Care Home: Chepstow House

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What the care home does well The home ensures it could meet the needs and wishes of possible new residents before they move in. They can also visit and stay at the home to check that it suits them. Each resident has a plan that shows their care needs, likes, dislikes and goals. Plans help staff to know people`s needs and so give them the right support. Residents can make choices about what they do every day and about their lives. They are encouraged to express their views and concerns. Staff respect their individuality. Staff enable residents to take part in activities they like and go out in the community. They also support them to keep in touch and meet up with their family and friends. Residents have good support with their personal and health care. Staff manage their medicines safely for them if they are not able to manage their own medicines. Chepstow House offers residents a safe, pleasant and comfortable home. It is in a good place that is quiet but is also near to town and its shops and other facilities. Staff reflect the findings of this inspection. One comments in their survey "the service provides a relaxing, homely atmosphere. Activities are set which benefit service users and a high standard of care is provided to suit individuals` needs and wishes". Staff are well trained, which helps them to understand residents` needs and keep them safe. An advocate comments about staff in their survey that "they are well organised and develop a good, caring relationship with the resident". The manager has the right skills and knowledge and the home is run well. Staff get good support from management and the staff team work together to make sure that people receive a good individualised service. The way the home is run is checked and there are ways of making sure the service is right and continues to improve. What has improved since the last inspection? The last key inspection of the home was carried out on the 28th of November 2006 and the improvements made since then are as follows:Each resident now has a special plan about their health (called a health action plan), which should help to ensure that their health needs are met better. Some parts of the home have been redecorated with new furniture, which makes it look very nice and more homely. The new chairs and sofa in the sitting room are easier for people with poor mobility to use and a new stair lift helps them to access the first floor. The home now obtains a full employment history for all possible new staff. This is part of the way they check that staff are suitable to work with vulnerable people.Staff have attended training to help them understand residents` individual rights better and how they should value, respect and safeguard them. The home has introduced more kitchen hygiene and medication checks. They should help to promote good food safety and better medication management. What the care home could do better: When the home helps residents set up care plans in a more suitable way they should be able to understand them better and be more involved in planning their own care. If risk assessments relating to residents` behaviours are reviewed and updated they would better reflect any current risks. Staff would then also know how best to manage their behaviours consistently. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Chepstow House Old Maids Walk Ross on Wye Herefordshire HR9 5HB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Christina Lavelle     Date: 2 8 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Chepstow House Old Maids Walk Ross on Wye Herefordshire HR9 5HB 01989566027 Telephone number: Fax number: Email address: Provider web address: salkee@aol.com Name of registered provider(s): Name of registered manager (if applicable) Ms Sally Keene Type of registration: Number of places registered: Chepstow House (Ross) Ltd care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Service Users may also have physical disabilities in addition to their learning disabilities. Service users may also have a mental health disorder that is associated with their learning disability. Service users must be at least 30 years of age. Date of last inspection Brief description of the care home Chepstow House offers accommodation with personal care for fourteen adults. People living there are normally aged at least 30 and seven of the current 13 residents are over 65. Residents must require care primarily due to learning disabilities and may also have physical disabilities and/or a mental health disorder that are associated with their learning disability. Some people may use behaviours that can challenge a care service and have limited communication and social skills. The homes stated purpose is to provide a homely environment and to encourage people through education and stimulation to achieve as much as they can, in a way that is generally valued by Care Homes for Adults (18-65 years) Page 4 of 30 14 Over 65 0 Brief description of the care home society. The home is a large detached house with a quiet location. It is a short walking distance from the centre of the market town of Ross-on-Wye with its shops and facilities. The original house has been substantially extended and was formerly a doctors surgery. All the bedrooms are single and there are four on the ground floor and six on the first floor in the main part of the home. The other four bedrooms are in a self contained flat on the ground floor. There is now a stair lift to provide access to the first floor. Two bedrooms have en-suite facilities including a shower. The home has two sitting rooms (the one in the flat has a dining area) and a separate dining room in the main house. The garden is at the front of the house with a patio. There are parking spaces at the back and a small internal courtyard, designated for smoking. Information about the service is in a service users guide that is available from the home. The weekly fee varies according to the assessed needs of the individuals who live there, as agreed between the provider and their funding authority. Extra charges include for such as dry cleaning, newspapers, private health care e.g. chiropody, a contribution towards