Care Home: Creative Support - Ulverston Services

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What the care home does well The homes assessment and admission procedure is thorough and ensures peoples needs can be met by the home. Based on the detailed care needs assessments comprehensive person centred care plans are developed with input from a range of other professionals. These provide staff with detailed strategies and guidance about how a person likes to be supported and what is important to them in their day to day lives. There was evidence these have been regularly reviewed to make sure they are up to date and accurate and reflect peoples changing needs and preferences. A lot of work has been put in to producing communication information to support staff in understanding how people make their needs known and make choices in their lives. This has helped staff to develop a weekly activity planner that is produced in an easy read format to help people structure their time as they choose.The home environment is safe and suitable and provides people with a comfortable private space to enjoy their chosen lifestyle. All areas of the home were clean and hygienic and were well maintained.Staff receive good induction training covering both basic training and some specialist training to guide their practice. The staff team are well motivated and work well together to provide a consistent level of service. What has improved since the last inspection? This is the first key inspection of the home since registration. What the care home could do better: Due to the complex needs of the people living in the home further specialist training should now be planned to make sure staff have the relevant skills and knowledge for their role. It is recommended that infection control training is now provided to staff to make sure they follow good practice guidelines and reduce the risk of infections.A review of the activities provided to people should take place on a regular basis to ensure people are being provided with a suitable range of activities both in the home environment and in the local community.It is recommended people are weighed on a regular basis to enable a full nutritional assessment to be maintained.The front doors to the flats could be improved by personalising the doors making it easily recognisable by the person living there and making the environment feel more homely.The deployment of staff should be reviewed to make sure they are being used effectively to meet the changing needs of the people living in the home. There must be sufficient numbers of trained staff on duty at all times to meet the assessed needs of the people living in the home. The proposed new staffing structure must be implemented as soon as practicable to ensure there is sufficient supervisory staff and care staff on duty each shift.Regulation 37 notifications must be completed and sent to the Commission when reporting significant events in the home that affect the well being of the people living there.Deprivation of liberty safeguards should be reviewed in relation to specific situations in the home to make sure people are not having their Liberty Deprived when care plans are being implemented.Job descriptions and contracts of employment should be issued to all new staff at the start of their employment with the organisation. All staff should be having formal supervision meetings with their line manager or supervisor on a regular basis, to enable them to reflect on their practice and receive support and guidance in their role.More regular staff meetings should be taking place to enable staff to share information, changes and concerns, which will help them to provide a flexible and consistent service. Key inspection report Care homes for adults (18-65 years) Name: Address: Creative Support - Ulverston Services 18 Victoria Road Ulverston Cumbria LA12 0EP one star adequate service The quality rating for this care home is: A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ray Mowat Date: 2 8 0 4 2 0 1 0 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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 mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983   Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Information about the care home Name of care home: Address: Creative Support - Ulverston Services 18 Victoria Road Ulverston Cumbria LA12 0EP 01612360826 01612375126 debbie.nutt@creativesupport.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Creative Support Limited Name of registered manager (if applicable) Ms Debbie Anne Nutt Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 6 0 care home 6 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 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 Disabilities - Code LD Date of last inspection A bit about the care home 18 Victoria road is a purpose built care home and is designed to be a suitable home for people with Autism and other complex needs. It is a six bed home, with each person having their own self contained flat within the main building. This includes a large bedroom, lounge and dining room and a bathroom with toilet and shower. There are patio doors in each flat leading to a separate private garden and patio area. There are also communal areas in the home including a large lounge, which leads on to a shared garden area to the rear of the home. There are two well equipped kitchens and dining areas, a suitable well equipped laundry and additional toilets. Adjacent to the main entrance and hallway is an office and training/meeting room. Information about the home is provided to people in an informative statement of purpose and service user guide, which are also available in the home. Fees charged are assessed on an individual basis as a result of a multi disciplinary care needs assessment. 