The complaint policy and procedure had been given to people in the Statement of Purpose when they first arrived at the home. A copy was also displayed on the notice board outside the office. Several people spoken to during the visit all knew that they could talk to staff and the management about their concerns and worries. The residents committee and meetings were also an opportunity for people to raise any concerns and issues that affect them and their life at the home. According to information provided by the manager in the self-assessment form they had received two complaints in the last twelve months. Records showed that the complaints had been upheld by an investigation and that action had been taken to resolve it within 28 days. The management and staff followed a clear adult protection policy and procedure. Staff had attended training events in understanding and responding to the protection of vulnerable adults. Three members of staff spoken to were able to explain how they would respond to an incident or allegation of abuse and knew that they could not keep secrets for people if it involved their safety. The manager was aware of the implications of the Mental Capacity Act and Deprivation of Liberty (DOL) guidance that aimed to protect people and act in their best interest. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: They have undertaken training and staff were being briefed on how it affected their role and work. The care plan was being reviewed and updated to include a section for assessing DOL incidents and assessments. One person managed their own finances with most others having appointees to help them with their benefits. Where people needed support to manage their finances this was recorded in their care plans and risk assessments. Records of the money kept by the home on peoples behalf were being maintained with all incoming and outgoing transactions recorded. Care Homes for Adults (18-65 years) Page 20 of 30 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. People using this service are provided with a clean hygienic, safe and comfortable living environment. Evidence: The home was found to be clean and generally well maintained and had a layout that meant that people had a choice of communal and private areas to spend their time. The home had a large lounge with comfortable domestic seating and was where most people watched television, listened to music and spent time with each other. The dining room also had a lounge area with a television and music and had recently replaced the chairs. In addition, there was a separate smoking lounge that had been recently decorated as well as a gazebo in the garden that people used to smoke outside. There were enough toilets and bathrooms for the number of people living at the home. It was found that some of the toilets were in need of decoration and some fixtures replacing such as flooring and toilet seats. A bath also needed updating due to wear and age. It is recommended that the areas identified to the manager during the inspection were made good. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: It was also found that several of the toilets had cloth towels for drying hands and it is recommended that communal toilets should find alternative, more hygienic methods for hand drying. The home employed maintenance staff responsible for maintaining the environment of the home and to keep the decoration up-to-date as well as the safety of any equipment used. There was a plan of ongoing maintenance and they conducted regular checks of the different areas of the home and records were seen of the actions they had taken. Due to a recent break-in the door leading to the back of the building had been replaced and made secure to allow people to come and go but could be locked in the evening. The handrail along the ramp leading to the back door was in a poor state of repair and when pointed out to the manager action was taken to make sure that it was safe to use. Suitable laundry facilities were available for people living in the home and staff had been trained in infection control procedures. One staff spoken to was able to describe in detail the measures taken whilst providing personal care to maintain good hygiene practices. In addition, infection control audits were carried out every three months to make sure that standards of cleanliness and hygiene were being maintained. Care Homes for Adults (18-65 years) Page 22 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Robust systems were in place for the training, supervision and recruitment of staff that safeguards and promotes the rights of people using this service. Evidence: The staff team consisted of the manager, deputy manager, RMNs, senior carers, carers, chef and kitchen staff, maintenance and domestic staff. The Chief Executive of the home also provided administrative support in the running of the service. The home also had access to its own bank staff (both carers and RMNs). The manager stated that if cover was needed then either the permanent or bank staff would provide this. The staffing levels can be flexible during the day depending on what health appointments or activities were planned. Generally between 8:00 am and 3:00 pm there was four to five staff with an RMN always being on duty. Between 3:00 pm and 9:00 pm there were two care staff and a RMN and on night shift two carers and a RMN. During the visit staff were seen to be very positive and outgoing in their relationships with people. There was a lot of chatting and time spent with people rather than with other staff. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: People spoken to during the visit were very positive about the staff team and their relationship with them. Several people commented how well they get on with staff and that they could go to them with any worry or concern. Staff had the chance to get together as a team and as nurses and carers to receive information from the management team about issues that affect their work. There was also the opportunity for staff to give their views and to make their own contribution to how the service was provided. All staff also had the opportunity for supervision every 6 to 8 weeks to talk about their work, the people they support and their training needs to do their job. All the staff spoken to were able to describe clearly their roles and responsibilities in supporting people and in helping them maintain their emotional and general health. They all also commented on the importance of encouraging and supporting people to be as active as possible both socially and physically. All the staff spoken