holidays and any additional transport costs such as taxis. Care Homes for Adults (18-65 years) Page 5 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: 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: This is a key inspection of the service provided by Chepstow House. This means all the standards that can be most important to people who use care services are assessed. As part of this inspection we, the commission, visited the home for five hours without telling the staff or people living there beforehand. It was agreed with the manager that the people who live there should be referred to as residents in this report. We spoke with four residents about their experience of the home and their lifestyle. Two care staff were interviewed and asked about the service, their role, training and support. The way the home is run and plans to develop the service were discussed with the manager. Surveys had been completed by three residents, one of their advocates and seven staff. All feedback received about the service is referred to in this report. Care Homes for Adults (18-65 years) Page 6 of 30 The manager had completed an AQAA (annual quality assurance assessment), as is now required, before our visit. The AQAA asks managers to say what their service does well, could do better and about their plans to improve the service. Some relevant records were checked, including residents care plans and staff files, and parts of the building were looked at. All other information received by the commission about or from the home since the last key inspection is also considered. This includes two complaints and events that had affected the safety and welfare of residents (these are called notifications). What the care home does well: What has improved since the last inspection? The last key inspection of the home was carried out on the 28th of November 2006 and the improvements made since then are as follows:Each resident now has a special plan about their health (called a health action plan), which should help to ensure that their health needs are met better. Some parts of the home have been redecorated with new furniture, which makes it look very nice and more homely. The new chairs and sofa in the sitting room are easier for people with poor mobility to use and a new stair lift helps them to access the first floor. The home now obtains a full employment history for all possible new staff. This is part of the way they check that staff are suitable to work with vulnerable people. Care Homes for Adults (18-65 years) Page 8 of 30 Staff have attended training to help them understand residents individual rights better and how they should value, respect and safeguard them. The home has introduced more kitchen hygiene and medication checks. They should help to promote good food safety and better medication management. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 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 10 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be confident the home could support them. This is because a full assessment will be made of their needs. The home would also know their preferences and goals from involving them and/or their representatives in their needs assessment and admission. Evidence: There have not been any new residents move into the home since the last key inspection. It is evident however from discussion with the manager, and the homes assessment and admission procedures, that new people would not be admitted to the home until a thorough assessment of their needs has been undertaken. The manager confirmed that the home always obtains a community assessment completed by the care professional who referred them. The manager then visits them at their current residence to assess their needs and provide them information about Chepstow House. Introductory visits to the home are arranged next, including for meals and to join in with the homes activities and for overnight stays when feasible. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: A trial stay of three months is then arranged and at the end of this trial period a review meeting is held when a decision is made about the suitability of the placement. The prospective residents, their family and significant other people are included in these processes. Staff are also consulted and involved in the assessment and their views, and those of current residents, are sought and their compatibility with the resident group is carefully considered. Care Homes for Adults (18-65 years) Page 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs and goals of residents are met. Whilst each person has a care plan that they and their representatives are involved in making and reviewing they could be more involved if plans were user friendly. Support needed in relation to residents behaviours would better identify any current risks and how staff should manage them, if they are reviewed and updated. People can make decisions in their lives because staff promote their rights and choices. Evidence: Chepstow House involves the residents in planning their own care. Staff also support and encourage them to make decisions and choices in their daily lives and routines. Each person has a care plan that includes their strengths, needs, wishes and some short and long term goals. Plans include information about their background, their photograph, a pen picture, their likes, dislikes and things that are important to them. One residents advocate confirms in their survey that the home always meets the Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: individuals needs and gives them agreed support. Staff also keep detailed records about significant events, health and behaviour issues, activities etc. for every resident. Whilst plans cover relevant areas of need, and are person centred because they focus on what individuals want, they are currently not in a format that people with learning disabilities can understand easily. It is positive that the home plans to implement a more person centred care plan format with simple language and pictures so residents can be more involved in developing, agreeing and reviewing their plans. Staff will be fully involved in setting up these new plans and residents have a staff member