Care Home: Edgar Street Residential Care Home

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What the care home does well The residents were provided with appropriate written information about the home, which was presented in a clear format. This meant that the residents were provided with up to date information about the services and facilities available in the home. The residents needs were properly assessed and reviewed at regular intervals. This ensured that the staff were aware of the residents` current needs and preferences. All the residents had a person centred care plan based on their assessment of needs. The plans provided clear guidance for staff on how to meet people`s personal, health and social needs. The plans were supported by thorough risk assessments, which meant the staff had good information about how to manage and respond to any areas of identified risk. This meant the residents were able to able to take responsible risks as part of a varied lifestyle. A key worker system enabled the staff to get to know the residents views, wishes and aspirations. The residents shared good relationships with the staff. One person told us, "I am happy living here, the staff are great". The residents were supported to plan and purchase their own food, this meant that the residents could buy and eat meals of their choice. The residents were supported to hold various voluntary positions in the community. This meant that the residents were able to meet different people and develop their skills in a work environment. Visitors were welcome in the home and the residents were supported to maintain good contact with their family and friends. A relative spoken to was satisfied with the quality of care provided and felt that the residents were looked after in a caring manner. The residents had access to a clear complaints procedure and there were established ways of consulting the people living in the home. This made sure the manager and staff could respond to any concerns. All the residents spoken to were aware of the complaints procedure and who to speak to if they had a concern. A good percentage of staff had achieved NVQ (National Vocational Qualifications) level 2 or above. This meant the staff had the necessary qualifications to carry out their role effectively. The manager had developed ways of monitoring the quality of the service, which included ongoing consultation with the residents and staff. This meant that the residents were able to have some input into the future development of the service. What has improved since the last inspection? Since the last inspection, the residents had been involved in the development of a new service user`s guide, which provided up to date and useful information about the home. The residents had been issued with a contract with the registered provider. The contracts provided clear information about the terms and conditions of living in the home and had been explained to each resident. This meant the residents had a understanding of what they could expect from the service.Monthly group activities had been arranged for all the residents who wished to join in. The residents planned and agreed the activities at each residents` meeting. The residents who had participated in these activities said they had enjoyed them. A number of improvements had been made to the premises to promote the comfort of the residents. These included the redecoration of several areas including the lounge, hall, stairs and landing and kitchen. A new carpet had also been fitted in the hall and stairs and new curtains had been put up in the lounge. The residents confirmed that they had chosen the colour schemes and wallpaper, which meant they had actively influenced the appearance of the home. One person said, "I really like it, it looks much better". The manager has applied for registration with the Commission, which meant that there was a designated person to take legal responsibility, along with the registered provider, for the day to day management of the home. What the care home could do better: Two residents told us that there were limited opportunities to pursue individual activities and they would like to spend more one to one time with staff. However, this was difficult due to the staffing levels, with often only one staff on duty to support 6 residents. The registered provider must therefore consult each resident about their preferred activities and devise a programme of planned activities which meets the residents needs and expectations. The registered provider must also carry out a full review of the staffing levels to ensure the residents benefit from individual support, as is appropriate for their needs and welfare. Three residents separately confirmed that they had been informed that their bedrooms were due to be decorated. They therefore began stripping the wallpaper off the walls. This was several weeks ago and the rooms have not been decorated. This meant the rooms looked shabby and unsightly. The decor in these rooms must therefore be improved, to ensure that the residents have comfortable homely surroundings. There were some recruitment checks missing from one staff member`s personal file and the employment status of this person was unclear and confused. The registered provider must therefore ensure that all relevant checks and records are collated and available for inspection purposes in line with regulatory requirements. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Edgar Street Residential Care Home 3 Edgar Street Huncoat Accrington Lancashire BB5 6ND     The quality rating for this care home is:   one star adequate 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: Julie Playfer     Date: 0 4 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Edgar Street Residential Care Home 3 Edgar Street Huncoat Accrington Lancashire BB5 6ND 01254872119 01254872119 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dr Morgiana Muni Nazerali Name of registered manager (if applicable) Mrs Susan Hendren Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 6 Date of last inspection Brief description of the care home 3 Edgar Street is registered with the Commission for Social Care Inspection to provide personal care and accommodation for 6 adults with a learning disability. The home is semi-detached in a residential cul-de-sac. It is close to local amenities and within walking distance of public transport to the nearest large towns. The accommodation is provided on 2 floors. There is a lounge, conservatory, kitchen with dining area, and laundry facilities. All bedrooms provide single accommodation. The residents have access to and use all areas of the home, with supervision from staff Care Homes for Adults (18-65 years) Page 4 of 30 care home 6 Over 65 0 6 Brief description of the care home if required. Outdoor space, with seating, is available. At the time of the inspection the level of fees ranged from £384.00 to £628.00. The home has a statement of purpose and service users guide, which informs the current and prospective residents about the services and facilities available at the home. Previous inspection reports can be viewed in the home or obtained from the Commissions website at www.csci.org.uk Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 peterchart Poor Adequate Good Excellent How we did our inspection: A key unannounced inspection, which included a visit to the home, was conducted at 3 Edgar Street on 4th February 2009. The inspection was carried out by one inspector, however, the report refers to we as it was written on behalf of the commission. We carried out the previous key inspection of this service on 7th February 2007. We also visited the home on 23rd August 2007, to carry out a random inspection. The purpose of the random inspection was to discuss the management arrangements in the home. An annual service review was carried out on 19th December 2007. At the time of the visit there were 6 residents accommodated in the home. During the inspection we spent time with the residents, looked round the home, read some of the residents care records and other documents and talked to the staff and the manager. Care Homes for Adults (18-65 years) Page 6 of 30 We also consulted our records about the service. As part of the inspection process, we used case tracking as a means of gathering information. This is a way of inspecting which allows us to focus on a small group of residents living at the home, to assess the quality of the service provided. Before to the inspection, the registered provider and regional manager completed an Annual Quality Assurance Assessment known as AQAA. This is a detailed self assessment questionnaire covering all aspects of the operation and management of the home. This provided us with useful information and evidence for the inspection. Satisfaction questionnaires were sent to the home for distribution to the staff and the residents. Three questionnaires were returned from the staff and five questionnaires were received from the residents. The responses from the questionnaires were collated and used throughout the inspection process. What the care home does well: What has improved since the last inspection? Since the last inspection, the residents had been involved in the development of a new service users guide, which provided up to date and useful information about the home. The residents had been issued with a contract with the registered provider. The contracts provided clear information about the terms and conditions of living in the home and had been explained to each resident. This meant the residents had a understanding of what they could expect from the service. Care Homes for Adults (18-65 years) Page 8 of 30 Monthly group activities had been arranged for all the residents who wished to join in. The residents planned and agreed the activities at each residents meeting. The residents who had participated in these activities said they had enjoyed them. A number of improvements had been made to the premises to promote the comfort of the residents. These included the redecoration of several areas including the lounge, hall, stairs and landing and kitchen. A new carpet had also been fitted in the hall and stairs and new curtains had been put up in the lounge. The residents confirmed that they had chosen the colour schemes and wallpaper, which meant they had actively influenced the appearance of the home. One person said, I really like it, it looks much better. The manager has applied for registration with the Commission, which meant that there was a designated person to take legal responsibility, along with the registered provider, for the day to day management of the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents had their needs properly assessed and they were provided with appropriate written information to enable them to make an informed choice about where to live. Evidence: Written information was available for the residents in the form of a statement of purpose and service users guide. Both documents met regulatory requirements and were presented in a clear format. The service users guide had been updated since the last inspection with the full involvement of the residents. As such each person had contributed a paragraph about their experience of living in the home and had received a personal copy of the guide. This meant the residents were provided with up to date information about the services and facilities available in the home. The previous inspection report was available for reference purposes in the hallway and conservatory. The residents had been established in the home for