Care Home: Claro Road Care Home

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What the care home does well The home is purpose-built with large rooms and wide spaces suitable for wheelchair users. It is nicely furnished and warm and comfortable. This makes it a nicer place for people to live and enables people to be more independent. One person commented. ` Claro Rd is better than St George`s`. (This was the previous home, owned by the same organisation, before Claro Rd was built). ` I`m glad I`m here. I like it. The facilities are better`. The staff group of both men and women are of different ages and backgrounds and are well trained. They understand that people need to follow their own lifestyle choices and support them in that choice. One health care professional commented. They provide `a high standard of care whilst promoting independence and a positive self image`. People say they are listened to when they want something doing or organised for them. This helps them to stay in charge of their own lives as much as possible. People say that they are confident that complaints are looked into properly and sorted out. One person said that `there is always someone to listen and help sort things out. If not the manager, then the carers`. Staff recognise that people need to be protected from harm and know to immediately report any incident where they are concerned that someone may be at risk of harm. What has improved since the last inspection? Records relating to meeting people`s needs have been updated and now more accurately describe the support people need to live more independent lives. The manager now makes sure that the results of police checks, carried out on new staff, are available to look at, before they start working at the home. This helps to make sure only suitable staff are employed to work at the home, in order to contribute to people`s safety. People have more opportunities to be involved in community events and educational activities. This though could be looked into still further to make people`s lives more fulfilling and stimulating. Hot water temperature monitoring is now carried out regularly to check that people aren`t being put at risk of scalding, from water that is too hot. What the care home could do better: The manager could make sure that staff adhere to the medication policy and then carry out his own checks to make sure this happens. This would help to make sure people receive their drugs according to their prescription and the risk of errors are minimised. The manager could consider exploring whether people are now satisfied that their social and educational needs are being well met and they are doing what they would like to do, in order to lead interesting lives. The manager could send a copy of the updated gas safety certificate to the commissionto show that gas systems at the home have been checked and are still safe to use. The manager could write down how he plans to deal with people`s comments about how the home runs, which he receives in survey responses. Writing a plan of what changes he is going to make, and making sure people know what this plan is, will tell people that he is listening to what they are telling him. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Claro Road Care Home 34 Claro Road Harrogate North Yorkshire HG1 4AU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jean Dobbin     Date: 0 9 0 4 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 33 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Claro Road Care Home 34 Claro Road Harrogate North Yorkshire HG1 4AU 01423855410 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Disability Action Yorkshire care home 20 Number of places (if applicable): Under 65 Over 65 0 physical disability Additional conditions: 20 The maximum number of service users who can be accommodated is: 20 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 category: Physical Disability, Code PD, maximum number of places 20 Date of last inspection Brief description of the care home Claro Road was built and opened in February 2007, and is owned by the charity Disability Action Yorkshire. The home offers personal care and support for up to twenty people from the age of eighteen, with physical disabilities. The homes main aim is to support people living there to meet their personal lifestyle aspirations, whilst participating in the running of the home. It is situated about one mile from the centre of Harrogate, with its major transport links. The home has level access and parking both on site and on Claro Road. The homes main entrance leads into two separate units that each accommodate ten people. Each unit has a communal integrated lounge, dining and kitchen area and a Care Homes for Adults (18-65 years) Page 4 of 33 Brief description of the care home communal bathroom. All the bedrooms are for single occupancy and all have en-suite facilities, including showers. There is a large garden to the rear. There are two self contained training flats, which will be used for people to experience living and managing alone before they move back to live in the community independently. The home produces a Statement of Purpose, which provides information about the home. This and the last inspection report, written by the Commission for Social Care Inspection, which was the predecessor of the Care Quality Commission, are available on request from the manager. Weekly fees to live at 34 Claro Rd, provided on April 9th 2009, are between 324 pounds and 825 pounds. This fee depends on the persons assessed needs. People also receive benefits with which to pay for personal items. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This is what was used to write this report. Information about the home kept by the Commission for Social Care Inspection. Information asked for, before the inspection, which the manager provides. This is called an Annual Quality Assurance Assessment or AQAA. Information from surveys, which were sent to people who live at 34 Claro Road, to staff and to other professional people who visit the home. 11 were sent to people at the home, and all were returned. 