to were aware of what to do to protect people in the event of an incident or allegation of abuse. At the time of the visit eight care staff had achieved the National Vocation Qualification (NVQ) Level 2 in Care, two were currently studying for the qualification and four staff were yet to be enrolled. We sampled four staff files, carers and RGNs, to find out if all the necessary recruitment checks had been made before the members of staff had started work. All staff had a Criminal Records Bureau (CRB) check certificates, completed application forms, references and evidence of identification. people were involved in the recruitment of staff and were supported to be part of the interview panel and ask prospective staff questions. The manager stated that peoples views had equal value when deciding on whether a person was right for the job. The RMNs staff files held details of their Nursing and Midwifery Council (NMC) registration. However, five of the RMNs registration dates had expired and there was no evidence to show that these had been updated. It was also found that a CRB certificate identified convictions but there was no recorded evidence to show the decision making process of why these did not affect the decision to employ the member of staff. It is recommended that RMNs staff files contain evidence of current registration with the NMC and that the decision making process in employing staff with criminal Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: convictions was clear recorded. All new care and nursing staff, including bank staff, received an induction based on the needs of the people living at the home and nationally agreed standards (such as the Skills for Care Induction modules). Records of staff progress in the induction were recorded and all mandatory training was expected to be provided within the first 12 weeks of employment. Both nursing and care staff on duty were asked about the training they had attended over the past 12 months. These included protection of vulnerable adults, infection control, health and safety, food hygiene, the mental capacity act and the deprivation of liberty. All the staff spoken to said that they talked about their training needs during supervision. The manager provided us with a matrix record that showed what training staff had undertaken, what needed refreshing and what they still had to do. The training plan showed that a number of staff still needed to attend some mandatory training but there was an ongoing training programme and that the manager was identifying staff training needs. We asked two care staff on duty about the training they had taken part in around understanding mental health. One carer said that they had no training in this area and the other last had some form of training over two years ago. As the service supports people with enduring mental health issues it is recommended that all care staff received appropriate training in understanding mental health issues. Care Homes for Adults (18-65 years) Page 25 of 30 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. The management and administration of the home was based on openness and respect. This ensured that the home is managed in the best interests of the people who live there. Evidence: The manager had been appointed in December 2007 and became the registered with the commission in July 2008. They were a RMN and described to us the range of their hands on and management experienced and the management qualification gained. They spend some shifts as part of the roster and have around 20 hours per week supernumerary for their operational management role. Speaking to the manager found that they were very knowledgeable about the people the service supported and positive in the their role in maintaining peoples mental health and in improving the quality of their lives. We found the atmosphere in the home to be positive and inclusive, resulting in a service that was being managed in the best interests of the people accommodated. Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: Staff spoken to during the visit were all very positive about the support and encouragement they received from the manager and management team. They were described as open and willing to listen and open to suggestions and ideas. Robust systems were in place to monitor the quality of the service provided and listen to the views of staff and people living in the home. The role and involvement of the residents and committee meetings have already been raised in this report. This provided positive outcomes for people using the service in being able to influence the way the service was being managed. In April and May 2009 people were given with the opportunity to complete questionnaires asking them to comment on the service and a range of issues that affected their lives at the home. From this information the manager had developed a table of results and action plan. The plan set out actions to be completed as a result of the comments from the questionnaires. This included issues around cleaning, furnishings, heating the environment and the smoking room. Records and evidence found during the visit confirmed that these improvements had been completed. Care had been taken to ensure that staff working practices and the environment were safe. The health and safety records provided were found to be accurate and up to date. Quarterly health and safety management audits and reports have enabled action to be taken to keep risks in the environment under control. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 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 18 It is recommended that care plans relating to personal and health care be more individually person focused and reflect the actual support given to maintain their health and wellbeing. It is recommended that the areas of decoration and repair identified in the report and to the manager during the inspection were made good. It is recommended that communal toilets should find an alternative, more hygienic methods for hand drying rather than cloth towels. It is recommended that RMNs staff files contain evidence of current registration with the NMC and that the decision making process in employing staff with criminal convictions was clear recorded. As the service supports people with enduring mental health issues it is recommended that all care staff received appropriate training in understanding mental health issues. 2 24 3 30 4 34 5 35 Care Homes for Adults (18-65 years) Page 29 of 30 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). 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