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: one star adequate 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 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 1 star. This means the people who use the service experience adequate quality outcomes. During this the first key inspection visit we (The Care Quality Commission) met with people who live in the home, and spent time with the manager and care staff. We also met with care staff individually and talked to them as they went about their duties. The Registered Manager Mrs D Nutt, completed a self assessment questionnaire called an Annual Quality Assurance Assessment, AQAA. This provided us with information about how the home is run and the managers views on what the service does well, where they have improved and plans for the future. There is also information about the people who live in the home and the staff working there. Surveys were sent out as part of this inspection to people using the service, their relatives, staff and other professionals, with their views being used to formulate the judgements in this report. We also examined records relating to the running of the home that are required by legislation, which included policies and procedures, staff files and care plan files that guide staff in supporting people to achieve their goals and promote an independent lifestyle. What the care home does well The homes assessment and admission procedure is thorough and ensures peoples needs can be met by the home. Based on the detailed care needs assessments comprehensive person centred care plans are developed with input from a range of other professionals. These provide staff with detailed strategies and guidance about how a person likes to be supported and what is important to them in their day to day lives. There was evidence these have been regularly reviewed to make sure they are up to date and accurate and reflect peoples changing needs and preferences. A lot of work has been put in to producing communication information to support staff in understanding how people make their needs known and make choices in their lives. This has helped staff to develop a weekly activity planner that is produced in an easy read format to help people structure their time as they choose. The home environment is safe and suitable and provides people with a comfortable private space to enjoy their chosen lifestyle. All areas of the home were clean and hygienic and were well maintained. Staff receive good induction training covering both basic training and some specialist training to guide their practice. The staff team are well motivated and work well together to provide a consistent level of service. What has got better from the last inspection This is the first key inspection of the home since registration. What the care home could do better Due to the complex needs of the people living in the home further specialist training should now be planned to make sure staff have the relevant skills and knowledge for their role. It is recommended that infection control training is now provided to staff to make sure they follow good practice guidelines and reduce the risk of infections. A review of the activities provided to people should take place on a regular basis to ensure people are being provided with a suitable range of activities both in the home environment and in the local community. It is recommended people are weighed on a regular basis to enable a full nutritional assessment to be maintained. The front doors to the flats could be improved by personalising the doors making it easily recognisable by the person living there and making the environment feel more homely. The deployment of staff should be reviewed to make sure they are being used effectively to meet the changing needs of the people living in the home. There must be sufficient numbers of trained staff on duty at all times to meet the assessed needs of the people living in the home. The proposed new staffing structure must be implemented as soon as practicable to ensure there is sufficient supervisory staff and care staff on duty each shift. Regulation 37 notifications must be completed and sent to the Commission when reporting significant events in the home that affect the well being of the people living there. Deprivation of liberty safeguards should be reviewed in relation to specific situations in the home to make sure people are not having their Liberty Deprived when care plans are being implemented. Job descriptions and contracts of employment should be issued to all new staff at the start of their employment with the organisation. All staff should be having formal supervision meetings with their line manager or supervisor on a regular basis, to enable them to reflect on their practice and receive support and guidance in their role. More regular staff meetings should be taking place to enable staff to share information, changes and concerns, which will help them to provide a flexible and consistent service. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Ray Mowat CQC Northwest, Citygate, Gallowgate, Newcastle Upon Tyne NE1 4PA 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 http:/www.cqc.org.uk/. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. 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 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. Good systems and procedures are in place to make sure the home is suitable and able to meet peoples individual and complex needs. Evidence: The organisation has developed an informative statement of purpose and service user guide providing people with relevant information they require about the purpose of the home and the services they provide. The service user guide is produced with pictures and symbols alongside the text to make it easier for people to understand the information. It contains more detailed information about how the home operates, the qualifications of the management and staff team and the terms and conditions of their stay including how to make a complaint. There has been and continues to be a strong input from the multi disciplinary team with the initial and ongoing assessment of people moving in to the home. As a new and specialist facility it is important that comprehensive needs assessments were completed to ensure the success of the project, in supporting people with very complex and at times challenging needs. As part of the admission process detailed transition plans were compiled to help both the person moving in and the staff supporting them