10 were sent to healthcare and social care professionals and 3 were completed and returned. 5 were sent to staff at the home and 4 were returned Care Homes for Adults (18-65 years) Page 6 of 33 A visit to the home by one inspector, which lasted about 7 hours. This visit included talking to people who live there, and to staff and the manager about their work and training they had completed. It also included checking some of the records, policies and procedures that the home has to keep. Some time was also spent watching the general activity to get an idea about what it is like to live at 34 Claro Rd. Information about what was found during the inspection was given to the registered manager at the end of the visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: The manager could make sure that staff adhere to the medication policy and then carry out his own checks to make sure this happens. This would help to make sure people receive their drugs according to their prescription and the risk of errors are minimised. The manager could consider exploring whether people are now satisfied that their social and educational needs are being well met and they are doing what they would like to do, in order to lead interesting lives. The manager could send a copy of the updated gas safety certificate to the commission Care Homes for Adults (18-65 years) Page 8 of 33 to show that gas systems at the home have been checked and are still safe to use. The manager could write down how he plans to deal with peoples comments about how the home runs, which he receives in survey responses. Writing a plan of what changes he is going to make, and making sure people know what this plan is, will tell people that he is listening to what they are telling him. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre admission assessment ensures that individual care needs can be met at the home and the prospective resident receives information and help to enable them to choose whether 34 Claro Road is the right place for them. Evidence: Three service files were looked at as part of the inspection process. Two of these belonged to people who had lived at Claro Rd since the home opened over two years ago, and both had transferred from the previous home owned by the organisation, which was called St Georges. These files contained comprehensive information, completed by their care manager, but no written pre-admission assessment completed by the home. The manager explained that whilst people had been assessed, before moving to the home, those records were less relevant after the passage of several years and had been removed from the file. Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: Another person had moved to the home in the last year and again there was no evidence of an assessment of needs completed prior to their arrival. The manager said that the pre-admission assessment records had been stored at the back of the file and so were not obviously apparent. Peoples records need to be put together in a similar way so that information can be easily located. That person was able to say though that they had moved to the home at short notice, because of their personal circumstances. They confirmed that they came to look round the home and meet the other people living there. They could also recall someone from the home talking to them about their life and what they were able to do, and hoped to be able to do in the future. The manager explained that an assessment is always completed before people move there. One person living in a different care setting had been assessed for moving to the home only that morning. This assessment was available to look at. It provided a lot of detail particularly in relation to what the person can manage independently and what they would like to do in the future if they choose to move there. All the surveys completed by eleven people living at the home say that were asked if they wanted to move to the home. Three said they would have liked more information about the home to help then to decide whether to move there, however two of those say they are now much happier at the new home, compared with St Georges. One person wrote. Glad I came here. We were told a little bit about Claro Rd before I came. An illustrated brochure is sent to all people interested in moving to the home. There is also a Statement of Purpose and service user guide, which provided information about the service and facilities it provides. People are given their own copy when they move to the home. The manager also recommends people coming for a trial stay at the home, so that they can get a feel of what its like to live there, meet the support staff and see if they get on with those already living there. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care plans explore individuals strengths and personal preferences in good detail and staff are committed to helping people to maintain choice and control in their lives as much as possible. Evidence: People spoken with said they were very happy living at 34 Claro Rd. Comments include the staff are brilliant. They go out of their way to do what we want. And I moved because of the lack of support at my previous address. In comparison Claro Rd is a much better place to live. All the surveys state that people are able to make decisions about what they do and how they spend their time. One person said that evenings can be quite quiet, however the manager says this is because many of the people choose to go to their room, to spend time doing what interests them, like working on their computer, their games console or watching a DVD or television. Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: All the people have a personal service plan, written in the first person, describing what is important to them and how this can be achieved. For example it records which family members and friends they are happy to see anytime, and which they dont want to see at all. Care staff can then support them with this choice. The records are written in a way that emphasises daily living skills that people can achieve independently and records the support they need from others to complete those tasks. For example needs help with shoelaces and I need help to dry my hair and dress my bottom half. This is good practice and helps to ensure that care staff do not take over, but recognise and acknowledge peoples skills. There are robust risk assessments in place and people are supported in taking reasonable risk, as part of everyday living. These assessments include activities in the house, like using kitchen equipment and having a hot water bottle, as well as events in the community, like being out alone on an evening, road safety, and drinking alcohol. One persons file contained some restrictions, because of a high risk of harm. There was written evidence that this had been discussed with the individual and they had signed to confirm their agreement. The service plans are reviewed every three months with the individual and some people had signed their agreement to what was written. These signatures were not consistently in place, however one person spoken with said they hadnt had a look at their file for a while but this wasnt a problem to them and said they could ask to read it anytime. Care Homes for Adults (18-65 years) Page 14 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst people like the meals and are generally supported to live the life they choose, the manager could do more to satisfy himself that peoples social needs are being well met. Evidence: People are encouraged to be actively involved in the day to day running of the home. The service files record the tasks people have agreed to undertake. These include helping with cooking, cleaning and personal laundry. Those people with more complex disabilities are encouraged to help with supervising some of the others, so their contribution is still valued and acknowledged. For example comments include I can make sandwiches, dust and tidy my room. One person said those that cant do it - we supervise. Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: People are supported to take charge of how they spend their time each day and with whom. Many people maintain close contact with families and partners. One person said that the staff are very sensitive to their need for privacy, when their partner visits, and never interfere. Other people spoken with said how they go home, or on holiday with their family and another attends church each Sunday with their family. People are encouraged to go out independently, if they are assessed as able to do this, whether this is shopping, to the pub or to a party. The home also has a wheelchairadapted car, which many of the staff are able to drive. At the last inspection two years ago comments were made about the lack of opportunities for community based events. One person spoken with said they thought this had improved since then and it was now brilliant. The manager wrote in the AQAA that external activities include horse riding, cinema, concerts and the theatre as well as more routine events like shopping and the pub. The calendar of events though for March comprises mainly of shopping trips, however one person attends college each week and another a weekly art class. One person went to the cinema, another to a party and a third visited someone who used to live at Claro Rd, but now lives at a different home. A health care professional said in their survey that the home needs to facilitate individuals to go out in the community on a regular basis. Such as cultural events, cinema, theatre, swimming and visiting people. Whilst people did not say that they wanted the opportunity to do more, the manager should consider carrying out his own checks to see whether the home is always meeting their social needs. Several people living at Claro Rd attend Spot On, which is a division of Disability Action Yorkshire. This is a social enterprise, which provides training in employment skills for disabled people. One person, who returned to the home on the day of the visit, after spending several hours there, said they had been attaching shop labels onto bags. Several people attend the local PHAB meetings (Physical Handicap and Able Bodied social group) and in-house games and exercise classes are also held at the home and organised by the people living there. People decide between them for the meals the following week, which are then shopped for. One person said we all sit round the table and choose what to have. Most people would have the same, but if you didnt like something, then youd have something else. These include takeaways. The service files describe peoples specific needs. For example may need help with cutting things. And If Im hungry or thirsty then I can get something myself. People said the food was good. One said X (staff member) is a Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: qualified chef, so they teach other staff. Examples of meals that week were cornish pasties, chips and beans, and liver and onions with roast potatoes. Care Homes for Adults (18-65 years) Page 17 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst peoples health and personal care needs are well met and their independence in managing these is promoted, shortfalls in medication practices need to be sorted out to ensure people are receiving their drugs according to their prescription. Evidence: The care staff at the home help people to maintain their independence and make their own decisions about their health care. They ensure that help is given in a sensitive and respectful way and this kind of support was observed