Care Home: Church Road (41)

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What the care home does well The service continues to employ longstanding members of staff who offer great stability to Laurel cottage. The personal support plans gave enough information to show how each persons personal care, social support and likes and dislikes would be met. They showed how each person would be supported with a range of diverse needs including their medical needs and support with communication. As we did not meet anyone at the service due to them being out, we looked in detail at these records to evidence how they are being supported on a daily basis. The staff have developed records called, "communication passports." These records are developed over time by staff who get to know each persons needs, choices and behaviours. The passports are a good example of the time taken by staff to produce records that help everyone to be kept updated in each persons likes, dislikes and choices, helping people be supported in all aspects of every day life. This is an example of how much input and development the organisation go to, to continually improve the support and care provided at Laurel cottage. Regular checks are made on the safety of the building and equipment to make sure the service is a safe place to live. What has improved since the last inspection? The service is meeting the vast majority of the national minimum standards and has met all of those assessed on this occasion. In a number of respects these standards are being exceeded. The manager continues to look at ways in which the service can be exceeded. The service has produced good information and brochures about the home which uses some pictures. They give these documents to people who are thinking about moving there. They have procedures in place for assessing peoples needs including trial visits and overnight visits to help people make a choice about the service. Alot of consideration is being made by staff before anyone moves into the vacant room. The society`s aims and plans for the future are published in a document called, " Our future strategy for 08/09-2012/13". This has helped to keep everyone involved and updated with the aims of the organisation especially in their plans to extend their services. The service had procedures for responding to concerns and complaints and for making sure that people have a pictorial complaints procedure which is clear to read and understand. The commission have not received any complaint about the service following the last inspection. There have been no additional visits to the service since our last visit to Laurel cottage. The company and staff have managed to deal sensitively with one subject that is often difficult to discuss. They have produced a sensitive document requesting information regarding bereavement and support offered. The questionnaire helps identify personal wishes such as, "are there any instructions or personal requests ."Each persons file showed that staff do try to plan social events and activities and also carry out risk assessments to help make activities as safe as possible. Plans showed important information to help support people with a varied amount of activities eg, diet, alcohol, health and self care and communication. Each person is provided with a range of opportunities to help their personal development and they have a time table of activities that they would do during the week.eg such as, domestic skills, horticulture, swimming, technology, art therapy and woodwork. We have received 2 surveys back from people living at the service. Just one has been completed in parts indicating they are happy living at Laurel cottage. Staff had developed a clear visual menu plan were everyone has the opportunity to pick a picture of what food they would like for their meals. This helps staff to support people with their choices in meals. The manager had developed training action plans, so each time a person attends training they complete a training action plan which is similar to an evaluation form. This asks them what they had learned and how they would bring the knowledge and skills back to the workplace. This is an example of good practice in developing staffs skills and knowledge after receiving various training. The manager now has 100 per cent of staff with an nvq ( care )qualification. This is an example of how they have exceeded the basic guidance which suggests that at least 50 per cent of staff should have a care qualification. This is a good percentage of staff with a care qualification offering a team of people who are skilled in being able to provide the right type of support for people living at Laurel cottage. A staff satisfaction survey dated Oct 08 was overall very positive with 3/4 of the staff team, "...feeling the society is a good place to work..." We received one survey from a medical professional who was overall very positive in their comments about the service, stating, eg, "individualised care appropriate for persons disabilities." "Continue to develop as they have always done." We have received 3 staff surveys and some comments were very positive including, eg, "....it has respect and consideration for residents." "provides high standards of care for clients, good support to staff, good training." Staff are regularly supported by the manager with regular appraisals and supervision. This is a good example of how the staff are supported and helped to develop while working at the service. The manager carry`s out detailed monthly audit reports to help make sure that the service is being managed appropriately and providing the right support at all times. The audit was a good example where the manager had been able to show what quality assurance checks she had put in place to show that the standards are always maintained within the service to always benefit the people living there. What the care home could do better: Full feed back was given to the manager both during and on conclusion of our visit. The manager should have clear procedures and records to show how each persons finances are managed. This will help to provide clear and transparent financial procedures