to adjust to their new home and the changes this involved. So far four people have successfully moved in to the home and a further two admissions are planned. The assessment and admission process was very individual ensuring it met the needs of the person and happened at a pace they were comfortable with. The staff continue to work closely with a range of professionals and specialist agencies to ensure a comprehensive person centred care plan is developed based on the individual care needs assessments. It was evident from our discussions with staff and from examining records relating to the Evidence: operation of the home, all new staff completed a thorough induction training programme that included core subjects and some specialist training such as Autism basic awareness and CITRUS restraint and breakaway techniques. Due to the complex nature of the people living in the home further specialist training should now be planned to make sure staff have the relevant skills and knowledge for their role. The assessment process is making sure the home is able to meet peoples individual needs and they are compatible with people already living in the home. Although the way the home operates, each person has their own flat with a private garden area, meaning that they only have very limited contact with other people living there in the communal areas. Introductory visits to the home were a key part of the assessment and admission process for all the current residents and this has helped them settle quickly in to their new home environment. This was part of the agreed transition plan that has been developed by the multi disciplinary team that was designed around the specific needs and preferences of each person. This resulted in one person not visiting the home prior to the move as it was agreed, based on past experience, that they would cope better moving straight to the home, which was very effective for them. All the people living in the home have been issued with a licence agreement explaining their rights and the terms and conditions of their stay. 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. Comprehensive care plans record peoples individual needs and preferences ensuring staff can provide a consistent and personalised service that meets their needs. Evidence: Detailed person centred care plans have been developed and agreed for each person with input from a range of other professionals and agencies. They include detailed strategies to guide staff in how best to provide the care and support people require. This ensures even the most complex needs are responded to in a safe and consistent manner. A good example of this was the behaviour management plans that were in place, in one case including specific physical intervention, restraint and breakaway guidance for staff. These detailed plans identify for staff what triggers specific behaviours and how to respond to any challenges making sure both the person and the staff safe. All staff working in the home have completed suitable training to guide their practice and clear records are maintained of all significant events. The manager will conduct a debrief with staff after a violent incident to make sure strategies and good practice were followed and to give staff a chance to reflect on their practice and evaluate the incident and their response. Based on our observations and discussions with staff they are aware of the importance of taking on an enabling role when supporting people and promoting their independence and choice. Limitations on decision making that were evident were identified through the multi disciplinary assessment process and were recorded within care plans and were in place to safeguard the person. Due to their complex and challenging needs the people living in the home have very limited verbal communication. However their communication needs were recorded in detail as part of a communication passport, which provides staff with valuable information about how people make choices and communicate their needs. Evidence: It is recommended Deprivation of Liberty safeguards are reviewed in the home to ensure people are not being deprived of their liberty and good practice guidelines are followed. Although people living in the home cannot articulate their needs and preferences the staff work closely with the person, their family and other professionals to make sure the home is operating in their best interests. Weekly reviews were taking place and learning logs were being used to gather relevant information about what is working well and what could be improved. Plans are also in place to use six monthly quality questionnaires to get feedback about the service from all interested parties. A good range of risk assessments has been developed for each person to safeguard both them and the staff supporting them. Control measures are agreed with clear guidance for staff where known hazards are recorded. The likelihood and severity of the risk is also assessed giving an overall risk rating to help identify serious concerns. Based on our discussions with staff they are aware of the importance of maintaining confidentiality when handling personal and confidential information. They are made aware of their responsibilities through the induction training with further guidance contained in the organisations policies and procedures. A statement relating to confidentiality is contained in the service user guide to make sure people are aware of how confidential information will be handled. All the records we examined were securely stored in the home and electronic records were password protected on the computer system. 