on the day of the visit. One person said they would use their phone to make their own appointment with their doctor and visit the surgery independently, whilst another said they would ask a member of staff to do this for them. The individual support plans document how much personal help people need and how this is to be provided. Both male and female staff work at the home so that people can express their preferences when receiving personal care. One person spoken with though said that as far as they could recall no-one had ever asked them if they would Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: prefer to receive their care from specifically male or female staff. Whilst the manager says these issues are discussed with people, this needs to be recorded so that all staff are aware of these preferences and can respect them whenever possible. Those plans of care looked at were written in a way that promoted peoples dignity and privacy and emphasised healthy living as a way of maintaining good health. The personal care plans stressed the need for people to be supported in the way they choose, as much as possible. The service file records visits from, and consultations with, health care professionals. People have special aids and equipment to promote their independence. One health care professional said in their survey that the home provides a high standard of care, whilst promoting independence and positive self image. Peoples weight is monitored regularly, however people do not have a nutritional risk assessment completed, unless the admission assessment identifies a potential problem, or peoples weight changes. Peoples medicines are securely stored in their rooms. The medicines are dispensed by the pharmacist into weekly disposable cassettes and staff, who have received extra training pop the drugs out for people to take. Peoples extra supplies are securely stored centrally. Some people look after their own medicines and a risk assessment is completed and reviewed regularly with the individual to make sure they are still able and willing to undertake this role. Medication record sheets are kept in peoples rooms with their drugs, and those looked at were filled in properly. Checks of three peoples medicines though highlighted a serious shortfall, which the manager addressed immediately. One person was self-medicating, however one of their drugs had to be stored in its original packet, rather than the cassette. This packet had not been given to them when new supplies had been provided five days earlier. The medication record sheet is not signed for by staff when a person looks after their own medicines, and so no member of staff had noticed this error. The manager needs to urgently introduce a system to make sure this doesnt happen again. And he needs to be carrying out his own medication checks each month to satisfy himself that staff are following the homes detailed medication policy, which is now in place. This policy states that hand-written changes to the medication record sheet should Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: have two signatures to minimise the risk of error. The record sheet for the person self medicating however, contained a hand-written prescription, which was neither signed nor dated. Medication systems need to be very robust, to protect people from potential harm, and these shortfalls were discussed with the manager. Care Homes for Adults (18-65 years) Page 20 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples concerns and welfare are taken seriously, and the right action is taken where necessary to keep them safe from abuse. Evidence: People spoken with and the survey responses from people living there confirm that people know what to do if they are unhappy about something. All said they would tell someone. One person said I would go straight to Steven and he would sort it. The commission has received one complaint about the home in the past year, but this was related to employment issues, rather than care practices. The home has received four in this time. These have been investigated and addressed properly by the manager and there is good documentation to evidence this. However all these complaints relate to the way care staff talk, either to each other about others who live there, or the way they have spoken to the individual. These complaints were discussed with the manager who said he was satisfied that they had been dealt with properly. However the manager should consider whether more staff training is required so that support workers are more clear about how they talk with or about people in a public area. One member of staff was disciplined as a result of one complaint, however this was not recorded in their personal supervision records. Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: None of the people spoken with on the day of the visit however said anything negative about the attitudes and behaviours of the care staff. Comments include theyre good people. Staff are very good. Staff are brilliant. People spoken with also said they would speak out if someone was unkind to them. A care worker spoken with was also alert to the need to keep people safe and report any incident which may suggest that someone had been harmed. They also were alert to the need to report an incident even if they had been asked not to tell anyone. This is good practice as it shows that they understand they mustnt keep secrets if people are at risk of harm. The manager now has a copy of the North Yorkshire Safeguarding Adults policy to refer to. The home has made two safeguarding referrals in the past year to the local authority, who have primary responsibility for investigating these incidents. These referrals were made promptly and the manager worked well with outside agencies to make sure systems were introduced to make sure people were kept safe. People are supported to look after their own money, if