accessible to everyone. People should be included in the management procedures offered in managing their finances. Capacity assessments will help show they are managed in each persons best interest. To have updated individual training and development plans for each member of staff so they can be supported with necessary updated training to help them with their job roles. A company training development plan will help people be aware of what training they will be provided with by the company and should give them details as to what they can expect with eg timescales for refresher courses including specific timescales for, medication, health and safety and safeguarding. To provide evidence of at least 5 days paid training per person each year. To carry out monthly visits to Laurel cottage and to include the opinions of people living and working at Laurel cottage while carrying out these checks, so that their views can be considered regarding the service. To provide information for everyone at Laurel cottage as to when they can purchase a new settee, so they can be kept informed and included in the developments of their home. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Church Road (41) 41 Church Road Bebington Wirral CH63 3DY     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Diane Sharrock     Date: 0 5 0 2 2 0 0 9 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 32 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 32 Information about the care home Name of care home: Address: Church Road (41) 41 Church Road Bebington Wirral CH63 3DY 01516449493 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Wirral Autistic Society Name of registered manager (if applicable) Jane Anne Roberts Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 3 Date of last inspection Brief description of the care home 41 Church Road is registered to provide personal care for three adults with autism. The home is a two storey terraced property located in a residential area. On the ground floor there are 2 lounges, a kitchen with a dining area and a toilet/cloakroom. On the first floor there are three single bedrooms, an office/staff sleep in room, a bathroom and a separate toilet. There is a patio and a garden to the rear of the home. Parking is available on the main road. 41 Church Road is close to local shops and to public transport services. The home is run by Wirral Autistic Society who have several care homes for adults with a learning disability in the area. Wirral Autistic Society provides a range of services and facilities, which are fully utilised by the service users, accommodated at 41 Church Road. At the time of the inspection, the weekly cost for Care Homes for Adults (18-65 years) Page 4 of 32 3 Over 65 0 care home 3 Brief description of the care home the service ranged from 887.00 pounds to 1130.00. pounds. A copy of the statement of purpose, which describes the services offered at 41 Church Road, is made available to relatives and social workers. The service users guide to the home is made available before a person comes to live at the home and the content is discussed with them to ensure their understanding. The manager will make available to everyone a copy of the latest inspection report. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The overall quality rating for this service is 3 star. This means that people who use the service experience excellent quality outcomes. This unannounced visit took place on the 5th February 2009 over a period of 4 hours. This was carried out with the help of the registered manager. Every body was at day service during our visit so on this occasion we were unable to meet people that lived at Laurel cottage and staff were also out except for the manager. We refer to Church Road as Laurel Cottage throughout this report as the manager explained this is the name given to the house. We gathered information for this visit in a number of ways. We sent surveys to 4 staff, Care Homes for Adults (18-65 years) Page 6 of 32 and to 2 people who live there and to a health professional. We (the commission) looked at records and included comments made in comment cards returned to us and surveys carried out by Wirral Autistic Society. Case tracking was used as part of the visit to the service. This involves looking at the support and care a person gets from the staff as recorded in their support plans, including information on medication, money, daily life and their living conditions. The manager completed a questionnaire we sent before our visit. The information from this was used by us to plan this visit and in writing this report. The document was completed and was returned to the commission before this visit took place. It gave alot of information to show how the service was managed. It gave various details of how the manager is continuing to develop the service for the benefits of people living there. What the care home does well: What has improved since the last inspection? The service is meeting the vast majority of the national minimum standards and has met all of those assessed on this occasion. In a number of respects these standards are being exceeded. The manager continues to look at ways in which the service can be exceeded. The service has produced good information and brochures about the home which uses some pictures. They give these documents to people who are thinking about moving there. They have procedures in place for assessing peoples needs including trial visits and overnight visits to help people make a choice about the service. Alot of consideration is being made by staff before anyone moves into the vacant room. The societys aims and plans for the future are published in a document called, Our future strategy for 08/09-2012/13. This has helped to keep everyone involved and updated with the aims of the organisation especially in their plans to extend their services. The service had procedures for responding to concerns and complaints and for making sure that people have a pictorial complaints procedure which is clear to read and understand. The commission have not received any complaint about the service following the last inspection. There have been