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. The range of activities provided needs to be kept under review to make sure peoples changing needs are being met and they have the opportunity to lead a lifestyle of their choice. Evidence: Staff have been working closely with each person, their families and other professionals to develop a person centred care plan that reflects their individual preferences about ho they live their day to day lives. This has included the development of a weekly activity planner produced using symbols and pictures to enable people to make their needs known. This has been kept under review and learning logs have been used to record what has worked well and what could be improved. One person is still attending school each week Monday to Friday and another person goes to a local Day Centre both of which provide them with opportunities to take part in educational and social activities and to socialise with their peer group. Daily care notes and an activity record are used to monitor the type of activities that are taking place. It appeared from the reduction in the number of recordings on the activity record that the range of activities provided has decreased. However staff explained that activities they were recording initially were not now recorded as they have become the norm. Staff also confirmed that at times the staffing levels in the home have been low, which has also impacted on the opportunity for people to undertake activities of their choosing. It is recommended a review of the activities provided to people takes place on a regular basis to ensure people are being provided with a suitable range of activities Evidence: both in the home environment and in the local community. This is of particular importance for people who are Autistic and with such complex needs, to ensure they receive appropriate levels of stimulation and a consistent service is provided. Family relationships were recorded in the care plan with staff supporting and encouraging people to maintain contact with family and friends. Visitors are made welcome in the home with private space provided to meet with people. The daily routines for each person are developed with them to make sure it is meeting their needs. With each person having their own flat within the home they are able to maintain their privacy and establish their own routines,without any impact from other people living in the home, which is important to them. Daily and weekly routines were well documented in care plans which support staff in providing a personalised and consistent service. Meals and mealtimes are very flexible and can be changed to suit individuals tastes and preferences. Healthy eating plans have been developed for each person recording their likes and dislikes. A daily record is maintained of each persons food and fluid intake to enable staff to monitor diet and nutrition. People can choose to eat in their own flats or in one of the communal areas of the home. Although weight was recorded on admission to the home it has not been recorded since then. It is recommended people are weighed on a regular basis to enable a full nutritional assessment to be maintained. 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. Good systems are in place to make sure personal and haircare needs are assessed, recorded and responded to appropriately. Evidence: The detailed care plans and individual strategies ensure staff can provide sensitive and flexible personal support. Staff respect individual needs and preferences therefore promoting peoples independence and control over their lives. Daily routines are well documented supporting and guiding staff to provide a safe and consistent service. There was evidence of ongoing support from a range of other professionals and specialist agencies. This ensures peoples specialist needs are assessed and responded to appropriately. On each shift staff are nominated to take a lead role with an individual to try and maintain a good continuity of care. They then complete daily care notes and a staff handover book to make sure all relevant information is shared with the next shift of staff coming on duty. We examined the content of individual medication cabinets against the records held. Stock control sheets are maintained for all medication coming in to or leaving the home. This ensures an accurate record is maintained at all times of the medication held in the home. We checked the balance recorded against the medication held and the medication administration charts (MAR) and found these to be up to date and accurate. Medication errors noted in the daily records were cross referenced to the MAR charts with suitable explanations were recorded. However these errors had not been reported to the Commission as required under Regulation 37 (notifications). The majority of the medication held in the home was in a monitored dosage system. All loose medication was held in the prescribing pharmacist container. Health action plans are used to record medical and health related needs in detail. This Evidence: provides staff with suitable information to enable them to respond to personal and health care needs under the guidance of the relevant professional. All health care interventions and appointments were recorded, including the development of specific strategies resulting from the involvement of other professionals. 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. Clear policies and procedures ensure people are protected from harm or abuse and their concerns are recorded and responded to. Evidence: There have been no formal complaints recorded since the home opened. The organisation has developed a suitable complaints policy and procedure, which clarifies how to raise a concern or make a complaint and how and when it will be responded to. The procedure is issued to all new people moving in to the home in the service user guide. Staff are made aware of their role and responsibilities in dealing with complaints through the induction training. All staff complete suitable safeguarding vulnerable adults training as part of the induction training programme. Staff we met during the inspection confirmed they were aware of the organisations policies and procedures and felt confident in identifying and reporting concerns. We discussed different scenarios they may encounter and what their role and responsibilities would be. They were all aware of the on call management support that is available to them for advice and guidance including out of normal working hours. There have been two safeguarding referrals made to the local authority since the home opened, however these were not reported under regulation 37 to the Commission. The manager must ensure all significant events in the home affecting the wellbeing of the people living there are reported appropriately to the Commission, which is addressed in the management section of this report. 