necessary with the help of care staff or family members. Their service file records the help they need, whether they can go and withdraw money from their bank independently or whether two staff members have to go to their bank with them. Some monies are securely stored at the home though, for the people who live there. Paper records are accurately maintained and regularly checked by a senior manager from the organisation. Two peoples monies were looked at and found to be satisfactory. People can also access their money at any time. Care Homes for Adults (18-65 years) Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is warm and comfortable and generally meets the needs of people living there. Evidence: 34 Claro Road is purpose built and was opened less than three years ago. People have a keypad entry to the home, which is divided into two units, each with ten bedrooms and a large communal living, dining and kitchen space. People have keypad entry into their own unit, but not the other one. They can only go there if they are invited by someone who is living there. The home also has a self contained flat, with two bedrooms where people can live more independently, in preparation for moving out of the home to live in the community. There is a well maintained garden, with a paved area around the whole building and a large patio area, which the manager says is well used in the summer. The home though, because of its position on the edge of a small industrial estate, has a perimeter of high metal fencing. The owners could consider more planting which in time would provide more privacy for people living there and hide this fencing. The home was noted to be clean, bright, warm and well maintained. There were no Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: unpleasant smells. Nine of the surveys said that the home was always fresh and clean, with the other two saying this was usually the case. All the bedrooms are for single use, have en-suite toilet and wet rooms and doorbells. Some of the rooms have ceiling tracking, which means wheeled hoists are not needed for people in those rooms. The manager explained that these will be fitted to all rooms in time, as people move to the home, who need this level of support. Each unit has one assisted bath, to provide people with a choice. The bedrooms are large and very personalised according to the individuals interests. one person said they had two computers, one for gaming and one to help them keep in touch with family and friends. One person has an environmental control system, so that they can be as independent as possible in their room. One person said the home is very homely. I used to have a little room, but this is very big. The communal areas are homely and furnished to allow people in wheelchairs to move around easily. The kitchen has been designed to enable disabled people to use the facilities, however some people spoken with said that the area is still not user-friendly for wheelchair users. The manager is aware of these views and says the organisation has plans to make changes to improve this. Each unit has a domestic laundry area, where people can be responsible for their own clothing. The home also has a bigger laundry area, which services both units and is used for things like bedding. The manager makes sure that appropriate aids are available and used to make sure that people living and working in the home are protected against infection. Care Homes for Adults (18-65 years) Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by enough staff, who get training so they know what good care is and how it should be provided. Evidence: Speaking to people and comments from the surveys say that people like the staff and think they know what they are doing. Comments include the staff are very good. Yes I think the staff know what they are doing and I feel very safe when theyre helping me. And the staff are brilliant. They go out of their way to do what we want. Another added the staff are nice. Oh boy, oh boy oh boy. Male and female staff are employed, with varied ages and backgrounds. Staff spoken with recognised the importance of recognising peoples lifetsyle choices and the importance of supporting people with these, regardless of their own views. One senior support assistant generally works all their time on each of the units to provide a continuity of care. Support assistants also work primarily on one unit, so that good partnership working can develop with individuals on the unit. People spoken with said there were generally enough staff working, so that they didnt Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: have to wait if they needed help. They added that they did though sometimes have to wait when they needed help at night. They also said they accepted this though, because there are two staff, and if they are helping someone else, then they cant come to them immediately. The staffing levels of 4 or 5 support assistants in the morning and 3 or 4 on the evening, which does not include the manager, have not apparently changed since the last inspection, two years ago, when some people commented that these levels were insufficient to meet all the needs of the people. One worker just does the cleaning, and a gardener is employed. Otherwise staff are responsible for all other duties. Both the manager and people spoken with said that four people had been recruited in recent weeks and were waiting for recruitment checks to be completed before they started work there. Only one person spoken with though commented negatively about the staffing levels. They said they wished staff had more time just to sit and talk. These comments were discussed with the manager. More than half the support team have achieved a Level 2 National Vocational Award in Care. This nationally recognised training helps care staff to understand their role and people are more likely to receive safe consistent care by well trained