sometime and there had been no Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: new admissions since the last inspection. However, it was clear from viewing the personal files, that the residents needs had been reassessed as part of the development and review of their care plans. The residents confirmed they had participated in their assessment of needs. This meant the staff were aware of the residents needs, wishes and aspirations. Further to this, the manager explained that documentation was available to assess a prospective residents needs, should a vacancy arise in the future. Since the last inspection, the residents had been issued a contract with the current Registered Provider. The contract was detailed and included the level of fees and any extra charges. The contracts had been explained to each resident to ensure they fully understood their rights and obligations. This meant the residents and their families were aware of the terms and conditions of residence and knew what they could expect from the service. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents individual needs were addressed and the residents were well supported to enable them make their own decisions and participate in life in the home. Evidence: The case tracking process demonstrated that each resident had an individual support plan, which reflected their health and welfare needs. The plans were detailed and included clear guidance for staff on how best each resident could be supported to meet their individual goals and needs. Personal profiles were incorporated into the care plan documentation, which provided details about each residents likes and dislikes, preferred activities and things which were important to them. The plans were person centred to ensure the residents fully participated in the development and review of their plans. The plans were written in plain language and looked at all areas of the residents life. The staff maintained daily records of care and support, which provided information about changing needs and any recurring Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: difficulties. The records were detailed and the residents needs were described in respectful and sensitive terms. The residents had free access to their records and one resident said she liked to copy out the staffs notes each day. An established key worker system allowed staff to work on a one to one basis with the residents when reviewing the plans. The care plans were reviewed at monthly intervals. The residents fully participated in their reviews and had signed their plans on each page to indicate their agreement. However, one resident felt that the plans were reviewed too frequently and she inquired if there was a need to sign every page, which at times she said was too much. The resident discussed her views with the manager during the inspection and it was agreed to discuss these issues more fully at the forthcoming residents meeting, in order to find a compromise. The care plans included risk assessments to help support the residents take responsible risks and lead the life they wanted. The risk assessments were supported by risk management strategies or control measures, which provided the staff with guidance on how best to manage and respond to particular risks. This meant risks were managed in a consistent and safe manner. During conversations with the residents, it was evident that they were consulted both formally and informally about life in the home. This was achieved by way of residents meetings, daily conversations, involvement in the recruitment of new staff and satisfaction questionnaires. The residents meetings known as House Chats had been held on a regular basis. This meant the residents had various opportunities to formally express their views about life in the home. At the time of our visit, an agenda had been posted on the window in the conservatory for the residents to contribute topics for the meeting. Policies and procedures were in place to support the residents with their financial affairs. Regular audit checks were carried out by the staff and records were made of all financial transactions. A random check of money deposited in the home for safe keeping corresponded accurately with the records. This meant that the residents finances were fully accounted for and safeguarded. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents were supported to make choices about their lifestyle and were supported to develop their life skills. However, the arrangements for individual activities did not always meet the residents expectations. Evidence: The individual plans and care records demonstrated that the residents had opportunities to maintain and develop practical life skills. As such, residents were supported and encouraged to identify their personal goals and work to achieve them. During the inspection, one resident spoke about the support she had received to achieve a specific task, which had promoted her independence skills. Since the last inspection, a monthly group activity had been organised for those residents wishing to participate. The type of activity was discussed and agreed by the Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: residents at the residents meetings. Recent activities included trips to the theatre, cinema and Blackpool. Following the monthly outings the residents completed a questionnaire about what they liked or disliked about the event, however, two residents said they did not want to fill in the questionnaires. One person said, Its too much filling in the same paperwork all the time. Overall the residents had mixed views about the sort and frequency of activities. Two residents said they wanted to participate in more individual activities and this was often difficult due to the level of staffing. One