no additional visits to the service since our last visit to Laurel cottage. The company and staff have managed to deal sensitively with one subject that is often difficult to discuss. They have produced a sensitive document requesting information regarding bereavement and support offered. The questionnaire helps identify personal wishes such as, are there any instructions or personal requests . Care Homes for Adults (18-65 years) Page 8 of 32 Each persons file showed that staff do try to plan social events and activities and also carry out risk assessments to help make activities as safe as possible. Plans showed important information to help support people with a varied amount of activities eg, diet, alcohol, health and self care and communication. Each person is provided with a range of opportunities to help their personal development and they have a time table of activities that they would do during the week.eg such as, domestic skills, horticulture, swimming, technology, art therapy and woodwork. We have received 2 surveys back from people living at the service. Just one has been completed in parts indicating they are happy living at Laurel cottage. Staff had developed a clear visual menu plan were everyone has the opportunity to pick a picture of what food they would like for their meals. This helps staff to support people with their choices in meals. The manager had developed training action plans, so each time a person attends training they complete a training action plan which is similar to an evaluation form. This asks them what they had learned and how they would bring the knowledge and skills back to the workplace. This is an example of good practice in developing staffs skills and knowledge after receiving various training. The manager now has 100 per cent of staff with an nvq ( care )qualification. This is an example of how they have exceeded the basic guidance which suggests that at least 50 per cent of staff should have a care qualification. This is a good percentage of staff with a care qualification offering a team of people who are skilled in being able to provide the right type of support for people living at Laurel cottage. A staff satisfaction survey dated Oct 08 was overall very positive with 3/4 of the staff team, ...feeling the society is a good place to work... We received one survey from a medical professional who was overall very positive in their comments about the service, stating, eg, individualised care appropriate for persons disabilities. Continue to develop as they have always done. We have received 3 staff surveys and some comments were very positive including, eg, ....it has respect and consideration for residents. provides high standards of care for clients, good support to staff, good training. Staff are regularly supported by the manager with regular appraisals and supervision. This is a good example of how the staff are supported and helped to develop while working at the service. The manager carrys out detailed monthly audit reports to help make sure that the service is being managed appropriately and providing the right support at all times. The audit was a good example where the manager had been able to show what quality assurance checks she had put in place to show that the standards are always maintained within the service to always benefit the people living there. Care Homes for Adults (18-65 years) Page 9 of 32 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 10 of 32 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 11 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information is given to anyone thinking about moving into Laurel cottage. This makes sure that the home is the right place for a person to live in and that their needs and be met. Evidence: There has been no one new move into the home since our last visit however the manager discussed plans to help someone new move into the home. Great consideration is taken in someone new moving in so that everyone is in agreement to who moves there and is able to get to know the new person. The manager explained that the bedroom would be decorated for anybody new coming into Laurel cottage so they can choose their own colour scheme. Good information is given to any prospective person including the option of having a trial visit to the home.This makes sure the home is the right place for the person to live in and and that their needs can be met. The manager has developed a residents guide and a statement of purpose which are available to anyone including any prospective resident. The guides include good Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: levels of information on the purpose of the home and the facilities on offer and includes some visual pictures which may help some people understand the information given. The guides also contain pictures of people based at head office with a brief description of their role and what they do within the organisation. The manager advised in the pre inspection questionnaire that she plans to develop these documents further by putting more pictures in to describe the service . Care Homes for Adults (18-65 years) Page 13 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The individual needs and choices of the people living at Laurel cottage are identified so that staff can support them to meet those needs, choices and all aspects of daily living. Evidence: Detailed individual support plans were available for each person. we looked at one of them. The plans were detailed and regularly reviewed and gave enough information to show how their personal and social needs would be met and covered a diverse range of needs, eg what they want to do in the day, night times and weekends. These plans provided staff with clear guidance and were appropriate instructions as to the support each person required in a range of environments and situations to enhance their life. They were also regularly reveiwed and monitored by the manager to make sure they were accurate and met each persons changing needs. Staff had developed a clear visual menu plans were everyone had the opportunity to Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: pick a picture of what