staff. The NVQ assessor was at the home on the day of the visit. Staff said that they were supported to undertake training appropriate to the support they provide. One person said they had received refresher training when they returned to work there after a period away. And training has been organised for all the support staff so that they have the specialist skills to meet an individuals specific needs. Two staff recruitment files were looked at. These showed that checks had been completed properly before they started working at the home. People living there are also involved in the recruitment process and two people said they had helped with interviewing, asking questions they wanted to know the answer to, and scoring applicants responses from 1 to 5. New staff have a six week induction programme, where they learn about the policies and procedures in the home and attend training. One person living there said the new staff will learn to use the hoist when they start working there and also will be expected to do their NVQ. Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: Care Homes for Adults (18-65 years) Page 27 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager and staff ensure that the home is run in the best interests of the people who live there. Evidence: The registered manager has been in post for a number of years and has undertaken extra management training to help him with his role. People spoken with said they saw him regularly around the home and he was easy to talk to. One person said though that they never knew, when he was in the office, whether he was busy or not, and said they listen at the door to try to hear if he is speaking with someone. These comments were discussed with the manager, as to how people could know whether he is available or not. Staff spoken with also said he was approachable although one person said they would speak with their senior support assistant if possible, before speaking with the manager. The manager has shown in discussions by telephone as well as on the day of the visit, Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: that he has a good understanding of how to support people with disability and the need to promote choice and respect peoples decisions about the way they choose to lead their lives. This promotes equality and ensures staff are working with people to achieve their personal goals. People are asked to complete a survey each year about how the home is running. The results of the latest survey was seen. However when people make negative comments then the manager needs to look into them and draw up an action plan as to what changes are to be made as a result. Making sure everyone is aware of this action plan will tell people that they have been listened to. If changes are not possible then people need to be informed of this, so they are kept informed of these decisions. Unit meetings are held each month, where people living there are able to talk about the day to day changes they would like to see. Minutes from these were seen. People also sit round the table each week to decide on the meal choices for the following week. Some people who live at 34 Claro Rd are also on a Shadow Trustee Board, so that they can meet with senior people from the charity a few times each year and contribute as a service-user to how the organisation runs. Minutes from all these meetings are displayed on the notice board. There are a range of health and safety policies and procedures in place. The home has made proper provision to ensure that there are safe working practices by providing staff training in first aid, fire, food hygiene, infection control and safe moving and handling techniques. Hazardous products are stored appropriately and monitoring arrangements are in place to ensure the delivery of safe hot water and minimise the risk of Legionella. An environmental health officer visit earlier this year had no concerns about the home. An external company supports the home to manage fire safety processes. Fire safety checks and refresher training are carried out regularly and recorded. A small sample of safety certificates were looked at. Although the gas boiler had been repaired a few weeks earlier, the annual gas safety check had expired. The manager organised for this to be completed within two weeks of the site visit and agreed to forward a copy of the certificate to the commission. Portable appliance teating had been completed. Care Homes for Adults (18-65 years) Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 The registered person must ensure that people who look after their own drugs are provided with all their prescribed drugs. And he should have systems in place to ensure this is happening. This will enable people to take their drugs at the times as recommended by their prescription. 22/05/2009 2 42 13 The manager must send a 22/05/2009 copy of the new gas safety certificate to the commission To show that gas systems at the home are satisfatory. 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 12 The manager should consider determining whether people are satisfied that their social care needs are now being well Page 31 of 33 Care Homes for Adults (18-65 years) met. 2 20 Hand-written prescriptions on the medication record sheet should be signed by two members of staff, who have completed medication training, as this will reduce the risk of error and ensure the correct information is recorded. This will also comply withthe homes medication policy. The manager needs to write action plans to show how he intends to address comments made by people in their surveys. These action plans need to be made available for people to read. If comments and suggestions cannot be implemented then people need to know why not. This will help people to know that they are being listened to. 3 39 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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