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 comfortable and safe and provides suitable private space for each person. It is decorated and furnished to a good standard and is well maintained. Evidence: The home is a purpose built home that is divided into six separate flats with communal areas of the home accessible from all of the flats. The design and layout was influenced by a number of professionals to make sure it is suitable for the needs of people with autism and other complex and sometimes challenging needs who are living there. All areas of the home were safe, clean and hygienic, with no obvious hazards noted. Routine maintenance has been taking place as required and the home was decorated and furnished to a good standard. There is a key fob locking system on all doors to communal areas with the other doors locked with a key. People who live in the home are not able to manage a key or the key fob system. The water supply to each room is also controlled centrally enabling staff to switch off the supply to prevent misuse/flooding. In addition to the six flats there are two communal kitchens and dining rooms, and a main lounge/conservatory. There is also a well equipped laundry and sluice room. Good infection control procedures were in place to ensure the safe handling and laundering of soiled linen. Each flat has a bedroom, lounge and bathroom with toilet with some having an additional room, which can be used flexibly to meet the individuals needs. One person was hoping to make this room in to a multi sensory room. Each of the bathrooms had a traditional bath with overhead shower, which could be problematical if a person has a physical disability. All the flats have a patio door leading on to a secure garden and patio area making the flats self contained. During this inspection visit people were spending time in their own rooms and also in the Evidence: main lounge. The flat doors were identified with a number giving this part of the home a clinical feel, which could be improved by personalising the doors making it easily recognisable by the person living there. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager needs to ensure there are sufficient staff and they are deployed appropriately to meet the changing needs of the people living in the home. Evidence: The organisation has sound recruitment policies and procedures in place in line with good practice guidelines. Staff we met felt the recruitment process was thorough including a good induction. The manager described how staff who successfully complete their six month probationary period are registered for the Learning Disability Qualification (LDQ) and the National Vocational Qualification (NVQ) relevant to their role and responsibilities. All new staff should be issued with a clear job description and contract of employment, which in addition to the induction programme will ensure they understand their role and responsibilities and are aware of the policies and procedures that guide their practice. In some of the files we examined the checklist was not completed confirming that the job description and and contract had been issued. All necessary security checks and references were in place making sure staff are both safe and suitable for the role. 75 of the current staff team hold a National Vocational Qualification (NVQ) in care level 2 or above, which is good practice. We examined staff files and met with a number of staff on duty. It was evident staff are receiving a thorough induction when they start, including both basic skills training and more specialist subjects relevant to their role and the needs of the people living in the home. It is recommended that infection control training is now provided to staff to make sure they follow good practice guidelines and reduce the risk of infections. The staff are working closely with other professionals and specialist services to make sure they understand and are responding consistently, to the individuals living in the home. Regular reviews are taking place with staff to make sure they are aware of changing needs and new strategies that support and guide their practice. Evidence: Due to the specialist needs of the people currently living in the home further specialist training should be planned in key areas to ensure staff have the skills and knowledge to support people effectively. Currently staff are only receiving basic awareness training in specialist areas such as Autism awareness. We examined staff rotas and spoke to the manager and staff on duty. Based on these discussions and observations it is evident the home needs between five and six care staff on duty to safely meet the needs of the people currently living in the home. Since opening the home has experienced staff shortages and at times has been reliant on inexperienced relief staff. On the day of this inspection despite only two people remaining in the home during the day, the staff levels remained the same as when there were four people present. The deployment of staff should be reviewed to make sure they are being used effectively to meet the changing needs of the people living in the home. Although staff we met and received survey responses from confirmed they received support from the manager, formal supervision meetings have not been taking place as required. Regular recorded supervision meetings with a senior member of staff or the manager should be taking place at least every two months. This gives the manager and staff member the opportunity to reflect on their practice, identify training and development needs and have their performance monitored, as well as being an opportunity to share relevant information and updates. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management structure in the home must be improved to make sure a Registered Manager is in full-time day to day charge of the home. Evidence: The Registered Manager Mrs D Nutt is suitably experienced for the role. However she spends a limited amount of time in the home due to her other responsibilities. Her main role identified in the service user guide is Service Director for Cumbria and the day to day management of the home has been delegated to another manager. It was evident from this inspection there are shortfalls in key areas of the administration and management of the home. This situation was discussed with the Registered Manager Mrs Nutt. She explained that the organisation had just negotiated an increase in funding that will enable them to appoint additional supervisory staff, care staff and domestic and administrative staff. It is recommended the new staffing structure is implemented as soon as practicable ensuring there is increased supervisory support and care staff in place on each shift and the care staff are supported by both domestic staff and administrative staff to enable them to focus on supporting the people living in the home. On the whole staff said they were well supported and the manager was accessible and alternative on call arrangements were in place for out of hours concerns or guidance. A list of staff meetings were planned for the year on a monthly basis, however when we examined the staff meeting minutes only one meeting was recorded. More regular meetings should be taking place to enable staff to share information, changes and concerns, which will help them to provide a flexible and consistent service. Although the service is new there was evidence of regular reviews and consultation taking place. Plans are also in place to introduce formal quality questionnaires to get feedback Evidence: from all the people with an interest in the home. Although significant events had taken place in the home such as two safeguarding referrals and medication errors these had not been recorded as required under Regulation 37. The manager must ensure all significant events as described in the regulations must be reported in writing to the Commission. The organisation has developed a comprehensive range of policies and procedures that guide and support good practice in the home and are in line with current legislation. These are introduced to staff through the induction process making sure they have a good understanding of the procedures relevant to their role. The records we examined were on the whole up to date and accurate. They were all securely stored in line with Data protection guidelines but were accessible to people as required. The servicing and maintenance of equipments has taken place and was recorded in the homes health and safety record and on the AQAA. Routine safety checks were taking place daily, weekly and monthly including fridge temperatures, fire alarms, emergency lighting and means of escape. However there was no record of freezer temperatures and hot water temperatures or a risk assessment regarding Legionella. In addition fire drills with staff had not taken place since the home opened. The home has a suitable business plan and financial monitoring systems in place to ensure the financial viability of the home. Appropriate insurance cover is in place for the protection of the business. Staff were aware of the management structure within the organisation and had a good insight to the lines of accountability and management support structures. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description Timescale for action 1 42 13 Routine fire drills and health 31/05/2010 and safety checks must take place at the required intervals to make sure people living and working in the home are safe at all times. If regular drills and checks are not taking place people will be at risk. 2 42 37 The manager must ensure all 04/06/2010 significant events as described in the regulations must be reported in writing to the Commission in line with Regulation 37. The Commission must be informed of any death, illness or significant events taking place in the home. 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 Deprivation of Liberty safeguards should be reviewed in relation to specific situations in the home to ensure people are not being deprived of their liberty and good practice guidelines are followed. A review of the activities provided to people should take place on a regular basis to ensure people are being provided with a suitable range of activities both in the home environment and in the local community. It is recommended people are weighed on a regular basis to enable a full nutritional assessment to be maintained. The front doors to the flats could be improved by personalising the doors making it easily recognisable by the person living there and making the environment feel more homely. All new staff should be issued with a contract and job description to ensure they understand their role and responsibilities. The deployment of staff should be reviewed to make sure they are being used effectively to meet the changing needs of the people living in the home. Due to the specialist needs of the people currently living in the home further specialist training should be planned in key areas to ensure staff have the skills and knowledge to support people effectively. It is recommended that infection control training is now provided to staff to make sure they follow good practice guidelines and reduce the risk of infections. All staff should be holding formal supervision meetings with their line manager or supervisor on a regular basis, to enable them to reflect on their practice and receive support and guidance in their role. It is recommended the new staffing structure is implemented as soon as practicable ensuring there is increased supervisory support and care staff in place on each shift and the care staff are supported by both 2 11 3 4 17 24 5 31 6 33 7 35 8 35 9 36 10 37 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 domestic staff and administrative staff to enable them to focus on supporting the people living in the home. 11 38 More regular staff meetings should be taking place to enable staff to share information, changes and concerns, which will help them to provide a flexible and consistent service. Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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