food they would like for their meals.We saw the plan displayed in the kitchen and looked at the records of meals chosen each day. People were supported every day with this menu plan and staff supported people in making their own choices. The staff have developed records called, communication passports. These records are developed over time by staff who get to know each persons needs, choices and non verbals ways of communicating. These documents are vital for people who are non verbal and rely on staff to interpret their behaviours regading what they are saying. The passports are a good example of the time taken by staff to produce records that help everyone to be kept updated in each persons likes, dislikes and choices, eg what time they want to get up and what they want to eat. Some of the services policies and procedures have been developed to make them more user friendly for some people who may like the use of pictures to describe a policy. eg the complaints procedure has been developed to include pictures to describe its procedures, there is also a group of pictures of the fire appliances including the fire extinguisher. We looked at a sample of financial records kept at the service of personal allowances which were well kept and accurate and in good order. One support plan had a section called, my personal allowance guideline. This gave details how staff support the person with their personal allowance. However the manager explained that various monies were stored and managed at head office. There was no evidence of whether capacity assessments had taken place. It wasnt clear as to whether peoples mobility benefits were used for the use of the communal vehicle or whether permission or assessment had been sought regarding the use and management of it. The manager arranges meetings for everyone at the service to discuss the running of the service. We looked at these records which showed good discussions on alot of things, keeping everyone informed and included in the developments of their home. Following our visit we have received 2 surveys from people at the service. One person said they liked living at Laurel cottage. The second survey could not be completed. Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people staying at Laurel cottage are always supported so they can live a lifestyle of their choice. Evidence: In discussions with the manager and in looking at records, it showed that the people living at Laurel cottage always receive the support they need to get out and about regularly in their local community. Most people are out at work each day or at the day centre in accordance with their wishes and abilities. During our visit they were both at day services following their weekly activity plan. Each person is provided with a range of opportunities to help their personal development and they have a time table of activities that they would do during the week.eg such as, domestic skills, horticulture, swimming, technology, art Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: therapy and woodwork. The records showed a variety of activties that each person is involved in to enhance their enjoyment and quality of life. Each persons file showed that staff do try to plan social events and activities and also carry out risk assessments to help make activities as safe as possible. Some of the plans showed important information to help safely support people with eg, diet, alcohol, health and self care, shaving and communication. One support plan had details in various sections called,How I express myself. and Helping me to develop my communication skills. These records gave individualized information helping everyone to communicate with each person. They also have a list called, personal objects which are special to me. This information was built up and developed by staff who had taken the time to get to know people regarding whats important to them. The service shares a communal vehicle with another local house. The records around the management and funding of the communal vehicle wasnt clear. This needs to be reviewed to show that everyone is included and in agreement to the current arrangements regarding who manages, maintains and funds this service. Records of meals served in the home showed that a variety of meals are served in order to offer people as much choice as possible. The dining room was well maintained offering a homely environment to enjoy meals in. The manager organises regular house meetings to discuss the running of the home. We looked at recent minutes and they showed good discussions on alot of things at the home keeping everyone informed and included in developments of their home. The house has two lounges in which people can relax. The manager explained that they are hoping to have some redecoration and a new settee but they are not sure when this will be done.The settee is old and out of date and the manager is hoping they will be able to purchase a more modern settee in plain colours which will be more suitable to people living there. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People coming to live at Laurel cottage are well supported with their health care. Evidence: Detailed support plans were available for each person we looked at one of them. The plans had been recently updated and revised and gave enough information to show how their personal care and support would be met. The plans provided staff with guidance and were appropriate instructions as to the support each person needed. They showed that they are supported in accessing health care services if it was needed, especially the doctor, optician, podiatrist and care managers. The system for recording health checks also makes sure that each person is offered regular health examinations. These sections were called, My personal health profile. They were all regularly updated and gave details of any health concerns or conditions the doctor or hospital were treating. The company and staff have also managed to deal sensitively with one subject that is often difficult to discuss. They have produced a sensitive document requesting information regarding bereavement. The questionnaire helps identify personal wishes Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: such as, are there any instructions or requests that effect how the individual should be treated after death. We received one survey from a medical professional who was overall very positive in their comments about the service, stating, eg, individualized care appropriate for persons disabilities. Continue to develop as they have always done. We looked at the storage and procedures of managing medications at the service and they were found to be well maintained and safely managed. The medications records were very detailed and everyone had worked hard to offer accurate and up to date medication records, providing a safe system of supporting people with the administration and storage of their medications. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the homes procedure for responding to concerns and complaints. Evidence: Information about how to raise a concern or complaint is made available to the people living at Laurel cottage in a pictorial format. This is good practice as it helps to increase the opportunities for people using the service to have a better understanding of the ways in which they can raise concerns. They had detailed records showing they were listening to peoples concerns and taking some actions in helping people feel better about their concerns. We looked at a sample of staff training records which described various training that they had attended including, safeguarding and abuse awareness. However in looking at training records it was noted that some staff had not received this training or update to some subjects for quite a few years. The manager explained that they are usually provided with just one training session on safeguarding. There was no other evidence of how staff are updated in this area during their employment or how they keep up to date with this topic. The service helps to manage small amounts of money for each person who comes to live at Laurel cottage. These records were detailed and accurately maintained. We Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: discussed how the financial procedures were carried out and how they were maintained to help safe guard the financial affairs of each persons. However each person had other money stored at head office and this information was not in a persons support plan regarding how and were each persons money was stored. Care Homes for Adults (18-65 years) Page 21 of 32 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 at Laurel cottage live in a homely, comfortable and safe environment. Evidence: We were shown around the home and looked at a sample of areas. Each person has their own bedroom were they are encouraged to have personal belongings and to individualise the room the way they want. There are two lounges and the manager explained that they are hoping to get permission to buy a new settee as the present one is old and outdated. The kitchen and dining room offer a domestic style facility accessible to everyone. The home was decorated to a good standard offering a homely environment to live in. The manager explained that every new person is provided with a newly decorated bedroom when they first move in and they are encouraged to pick their own colour scheme for the redecoration of their bedroom. We looked at a sample of maintenance certificates which showed up to date checks as listed in the homes pre inspection questionnaire. This helped show what actions were taken to keep the home safe and well maintained. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: Care Homes for Adults (18-65 years) Page 23 of 32 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. People are supported and protected by the services recruitment and selection procedures. Evidence: Records showed that before anyone is appointed to work at Laurel cottage they have a series of checks that are carried out. These include obtaining written references and checking with the criminal records bureau (CRB). These checks help to make sure the people living there are safe and that staff are suitable to support them. The manager explained that they mainly have long standing members of staff and rarely have new staff which showed the stability of the current staff team. They have all had updated police checks as a matter of good practice. Staff personnel records are stored and managed at head office but the manager accessed the staff files for us to look at during our visit. We looked at staff training records which showed what training had been provided. Staff had received various training while employed by the service. However some staff had not received refresher training for necessary subjects. Staff need updated training to help keep them up to date in their practices and help to appropriately support people. Staff still needed training updates in eg, safeguarding, medications,epilepsy, Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: health and safety and food hygiene. The manager had already identified some areas for training that she had organised for certain staff. The manager explained they had developed training action plans, so each time a person attends training they complete a training action plan. This asks them what they had learned and how they would bring the knowledge and skills back to the workplace. This is an example of good practice in developing staffs skills and knowledge after receiving various training. We looked at a sample of records that showed staff are regularly supported by the manager with regular appraisals and supervision. This is a good example of how the staff are supported while working at the service. The manager felt they had 100 per cent of staff with a care qualification (nvq). This is an example of how the manager has exceeded the national minimum standards with all staff being up to date in a care qualification. The staff surveys gave a mixed opinion about the staffing levels at the service. One comment included, eg, I dont think there are enough staff in the company, though it is expanding, IE services are changing. One person felt they, always had enough staff, 1 person felt they, usually had enough staff and 1 person felt