Care Home: Cherriton

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What the care home does well The homes procedures for assessing and admitting people aim to ensure that people choose a home which is right for them . Person centred plans and communication profiles provide staff with up todate information about how best to support people in a way which gives them maximum choice and control over their own lives. Staff make every effort to support residents to take part in activities of their choice so that they don`t become isolated and get bored. Residents Personal and healthcare is well understood monitored and recorded to ensure they stay well and their privacy and dignity is respected by staff. Staff said: "I always make sure rooms are clean and warm and doors are shut when helping a person with personal care". The home has a complaints procedure to ensure that people are protected and their views and concerns are listened to and acted upon. Recruitment and training procedures and practices ensure the protection of residents. Staff are appropriately supervised and provided with ongoing mandatory training to ensure they develop within their role and are up to date with current care practices. The home is well managed to the benefit of the residents. Systems, which are in place, ensure that their health, safety and welfare is protected and promoted at all times. Quality assurance systems, which are in place, ensure the standard of the service is regularly monitored, reviewed and improved. Staff were complimentary of the Registered Manager and confirmed she was approachable and supportive. Staff made the following comments about the manager: "The manager is good " "She is approachable and understanding" What has improved since the last inspection? Residents files have been updated and included information about their assessed and changing needs so that staff know how to support people in the right way. Some indoor activities have been expanded upon so residents are better occupied at home. More pictorial communication aids are being used by staff to help residents make their own every day choices and decisions. Staff have a better understanding of risk assessments and now sign to show that they have read and understood them. A more varied menu is now available and records kept showing that residents have more choice of food. Parts of the home have been redecorated and newly furnished enhancing residents comfort and dignity. Written records showed that the manager is appropriately supporting staff through regular staff meetings and one to one supervisions. There is more staff attendance at staff meetings so that they can share information and experiences. Since the last in inspection more staff have undertaken a formal training qualification in care of adults with a learning disability. The registered manager forwarded onto the Commission a copy of her completed Registered Managers Award. Following the last inspection an up to date gas certificate was forwarded onto the Commission and the service has taken advice with regards to prevention of Legionella. What the care home could do better: There is not always enough staff on duty to support residents to get out and about therefore opportunities for residents are limited. The manager must ensure that there is enough staff on duty to meet the needs of the residents at all times. Staff records, which were looked at, showed that staff have received induction training when they started work at the home, however a survey completed bya member of staff showed that they did not have an induction. The manager must ensure that all staff receive structured induction training within six weeks of their employment including training on the principles of care, safe working practices, the organisation, worker role and the needs of the residents. CARE HOME ADULTS 18-65 Cherriton 1 Bedford Road Rock Ferry Bebington Wirral CH42 6RT Lead Inspector Mrs Janet Marshall Unannounced Inspection 31 October 2007 1:00 th Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cherriton Address 1 Bedford Road Rock Ferry Bebington Wirral CH42 6RT 0151 643 8145 F/P 0151 643 8145 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.macintyrecharity.org MacIntyre Care Tracy Nelson Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Only adults (aged 18-64 years) with a learning disability may be accommodated. 15th June 2006 Date of last inspection Brief Description of the Service: Cherriton is registered to accommodate 6 adults with a learning disability. Cherriton is a two storey, detached property located in a residential area. Service users have single bedrooms. Bedrooms are located on the ground and first floor. On the ground floor there is a lounge, dining room, kitchen, bathroom and a separate toilet. On the first floor there is a shower room and a bathroom. Bathing aids are provided in both bathrooms. The home has a large garden, which has seating areas. There is wheelchair access via a ramp from the lounge. Parking is available on the main road. There is access for the homes vehicle on the driveway. Cherriton is located in a central position close to Birkenhead and Prenton. There are local shops within walking distance and there is access to public transport. The fees charged are agreed with the placing authority and are dependant upon the assessed needs of service user to be placed. Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection. The Commission considers 22 standards for Care Homes for Adults as Key Standards, which have to be inspected during a Key Inspection. The report has been put together using information gathered from a number of sources including information that the commission have received about the service since the last inspection and details provided in the Annual Quality Assurance Assessment (AQAA). The AQAA, which is in two parts, a selfassessment and dataset, has replaced the pre-inspection questionnaire. The document, which was sent out to, the service was completed and returned to the commission before the site visit took place. A number of surveys were sent out to people as part of the inspection a number of staff surveys were returned and. The inspection also involved an unannounced visit to the home (site visit). This was carried out with the Registered manager Tracey Nelson who was on duty at the time. Records that were examined, staff comments and observations made during the visit have also been used as evidence for the report. All the residents that live at the home have limited verbal communication skills so were unable to express their views and opinions about the service. However, a number of residents were case tracked. This process involved talking to staff, looking at the environment and a selection of residents records such as assessments, care plans and daily notes to get an idea about peoples experiences and to find out if they are receiving the care and support that they need and which have been agreed by their representatives. What the service does well: The homes procedures for assessing and admitting people aim to ensure that people choose a home which is right for them . Person centred plans and communication profiles provide staff with up todate information about how best to support people in a way which gives them maximum choice and control over their own lives. Staff make every effort to support residents to take part in activities of their choice so that they don’t become isolated and get bored. Residents Personal and healthcare is well understood monitored and recorded to ensure they stay well and their privacy and dignity is respected by staff. Staff said: “I always make sure rooms are clean and warm and doors are shut when helping a person with personal care”. The home has a complaints procedure to ensure that people are protected and their views and concerns are listened to and acted upon. Recruitment and training procedures and practices ensure the protection of residents. Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 6 Staff are appropriately supervised and provided with ongoing mandatory training to ensure they develop within their role and are up to date with current care practices. The home is well managed to the benefit of the residents. Systems, which are in place, ensure that their health, safety and welfare is protected and promoted at all times. Quality assurance systems, which are in place, ensure the standard of the service is regularly monitored, reviewed and improved. Staff were complimentary of the Registered Manager and confirmed she was approachable and supportive. Staff made the following comments about the manager: “The manager is good ” “She is approachable and understanding” What has improved since the last inspection? What they could do better: There is not always enough staff on duty to support residents to get out and about therefore opportunities for residents are limited. The manager must ensure that there is enough staff on duty to meet the needs of the residents at all times. Staff records, which were looked at, showed that staff have received induction training when they started work at the home, however a survey completed by Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 7 a member of staff showed that they did not have an induction. The manager must ensure that all staff receive structured induction training within six weeks of their employment including training on the principles of care, safe working practices, the organisation, worker role and the needs of the residents. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes assessment and admission procedures ensure that people choose a home that will meet his/her needs. EVIDENCE: The AQAA and discussion with the manager showed that there have been no new residents admitted to the home since the last inspection. The manager clearly described the process that she would follow for assessing and admitting a new resident to the home. This included giving people information about the home such as the Statement of Purpose and a Service user Guide. Both documents, which were looked at, included all the information that people need to know about the services and facilities, which the home has available. They also provided other information such as details of the staff team, emergency procedures and the arrangements made for dealing with complaints. The AQAA showed in the next year the service intend to improve the format of the Statement Of Purpose and Service User Guide using a communication format which is more accessible for people that have difficulties reading. The next stage explained by the manager would be for her to carry out a ‘Getting To Know You’ needs assessment with the involvement of the prospective resident their families and other professionals. The assessment Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 10 covers things such as method of communication, family/social contact, physical and mental health care and risk management. Once completed the assessment gives people a good idea as to whether the home would be a suitable place for them to live. If they decide it is then the person would be offered a planned and staged move to the home including visits and overnight stays to meet with other residents and staff. Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents assessed needs are clearly set out in individual person centred plans so that staff have all the information that they need to enable people to live independent and safe lives. EVIDENCE: Residents had an individual plan of care, which was kept, securely in the home to ensure their confidentiality. Following a recommendation given as part of the last inspection report the plans have been reviewed and updated. This is because there was evidence at the last inspection to show that care plans and other care records had not been updated for sometime so there was a risk that peoples assessed and changing needs would not be met. Care plans were person centred. The person centred care planning approach enables people to have more choice and control over their own lives. The manager said all staff have completed training in person centred planning. Two plans were looked at in detail as part of the case tracking process. They covered all aspects of each person’s personal and social support such personal Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 12 and health care, independent living skills, accessing the community, relationships and financial needs. The plans also covered in detail things such as what is important to the person, what they are good at doing, what they like and dislike, what they need help with and what they want to happen with their lives. Care plans seen showed that they have been reviewed and updated involving residents and important people in their lives such as their family/representative and key worker. Staff surveys showed that staff are given up to date information about the needs of the people they support or care for, for example, in the care plan. A recommendation was given as part of the last inspection for pictorial communication to be expanded upon and the use of this encouraged to aid effective communication with residents. There was evidence at this inspection that a lot of work has gone into achieving this. Care records and discussion with the manager showed that since the last inspection communication profiles and diaries which are part of each persons plan have been developed and are used to support them to make every day decisions and life choices such as what to eat and were to go. During the inspection visit staff were seen communicating effectively with residents using communication aids such as picture books. Comments in staff surveys included: “The residents always come first and are given as much choice as possible” “Our service gives chances for our residents to be treated as individuals and to be able to do as much as they can for themselves”. Staff demonstrated an understanding of how to ensure service users rights are promoted and how limitations are only put in place for their safety and welfare. Residents’ personal files and discussion with staff showed that independent advocates are consulted when necessary. Some residents present with challenging behaviour. Staff are trained on how to support and manage certain behaviour in a positive way Residents are encouraged to take responsible risks, a range of risk assessments, which have been carried out, ensure their independence is promoted and they are protected from the risk of harm. The assessments clearly described the action that staff must take to minimise risks. A selection of risk assessments were viewed and showed that they are reviewed and updated at regular intervals. As part of the last inspection report a recommendation was given for staff to familiarise themselves with recent risk assessments and it was further recommended that staff members sign to say that they have read and understood these. Staff spoken with showed that have read and understand risk assessments and they sign records to show this. Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff try hard to ensure that residents get to do the things that they enjoy however opportunities for residents to get out and about are limited which increases the risk of isolation. EVIDENCE: The AQAA showed residents social care needs have been assessed and there is a range of activities available inside and outside the home to meet peoples needs and promote their personal development. None of the residents are currently involved in any employment, training or educational programmes, however some residents attend sessions at various day centres within the community. Activity programmes were in place for each person, daily records showed that activities at home are generally well supported and followed. One residents activity programme included aromatherapy and music sessions. Staff help Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 14 residents make choices about an activity or places to go using pictures, photographs and symbols. Available at the home for each resident was an activity book, which displayed photographs of places they have visited and events they have taken part in the last year. There were photographs of residents enjoying themselves at music concerts, the Blue Planet Aquarium, parties and on Christmas day last year. A requirement was given as part of the last inspection report to ensure that activities are expanded upon to fully stimulate residents this was because there was evidence to show that activities on the day were not being appropriately supported for some residents, and a residents relative spoken with at that time reported that they felt activities needed to be expanded upon. Information provided in the AQAA and discussion with the manager showed that every effort is made to occupy residents to prevent them from becoming bored and isolated however recent staff shortages has restricted some opportunities for one to one activities out in the community. The following comments made during discussion with staff and in staff surveys also showed this: “We have residents who are in need of 2-1 support out in the community but we don’t always have the right amount of staff to support this”. “There is not always enough staff to take residents out”. “Residents do not get out as much as they should do because there isn’t always enough staff on duty”. The evidence gathered during this inspection showed that there is not always enough staff