allocated to them as their keyworker. They are able to spend time on a oneto-one basis with residents and so get to know them better and what they like to do etc. Keyworkers are also expected to review and update the plans monthly. Staff confirm that they do this and they are always given up to date information about residents. Plans appropriately include risk assessments covering generic safety areas such as mobility, nutrition, bathing and going out in the community. Some residents also have specific risk assessments in place relating to behaviours that can be challenging, which specify how staff should manage them. However some management plans were set up several years ago and the manager said that some of the strategies detailed had not been used by staff for some considerable time because behaviours had improved. Plans therefore need to be fully reviewed and updated to just reflect any current risks. The home involves relevant other people in reviews and has access to an advocacy service if individuals without family need external support. Residents views are sought through monthly meetings when they discuss day-to-day running of the home, menus, the garden, outings and holidays and can also raise any concerns or suggestions. Action plans are set up as a result and staff follow them through, with keyworkers advocating for individuals if necessary. Staff recently had training on attitudes and values and the evidence shows that they are clear they should promote individuals rights and choices. Care Homes for Adults (18-65 years) Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents take part in activities that meet their personal interests and go out in the community. Staff treat people as individuals and enable them to lead their chosen lifestyle and encourage their independence. Residents are supported to maintain links with their family and representatives and the home provides healthy meals, which they like. Evidence: The manager and staff clearly recognise residents should be encouraged to maintain and develop their social, emotional and independent living skills. Although some people are older and becoming more frail, and others have particular difficulties that affect how they relate to people, efforts are made to seek and to offer them day services and social and leisure opportunities that help them to mix in their local community. A staff member says the home involves service users in the community Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: very well. Each resident has an activities sheet showing they have regular outings, walks and that regular in house arts and crafts, music and movement and flower arranging sessions are arranged. It would be good however if their plans reflect how their identified social and developmental needs are being met. Some people are involved in a recycling project, one person goes to college and most regularly go out to local pubs, cafes and to Church services. Keyworkers aim to take everyone into town at least weekly to buy their personal toiletries etc. One persons advocate comments that I have found that as much as possible the home is very good at social programmes and creative work which stimulates. Individual outings and holidays are also arranged and the home has vehicles to provide transport at no extra cost to residents. Staff support people to maintain links with their families and help them to telephone, write to them, send cards etc. and make visits. Regular social events are arranged at the home to which relatives and friends are invited, as well as being invited to attend their annual care reviews. One person has an advocate and although the home has not been able to find advocates for other individuals without family input they have an advocacy service they could consult and involve if any particular issues arise. Staff and some more able residents confirm that they are encouraged to be involved in the domestic tasks around the home. People are all supported to keep their own bedrooms clean and tidy and asked about such as menus and social events. They can also make choices about their day-to-day lives and routines. Regarding food provided by the home four week menus are produced, which include a variety of wholesome meals, including pasta and rice dishes. Staff say they aim to promote healthy eating and fresh fruit, juice, salads, yoghurts etc were seen to be in stock. Residents likes and dislikes are known and their preferences for such as two roast meals a week are included in the menus. The home plans to use pictures of meals so they can all be more involved in menu planning, which would be a good development. Records are kept of each residents daily meals. Weight records are also kept, and if necessary appetite and food intake are monitored, recorded and professional advice sought. People spoken to say they like the food at the home and also enjoy having meals out. Care Homes for Adults (18-65 years) Page 16 of 30 Care Homes for Adults (18-65 years) Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive personal care from staff in ways they need and prefer. Their health care needs are met and where necessary the home has procedures in place for staff to follow. Residents medicines are managed safely in the home by staff on their behalf. Evidence: Residentspersonal and health care needs are appropriately specified in their care and health action plans (HAPs). Their HAPs have been set up since the last inspection and include information about each persons medical condition, history and diagnosis. There are assessments in relation to such as their communication, mobility, sensory and dental needs. In addition to information about their sleep pattern, weight and dietary requirements. Records are kept in HAPs of any reviews carroed out and action taken in relation to individual residents health. Plans show the support each person needs and wants from staff for their personal care and how self care should be promoted. Residents were seen to be well presented and suitably dressed and are supported to shop and buy their own clothes. One younger adult proudly showed us their full wardrobe of up to date clothes they had chosen. Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: Residents access health care services from the local GP surgery. Staff also support them to have routine check ups, including to attend well person clinics, out in the community. Whenever necessary advice and input is sought from specialist health care professionals e.g. a psychologist and continence management nurse. A psychiatrist visits the home monthly. Health issues are monitored with records made of issues arising and kept about appointments attended and health care input received, with outcomes and guidance for staff. If necessary information and protocols are provided for specialist needs such as epilepsy and autism and staff interviewed were knowlegable about these. A policy and procedures for the management of residents medication by the home is provided for staff. They include for homely remedies, with protocols when individuals can be administered medication as and when required. Necessary medication records that are kept by the home were checked during our visit and found to be appropriately maintained. The home carries out a weekly audit of all medication in stock and a community pharmacist checks their system regularly. There are secure storage arrangements in the home for prescribed medications. Staff designated to administer medicines have undertaken a formal training process for the safe handling of medicines. The home also provides information about particular medications for staff. Consent to and self administration of medicines by residents is also considered (as it should be), although none of the current residents are able to manage their own and so staff do so on their behalf. Some people have signed their agreement to this or if not a relative or their keyworker had signed for them. Care Homes for Adults (18-65 years) Page 19 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. Residents can express their views and if people have concerns about the service they know how to complain and feel confident that they will be listened to and dealt with. There are systems in place to safeguard residents and the home takes appropriate action to follow up any allegations. Evidence: The home has a written complaints procedure that is also available in a way that should help people with learning disabilities to understand it more easily. Each resident has a copy of this in their bedroom and their families and advocates are offered and given one. The home has a record sheet that is completed when any complaints are made to include details of the issues raised, their investigation and outcomes. It is confirmed that keyworkers spend individual time with their allocated residents and encourage them to discuss worries they may have. They can also raise concerns in their regular meetings. It was observed that residents and staff had a good and open rapport and three residents spoken with, and surveys, confirm they like and trust the manager and staff and know who to speak to if they are not happy. One advocates survey says they know how to make a complaint but have never needed to do so. Staff surveys also confirm they would know what to do if concerns are raised with them. Since the last inspection the home has not received any complaints directly, however Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: one matter was raised with the provider and another complaint made to the local authority. The one issue involved an allegation that a staff member had spoken to a resident inappropriately and so was referred under local multi agency safeguarding procedures. Both matters were investigated and dealt with properly by the provider. Policies and procedures relating to abuse, adult protection and whistle blowing are available. The home also has a copy of the local multi agency procedures for the protection of vulnerable adults. Staff are directed to read these and staff interviewed confirm they have received relevant safeguarding training and would know how to report any suspicion or incidence of abuse or neglect. Care Homes for Adults (18-65 years) Page 21 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 who live at Chepstow House have a safe and well maintained home that is pleasant, comfortable and kept clean, which helps to promote good infection control. Evidence: Chepstow House has a convenient location near Ross-on-Wye town and the building fits in well with other local housing. The overall impression of the home is pleasant and comfortable and those areas visited were found to be warm, clean and tidy. The property is well maintained and improvements are ongoing. The home now has easier access to a maintenance worker who can carry out minor repairs and decoration. Since the last inspection the main lounge has been refurnished, carpeted and decorated and looks very nice. The new settees, two electric reclining chairs, pictures and flowers all make this large room seem more homely. The new furniture is also easier to get up and down from. Other communal areas have been redecorated and a stair lift has been installed to provide easier access to bedrooms for some older residents. Bedrooms visited are well personalised and some people had recently chosen their new decor and wardrobes. One persons room has a laptop, fish tank, large digital TV and Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: their own hot drink making facilities and they are clearly very proud of it. There are policies and procedures in relation to maintaining good hygiene and infection control in the home. Staff have a daily cleaning checklist to follow. They encourage residents to be involved in household tasks, in particular keeping their own rooms tidy. All staff receive instruction about infection control as part of their induction and some of the team had completed a comprehensive distance learning course. The home provides disposable gloves and aprons and the AQAA confirms that arrangements are made for disposal of soiled waste. Suitable hand washing facilities are provided in communal areas and bathrooms, which also have liquid soap and paper towels. Care Homes for Adults (18-65 years) Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by sufficient and qualified staff on duty at all times. They can be confident in staff because checks are carried out to ensure they are suitable. Residents needs are met because staff receive relevant training and are well supported by their managers. Evidence: Staffing levels normally include five or six care staff on duty throughout the working day. Staff confirm in their surveys, and two said, that there are always enough staff for them to meet the personal and social needs of residents, as well as household tasks and cooking. Extra cover for leave and when needed is always arranged. Residents are positive about staff, as already discussed in this report, and one persons advocate comments I have always found Chepstow House staff to be helpful, friendly and caring and I have a very good relationship with the manager and staff. Most staff have achieved an NVQ (National Vocational Qualification) in social care, which is a positive indicator of their competence. The staff team also receive relevant training in topics such as autism, epilepsy and for managing challenging behaviours. Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: Regarding staff recruitment the AQAA and previous inspection confirmed that thorough procedures are in place and are followed. This is supported by staff surveys, a sample of staff records and two staff interviewed. Two written references and an enhanced criminal records bureau (CRB) check are always taken up before new staff start work at the home. It is good that the home has tried to involve residents in staff selection and are looking at other ways to do this more successfully. New staff have to undertake a satisfactory six month probationary period before their appointment is confirmed. During this time they complete a comprehensive induction programme and staff say in surveys that their induction covered everything they needed to know. They have a mentor from the staff team and firstly work shadow shifts at the home with experienced staff. One staff member comments in their survey that the induction pack is well written, has excellent information regarding different aspects of the job, and you can always refer back to it. Staff receive regular individual supervision that covers relevant areas such as their work performance, role and responsibilities, working with colleagues and training needs. They also have an annual appraisal. The evidence obtained shows that systems are in place to ensure effective communication, including team meetings. Staff report that they feel well supported, that home management are approachable and team motivation is good. Their surveys say that they meet their manager regularly and they are given information they need and kept up to date. In addition they are able to make suggestions and contribute to decisions about the day-to-day running of the home. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can have confidence in the care provided at Chepstow House because it is run and managed well. There are ways of making sure that the service is reviewed, continues to be good and improves. The homes environment is safe for residents and staff because good health and safety practices are carried out. Evidence: The manager (Sally Keene) was registered in respect of Chepstow House in March 2004. Ms Keene is suitably experienced and qualified, having achieved a National Vocational Qualification (NVQ) in care and management. The home also has an assistant and deputy manager who have delegated management responsibilities and can take day-to-day responsibility for the home in the managers absence. The manager feels that the home is well supported by the provider and their representatives provide input and advice to the home. Ms Keene also has training opportunities and receives individual supervision. Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: The evidence obtained in this inspection demonstrates that the manager and staff team appear to understand and follow the key principles of the service. There is a focus on meeting the individual needs and wishes of residents and they are comitted to promoting a good quality of life for them. The ethos and approach of the home is open and staff seem motivated and are well trained. Staff make positive comments in their surveys including the support we get in our role is 100 and I feel that staff are treated very well and we are always being asked for our input in things happening in the home. There are formal processes to monitor, review and assure the quality of the service. This includes the required monthly visits from the provider when relevant aspects are checked and residents, staff and visitors have the opportunity to speak to them and raise issues. Weekly and monthly audits are carried out and the monthly reports made after the visits identify action points to address any shortfalls identified. There is also an annual development plan for the home. The manager is aware that the views of residents, their families and significant other people should be incorporated in these plans and intends to send them regular surveys, as well as use feedback from keyworkers and meetings. Regarding health and safety in the home staff receive training in all the core areas, including fire safety, first aid, food hygiene and moving and handling. The AQAA and previous inspection confirm that relevant, comprehensive policies and procedures are also provided for staff to follow in their working practices, which should help them to maintain and promote the saftey and welfare of people in the home environment. This includes having necessary risk assessments carried out and in place, checks on the fire safety and water systems and equipment and regular servicing of gas and electrical appliances and heating. 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 6 Care plans should be set up in a more person centred and user friendly format. This is so that residents could be more involved in planning and reviewing their own care and understand their plans better. A system should be put in place to ensure that risk assessments relating to individual residents behaviours are reviewed and updated. Staff would then be aware of any current risks and appropriate managment plans they should follow so that residents behaviours are better managed. 2 9 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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