they, never had enough staff on duty. We discussed these comments with the manager as she felt this was due to the additional hours that are currently provided for 2 evenings a week for 2 staff to provide individual support. The support packages agreed and funded by the local authorities have only agreed to fund 2 evenings a week. All other days the service has just 1 staff member on duty. Staff comments should be reviewed and discussed within the team so that feedback can be given regarding their comments. Care Homes for Adults (18-65 years) Page 25 of 32 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. Laurel cottage is well managed and the health and safety of everyone at the service is promoted and protected. Evidence: The manager has been at the home for approximately 7 years and offers great stability and a good rapport to everyone. Laurel cottage continues to benefit from an experienced and appropriately qualified manager who is able to demonstrate that she effectively manages the service in the best interest of everyone living there. The manager explained that they are due to have a reorganisation to the managers allocated to each home and that she would be taking over the management of another home in March 2009. The focus of the service is very much on providing the best for people living there and responding to their needs.The manager meets with everyone at the home on a regular basis and the minutes of these meetings shows good communication keeping everyone up to date and included with the developments of the home. The minutes show that Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: they regularly have training discussions on certain topics, eg infection control and autism. The home is visited on a regular basis by a representative of the organisation. These visits form part of the quality assurance process and form an opinion on the standard of care and support provided. These visits are also a requirement of the care home regulations and a report has to be produced to show evidence of these checks. There have been problems in getting these reports done previously but the manager explained that they have started to be completed for 2009. We were able to look at 2 reports dated 11/7/08 and 20/1/09. Records and certificates showed that regular checks are carried out on the building and equipment. This includes checking electrical installation and fire appliances and the gas supply. These checks help to make sure that the environment is well managed and is a safe place to live and work in. The organisation had developed a publication of a recent staff satisfaction survey dated Oct 08. Overall it was very positive with 3/4 of the staff team expressing comments such as, feeling the society is a good place to work. The organisation were able to use the survey for a benchmark to the future and following the survey the Chief Executive of the company visited each establishment to discuss the findings and the developments for the future. This published document was called, Our future strategy for 08/09-2012/13. This has helped to keep everyone involved and updated with the aims of the organisation. The manager explained that various records such as, personnel files, training and financial records are usually kept at head office. This meant that the manager was not always in receipt of necessary records covering Laurel cottage. We discussed the managers responsibilities within the care home regulations whereby all necessary information should be accessible to her. This will allow her to evidence that the service is safely managed and show evidence of good practice and management of finances and personnel checks. The manager produced various detailed monthly audit reports that she carries out to make sure that the service is being managed appropriately and providing the right support at all times. The audit was a good example where the manager had been able to show what quality assurance checks she had put in place to show that the standards are always maintained within the service to always benefit the people living there. Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: Care Homes for Adults (18-65 years) Page 28 of 32 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 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 20 To have updated financial 12/08/2009 records, care plans in place. To provide people with the name of the appointee and summaries of financial procedures. These records must be clear and accessible to everyone residing at Laurel cottage and their representatives. To show clear and transparent records as to how each persons monies, benefits are managed and safeguarded. 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 7 The Manager should have clear procedures and records to show how each persons finances are managed. This will help to evidence they are kept in the best interest of everyone living in Laurel cottage. To provide information for everyone at Laurel cottage as to Page 30 of 32 2 24 Care Homes for Adults (18-65 years) when they can purchase a new settee, so they can be kept informed and included in the developments of their home. 3 35 To have updated individual training and development plans for each member of staff so they can be supported with updated training to help them with their job roles. A published company commitment to training will help people be aware of what training they will be provided with including timescales for refresher courses, including specific timescales for medication, safeguarding, epilepsy and fire training. To provide evidence of at least 5 days paid training per person each year. To carry out monthly visits and to include the opinions of people at Laurel cottage while carrying out monthly checks, (regulations 26 visits) so that their views can be considered regarding the home. The manager should have all necessary information accessible to her so that she can evidence safe systems are in place for the management of finances and personnel checks. 4 39 5 39 Care Homes for Adults (18-65 years) Page 31 of 32 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. 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