resident said, I would really like to go out more with the staff, I get bored at home. Further to this, one person indicated in a questionnaire that she was not able to do what she wanted to do during the day, evening and weekend, Because there is only 1 support worker most days, I dont get one to one time. We also noted that one resident had not been out for several days, however, it was unclear whether this situation was due to the residents personal wishes or the level of staffing available. The residents held various voluntary positions within the local community. These included working in a school, a resource centre and a number of charity shops. All the residents spoken to said that they enjoyed their work and one person was celebrating a recent promotion. This meant that the residents were able to develop their skills in a work environment and meet new people. The residents were supported to develop and maintain important personal and family relationships. As such friends and family were welcome to visit at anytime convenient to the residents. This meant the residents could continue to play a key role in family life and develop significant personal relationships. A relative spoken to at the time of the inspection was pleased with the care and support provided to his daughter. The residents had unrestricted access to the communal areas and grounds. The residents were also able to use their room at anytime should they wish to spend time alone. The residents said they enjoyed spending time in their rooms. All the residents had been issued with keys, so they could lock the door to their private accommodation. The residents planned individual menus, a week in advance and were given an amount of money each week to purchase food of their choice. Separate storage facilities were available for each resident to store their food in the kitchen. The residents received support, as appropriate, to purchase, prepare and serve their food. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care received by residents was based on their individual needs. Evidence: The individual plans clearly set out the personal support required by each resident and provided guidance to staff on how the residents wished to receive this support. The residents spoken to confirmed that personal care was responsive to their needs and preferences. Discussion with staff demonstrated their awareness of the residents rights to privacy and dignity and the need to respond sensitively to individual issues and changing needs. This meant that the delivery of personal care was flexible and reliable. Health care needs were appropriately assessed and were included in the care plans. In addition to the care plans each resident had a health action plan, which detailed their medical history and current health needs. A separate record was made of medical appointments and there was evidence to indicate that the residents had access to specialist NHS services such as the Learning Disability Consultant. The residents also attended routine health appointments with the dentist and optician. This meant the residents healthcare needs were understood by the staff team and an Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: appropriate response was made to changing needs. Policies and procedures were in place to cover the management of medicines and were available for staff reference in the medication file. The home operated a monitored dosage system of medication, which was dispensed into blister packs by a local Pharmacist. All staff designated to administer medication had received accredited training. Several of the residents self administered their medication and risk assessments had been devised to cover any risks associated with this task. Appropriate records were in place to record the receipt, administration and disposal of medication, however, it was noted that not all handwritten entries had been countersigned by two staff and not all instructions from the prescription label had been recorded on the medication administration record. We also noted that procedures had not been drawn up to identify the specific circumstances for administering medication prescribed as necessary. It is important for staff to have ready access to this information to ensure all medication is given to the residents in a safe and consistent manner. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were able to express their views had access to a clear complaints procedure. There were established ways of working to respond effectively to any suspicion or allegation of harmful practice. Evidence: The manager had established ways of working to consult the residents and ensure they had the opportunity to express their views. This was achieved by means of the residents meetings, satisfaction questionnaires and daily conversations. The residents spoken to said they were able to voice their opinions about life in the home. Staff who completed a questionnaire indicated they were aware of what to do if the residents or their family had a concern. One member of staff wrote, I listen to the concerns and pass on to my manager, when necessary. This ensured any problems were addressed as quickly as possible. The complaints procedure was included in the service users guide and had been explained to the residents. The procedure contained the necessary information and included the relevant telephone numbers and contact details should a resident wish to raise a concern. All the residents spoken to and who completed a questionnaire were aware of the complaints procedure and how to raise a concern. According to records seen at the time of the inspection, three complaints had been Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: received during the last 12 months. Two complaints were raised by a relative and one was raised by a resident. The latter was directed through the Commission. All three complaints had been investigated under the homes complaints procedure and records had been made of the investigations and outcomes. Policies and procedures for safeguarding vulnerable adults provided guidance for staff should they suspect or witness any harmful practice. These issues were incorporated into the induction and mandatory training and staff received specific tuition as part of their NVQ training. The staff also had access to a whistle blowing procedure. This procedure set out a system for staff to report any concerns about colleagues or managers to the relevant authorities. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents were provided with a clean, pleasant and comfortable living environment. Evidence: 3 Edgar Street is a semi detached house situated in a residential area in Huncoat. It is close to local amenities and within walking distance of public transport to the nearby towns. Accommodation is provided in six single bedrooms on two floors. None of the bedrooms have an ensuite facility. There is one bathroom and shower room on the first floor and a toilet on the ground floor. Communal space is provided in a living room, dining kitchen and conservatory. The latter also doubles as a staff office and staff sleeping in area. Since the last inspection several areas had been decorated to good effect. These included the living room, the dining room and stairs and hallway, along with the toilet and shower room. A new carpet had been laid in hall, stairs and landing and new curtains had been fitted in the lounge. The residents were fully involved in the decoration of the home and said that they had enjoyed choosing the colour schemes and wallpaper. However, we noted that three residents had taken large amounts of the wallpaper off the walls in their bedrooms. As result the rooms looked very shabby and Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: unsightly. All three residents separately confirmed they had taken the wallpaper off several weeks ago on the understanding that the rooms were due to be decorated. However, the rooms had not been decorated at the time of the inspection. The manager explained that plans were now in place to decorate the rooms in March, when the residents were away on holiday. The residents had personalised their rooms according to their own tastes and preferences. All furnishings were domestic in character and were of a satisfactory standard throughout. The manager confirmed that arrangements were in place for general maintenance and repairs. This meant that routine problems with the building could be promptly rectified. The home had a good standard of cleanliness in all areas seen and was free from offensive odours. Arrangements were in place for the residents to do their own laundry, which meant the residents could maintain and build on their independence skills. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The level of staffing meant that residents were not always able to benefit from individual support. Some recruitment records were not available, which meant that the recruitment process was unclear and confused. Evidence: Staff had been issued with an appropriate job description, employers handbook and contract of employment. During conversations with the staff, it was evident that they were aware of the limitations of their role and had a good understanding of the needs of the residents. Staff referred to the residents in respectful terms and were observed to interact with the residents in a pleasant way. A staff roster was completed in advance and provided a record of the number of hours worked by the staff in the home. Whilst information supplied in the AQAA indicated that the staffing levels were reviewed and altered as needed to accommodate the residents specific needs, two residents were concerned about the minimum level of staffing and the impact this was having on their ability to pursue individual activities with appropriate staff support. It was also apparent that the manager was sometimes working in another service, which again affected the level of staffing. As such, there was often one member of staff on duty to support six residents. This meant that there Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: were only limited opportunities for the residents to spend individual time with staff. There was a recruitment and selection procedure in place, however, on viewing the staff files at the time of the site visit we noted significant shortfalls in the recruitment of one member of staff. It was stated and confirmed that this person left the company and then returned to a different position. There were no recruitment records seen in the persons file apart from a CRB reference number and a letter from the Registered Provider. However, following the inspection, information was submitted to us to indicate that the person was previously employed as a bank staff and had continuous employment. Recruitment checks carried out at the time of the persons employment as a bank staff were not available for inspection purposes, this meant that both the Manager and Area Manager were not able to confirm the persons employment status until after the site visit. Arrangements were in place for all new staff to receive appropriate induction training, which was carried out during the first three months of employment. Each member of staff had a training assessment and profile and there was a training development plan for the overall staff team. This meant the manager was able to identify any future training needs for individual staff and for the staff team as a whole. At the time of the inspection, two of the three care staff had completed NVQ level 2 or above, which equated to 66 of the staff team. In addition, one person was working towards this qualification. This meant the majority of the staff team had achieved the necessary qualifications to enable them to carry out their role effectively and efficiently. All members of staff who completed a questionnaire confirmed they had received training relevant to their role. Consultation with staff was ongoing and handover arrangements had been maintained. Staff had the opportunity to attend meetings on a regular basis and minutes were seen of the last meeting held in the home. The staff were encouraged to add to the agenda and discuss issues affecting the operation of the home. Arrangements were in place to ensure the staff received supervision with the manager. This enabled the staff to talk about their experience about working in the home and identify any future training needs. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and safety of residents was protected. However, the overall management of the home in relation to the availability of staff recruitment records and the allocation of staff time did not always reflect the best interests of the residents. Evidence: Since the last inspection, there have been two changes of manager, which meant that the residents have had to adjust to different ways of working and varying styles of leadership. These changes resulted in an unsettled time for the residents. The current manager has now held the position for several months and has applied for registration with the Commission. The manager has completed NVQ level 4 in Care and was working towards a Leadership and Management Award. She also had many years experience of supporting people in a variety of community settings. However, we noted that the manager was spending some time away from the home, which in turn affected the level of staffing provided for the residents and the level of support provided for care staff. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: As referred to in the Staffing section, there were concerns about how the recruitment of one member of staff had been managed and the fact that there were some recruitment records missing relating to this persons employment. The management approach was consultative and there were established ways of working to consult the staff and residents on an ongoing basis. Relationships within the home were positive and staff spoke to and about the residents in respectful terms. One resident said, The staff are very helpful and caring. They do what they can to help. The manager had established a quality assurance system to ensure the service was continuously monitored. The service has an Investors in People Award and has Preferred Provider Status with the Local Authority. Satisfaction questionnaires were distributed to the residents, their relatives and the staff once a year. The questionnaires were last given out in September 2008. The results of the survey had been collated and feedback had been given to the residents about their participation at a residents meeting. The manager had produced a development plan, which set out the objectives for the forthcoming year based on the results of the quality monitoring processes. This document linked with the AQAA questionnaire submitted to the Commission. All sections of the AQAA were completed and the information provided gave a clear picture of the current situation within the service and the planned areas for development. There was a set of health and safety policies and procedures, which included the safe storage of hazardous substances, food safety and infection control. Staff received mandatory health and safety training, which included moving and handling, food hygiene, first aid and fire safety. Documentation seen during the inspection and information supplied in the AQAA indicated that the electrical, gas and fire systems were serviced at regular intervals. The fire log demonstrated that the staff had received instructions about the fire procedures during their induction and had participated in regular fire drills. Arrangements were in place to record accidents and incidents in the home and the Commission had been notified as appropriate of any significant event in the home. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 14 16 Following individual 30/03/2009 consultation with the residents, a programme of planned activities must be established, in order to meet with the residents personal and social needs. This is to ensure the residents pursue individual meaningful activities of their choice and they receive appropriate support from the staff team. 2 26 23 The residents bedrooms must be kept reasonably decorated. This is to ensure that the residents have comfortable homely bedrooms. The registered provider must ensure that a full review is carried out of the staffing levels provided. This is to ensure that the residents benefit from individual support as is 01/04/2009 3 33 18 30/04/2009 Care Homes for Adults (18-65 years) Page 28 of 30 appropriate for their needs and welfare. 4 34 19 Staff recruitment records 30/04/2009 must be collated in line with regulatory requirements and be available for inspection purposes. This is to ensure the registered people can fully demonstrate that staff have been appropriately checked prior to employment. 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 20 Protocols should be drawn up for the administration of all medication prescribed as necessary. All handwritten entries should be countersigned by two staff and all instructions from the prescription labels should be recorded on the medication and administration record. This is to ensure all medication is administered consistently and safely. Care Homes for Adults (18-65 years) Page 29 of 30 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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