on duty to support residents to get out and about in the community mainly in the evenings and at the weekends, this has the potential to cause isolation. It is therefore a requirement of this report that the manager makes the necessary arrangements to ensure there are always the right amount of staff on duty to meet all the needs of the residents. The AQAA showed that arrangements are made for residents to go on holiday at least once a year. As well as recreational and leisure activities resident are also encouraged and supported to help with small tasks around the house such as cleaning their bedrooms, laundering their clothes polishing and shopping for personal items and food. On the day of the visit staff were seen encouraging and appropriately supporting residents with some of these tasks. Residents have keys to the their own bedrooms although they don’t have a key to the front door. This is because assessments showed that it is not safe for them. This information and the reasons why was recorded in their plans of care. Daily records showed that residents are encouraged to maintain contact with family and friends and personal relationships are respected and appropriately supported by staff at the home. On the afternoon of the inspection visit Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 15 residents and staff were preparing for an arranged Halloween party, which was later attended by many of the residents friends. A recommendation was given as part of the last inspection report to ensure that the different meals are served according to residents preferences and they are recorded to show the choices available. Records looked at during this inspection show that this is now being done. Menus which where viewed at the home showed a variety of healthy meals. The manager said that menus are often changed at a residents request. A member of staff showed a good awareness of the importance of nutritious and balanced diets. Records showed that staff have undertaken training in food hygiene. Residents have the use of two dining tables a small one, which is situated in the kitchen, and a larger one, which is in the main dining room. Staff were observed offering residents drinks and snacks. Care plans included information about resident’s likes and dislikes with regard to food. A good stock of fresh, frozen and tinned food was seen at the home. There were also sufficient crockery, cutlery pots and pans, which were of good quality. There was a fridge, freezer and microwave which were all of a domestic style and in good condition. A member of staff confirmed that residents are always involved in the main weekly shop for food as well as shopping daily for essentials such as fresh bread and milk. Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents personal and healthcare needs are understood, well recorded and monitored ensuring that they stay well. EVIDENCE: Following a requirement given as part of the last inspection personal and healthcare documentation has been updated. Person centred plans, which were viewed included detailed information about the type and level of support that each person requires with personal care as well as their preferred routines. Health action plans, which were part of each persons plan of care, covered in detail their healthcare, needs and the support that they need to stay well. Records within this section showed that they are offered minimum annual health checks. As well as visits to primary healthcare services such as dentist, opticians and doctors residents are also supported to attend specialist services. Records detailing the visits were available in good detail as was information about specialist health care appointments. Where appropriate visits to the home by healthcare professionals are arranged. Communication profiles show how a person communicates if they are in pain or unwell and the action staff should take in response. Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 17 The service operates a key worker system to enable residents to develop a closer relationship with a specific staff member particularly in the areas of health and personal care. The key worker is responsible for reviewing the resident’s monthly plan and to arrange healthcare appointments etc. for residents. During discussion a member of staff described clearly their role and responsibilities as a key worker. During the inspection visit staff were observed assisting residents in a gentle and polite way. Through discussion staff showed that they understood the importance of ensuring residents privacy and dignity one staff member said, “I always make sure rooms are clean and warm and doors are shut when helping a person with personal care”. During this inspection visit all medication and medication administration records were examined. Medication and records were stored in a locked cabinet in the office. Staff were observed administering medication in the correct way. Discussion with staff and examination of records showed that staff have completed medication awareness training. A policy for the safe handling and administration of medication was availble at the home. A member of staff showed a good awareness of the homes medication polices and procedures. Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives have the information that they need to make a complaint and practices carried out at the home ensure that they are protected from abuse. EVIDENCE: The AQAA showed that there have been no complaints made at the home in the last year. The Commission for Social Care and Inspection has received no complaints regarding the service since the last inspection. There was a complaints procedure on display at the home. There was also a complaints book and a ‘Say Something’ book this is for people to make comments about the service if they wish to. The Service User Guide and the homes Statement of Purpose also included a summary of the homes complaints procedure. The information was available in large clear print supported by pictures and photographs. It was not possible to assess residents understanding of the complaints procedure due to their limited understanding. The manager did however state that resident’s advocates and representatives have received a copy of the procedure. Staff interviewed said that they knew about the complaints procedure and would be confident about raising any concerns or complaints if they needed to. Staff surveys showed that they know what to do if a resident / relative /advocate or friend has concerns about the home. During discussion staff showed a good awareness of what to do if they suspected or witnessed abuse. Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 19 A Protection of Vulnerable Adults procedure was available at the home. The AQAA showed that staff have received Protection of vulnerable adults training. None of the residents manage their own finances. The director of MacIntyre Care is the appointee for the residents living at the home. The records in relation to this are held at the MacIntyre Care head office. The manager manages the personal allowances for all service users. Residents money and records, which were examined, were in good order. There were stick rules in place at the home for managing residents money and financial affairs, which ensure that they are safeguarded from financial abuse. An independent advocate has been introduced from Mind, the National Association for Mental Health. This offers an independent person for service users to share or voice concerns with and is an additional source of helping safeguard vulnerable adults. Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable and pleasant environment, which was free from hazards. EVIDENCE: The home is a large detached house located in a popular residential area of Rock Ferry, Wirral, Merseyside. It is in keeping with the local community and provides a comfortable and homely environment. There are gardens at the front of the house and a large enclosed back garden. The back garden, which was well kept, has a large lawn and patio areas with attractive wooden garden furniture. Parts of the garden was planted out with mature bushes, shrubs and fruit trees, a member of staff said that residents enjoy the fruit from the trees which is also used to make various jams and pies. A driveway to the side of the house provides off road parking for several cars. A number of requirements were given as part of the last inspection report. This was because resident’s comfort and dignity was undermined by parts of Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 21 the home, which were in poor condition. The AQAA showed the following improvements to the environment since the last inspection. • Redecoration of residents bedrooms • New furniture • New floor coverings • Redevelopment of the garden area including new furniture A tour of the home showed that the improvements have been carried out to a high standard. On the day of the inspection visit residents were seen moving freely around the home. Wheel chair ramps were fitted to all outside doorways and special equipment such as handrails, bath chairs and walk in showers were in place to enable residents to access all parts of the home. Each resident’s bedrooms was attractively decorated and furnished to a high standard. They were warm, bright and well ventilated. All bedrooms were personalised to suit each persons own tastes. Discussion with the manager and information provided in the AQAA showed that there are plans to carry out further improvements including: • The refurbishment and redecoration of bathrooms • Redecoration of the hall stairs and landing areas • Installation of a conservatory to provide an additional quiet area for residents. On the day of the inspection visit the home was very clean and tidy and there were no hazards identified. A cleaner is employed to work at the home Monday to Friday and is responsible for most day to day general cleaning duties as well as larger cleaning tasks such as cleaning windows and interior woodwork. The cleaner said she is provided with sufficient equipment and materials, which she keeps in a locked cupboard. During discussion the cleaner demonstrated high standards of cleanliness and hygiene and confirmed that she has attended training specific to her role including infection control, first aid and health and safety. None of the residents smoke, however there are a number of staff that do. The none smoking policy at the home restricts staff and visitors from smoking inside the home, however there is a discreet designated smoking area outside at the back of the house with facilities for disposing cigarette stumps. Laundry facilities are sited in a utility room separate to the kitchen. The room, which was looked at, was clean, well organised and equipped with sufficient washing, drying and ironing machines and equipment. The AQAA showed that the required policies and procedures for control of infection and cleaning routines are in place at the home. It also showed that soiled laundry is washed appropriately and clinical waste is disposed of in the correct way. The AQAA, discussion with staff and examination of records showed that staff have completed training in relation to infection control. Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment and training procedures ensure the protection of residents however there is not always enough staff on duty to fully meet the needs of the residents. EVIDENCE: The AQAA showed that strict staff recruitment procedures are in place and McIntyre is an equal opportunities employer that ensures issues of equality and diversity are thoroughly addressed during the interview process. Staff records which were looked at during the visit and details provided in the AQAA showed that satisfactory recruitment checks have been carried out for all staff that work at the home. Staff spoken to during the visit confirmed they have completed a Criminal Records Bureau check to ensure they are fit to work with vulnerable adults. Examination of the staffing rota and details provided in the AQAA showed that there are fifteen full time staff and nine part time staff that work at the home and the team is made up of people of various age, gender and ethnicity. The manager said that there is one waking member of staff on duty each night and generally three staff on duty throughout the day and evening. However, Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 23 discussion with her, examination of the staffing rota and comments made by staff showed that there is often only two staff on duty during these hours and every weekend. This means opportunities for residents are limited as described in the Lifestyle section of this report. The manager must ensure that there is enough staff on duty to meet the needs of the residents at all times. Discussion with staff and information provided in the AQAA and records seen at the home showed that staff have completed a range of appropriate training and a training programme for future training is in place. This training covered a range of courses relating to the care and support of the residents and the efficient running of the home. For example first aid, health and safety, protection of vulnerable adults and fire awareness. The AQAA showed five staff have an NVQ Level 2 or above in care and five staff are working towards it. The staff spoken to during the visit confirmed the organisation provide a lot of training, which they are always encouraged to attend. Staff records which were looked at during the inspection visit showed that staff have received induction training when they started work at the home, however a survey completed by a member of staff showed that they did not have an induction. The manager must ensure that all staff receive structured induction training within six weeks of their employment including training on the principles of care, safe working practices, the organisation, worker role and the needs of the residents. The staff spoken to during the visit confirmed MacIntyre Care is a good organisation to work for and they felt well supported in their role. Staff surveys showed that staff usually have the right support, experience and knowledge to meet the different needs of the residents. Staff surveys included the following comments: “Everybody treats the residents very well, they are well cared for by all the staff”. “I believe that the staff team create a friendly and warm atmosphere”. Records showed that since the last inspection staff are benefiting from more regular support and supervisions through regular meetings and one to one support sessions with the manager. Staff surveys showed that the manager regularly meets with staff to give them support and discuss how they are working. Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed to the benefit of the residents. EVIDENCE: Tracey Nelson has been the registered manager of the home for nearly two years. She is qualified and experienced to manage the service, she has a National Vocational Qualification level 4, and the Registered Managers Award, both recognised qualifications for a manager of a residential care service. The AQAA showed that the Registered Manager has also undertaken periodic training to update her knowledge and skills whilst managing the home. Staff spoken to during the inspection were complimentary of the manager, comments they made included: “The manager is very good ” “She is approachable and understanding” Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 25 Systems are in place to ensure the ongoing monitoring and improvement of the service. This includes supervising staff, reviewing administrative procedures and reviewing residents care plans to ensure their care need requirements are being met at the home. A manager within the company carries out regular audits of the homes systems and procedures. MacIntyre Care is an equal opportunities employer, discussion with staff and information provided in the AQAA showed this. The AQAA also showed that all other policies, procedures and codes of good practice which are required for this type of service are available at the home. There was evidence to show that all of the documents have been reviewed and updated in the last three years so that residents and their representatives have accurate and up to date information about their health safety and welfare. The AQAA also showed that equipment used at the home has been serviced or tested as recommended by the manufacturer or other regulatory body. The AQAA also showed that all the required checks have been regularly carried out on equipment used at the home. They include electrical circuits, portable electrical equipment, heating system and gas appliances. A selection of certificates and records, which were seen, supported this information. Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 27 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA13 Regulation 18(1) Requirement The manager must ensure that there is enough staff on duty to meet the needs of the residents at all times. The manager must ensure that all staff receive structured induction training within six weeks of their employment so that they have the necessary skills for the job. Timescale for action 31/12/07 2. YA33 18 (1)(i) 14/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cherriton DS0000018874.V339904.R01.S.doc Version 5.2 Page 29 - 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. 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