Care Home: Edward House

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What the care home does well Edward House is able to provide accommodation to residents with mental health needs Staff undertake good assessments to ensure that prospective service users needs can be met Service users are encouraged to take an active part in the care planning process and positive relationships are maintained between staff and service users. Service users are encouraged to be independent, are enabled to take informed risks and are supported in maintaining relationships. Good links are maintained with appropriate health care professionals. An atmosphere is maintained where service users feel safe to raise concerns. Residents felt they were well looked after by the staff who they described as, Warm, caring and kind. A resident said, I don`t think we could ask for more, everyone is so kind and friendly. Residents are encouraged to visit Edward House and ask questions of the staff to help them make a decision about the home. Residents spoken with felt the staff know there likes and dislikes well. One resident said, The staff encouraged me to keep my independence. The care practices in the home ensure the residents health and personal care needs are met. One resident said, I am well cared for here, they keep a good eye on me. The residents have some choice about their daily routine and can spend time doing what their individual preferences are. One resident enjoyed reading her book quietly and she said this was respected. The staff records were well maintained and the home had the systems in place for recruitment checks prior to employment. The systems and procedures in place for dealing with medication were satisfactory. What has improved since the last inspection? In the months since the last inspection service users no longer smoke in the house. A smoke shelter has been erected outside and this is now used. One service user said that they are able to use both lounges now which is much better for them The lounges have been decorated and look fresh and clean. The menus have been reviewed and reflect the choices and decisions service users said they wanted to the meals. The activity service users take part in is included in the care planning. This means that you can see what sort of activity or occupation service users take part in. Residents meetings are now held approximately four or five times a year. This is how often service users want to meet with staff to discuss the development of EdwardHouse. All staff whatever job they have now have access to induction training , supervision and protection of vulnerable adults training. This was recommended on the last inspection. The manager said that they were on track for a minimum of fifty percent of staff obtaining NVQ training. The manager said that she continually keeps under review the staffing levels over the weekend ensuring any additional staff are recorded on the staff duty roster. What the care home could do better: Outcomes for service users continue to remain positive as reported on previous inspection reports. The manager needs to look at providing service users as a part of the basic contract price the option of a minimum seven day annual holiday outside the home, which they help to choose and plan. To show that service users have a choice of meals at each meal time the menu needs to detail these choices. When medication is prescribed after the medication records are printed or if something is missed of the printed sheets. The manager needs to ensure when staff handwrite medication on the medication records this is signed by them and also signed by a second member of staff who has checked and can confirm and verify that the entry is correct. To further demonstrate the comments, complaints and incidents identified by service users, their advocates or their families the manager needs to record these in a central complaints/comments record and detail the action taken to remedy the compliant and the outcome for the complainant. The manager needs to arrange for staff to have first aid and food hygiene training at the right time so they are up to date with safe and acceptable practice which in turn will safeguard themselves and service users. The unannounced monthly visits by a Representative of the company must be reinstated so they can be assured that the home is run and managed effectively and they are accountable and are aware of what is happening at the home. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Edward House 14/16 Edward Street Werneth Oldham OL9 7QW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kath Oldham     Date: 2 9 1 0 2 0 0 8 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. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Edward House 14/16 Edward Street Werneth Oldham OL9 7QW 01616241908 01616203550 christine.mercer@turning-point.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Turning Point care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia 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: Mental disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 17 Date of last inspection Brief description of the care home Edward House is a large Victorian property, owned and managed by the charity Turning Point. The home is situated close to Oldham town centre, local amenities and public transport. Accommodation is provided in 12 single rooms, eight of which have ensuite. Two of these rooms also include a bath and shower. There are also three shared rooms, two lounges one of which is no smoking and a large dining room. There are ample communal toilets and bathrooms in addition to ensuite facilities. Attractive gardens are to the front of the property with patio garden areas to the rear. The home does not provide a lift, however most of the residents are physically able. Ground floor bedrooms are available as is an assisted bathroom, which provides level access for those residents who may find stairs difficult or require assistance. Edward Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 17 Brief description of the care home House is registered to provide care for up to 17 residents with enduring mental health problems and is a community-based project. Their aim is to encourage residents to take an active part in the community through education, work based projects and community work. Residents are provided with a licensing agreement, which states what they can expect from services in the home. This also includes information on how to access the complaints procedure. A copy of the last inspection report is on display in the hallway of the home. The weekly range of fees charged by the home range from range from #587.63 to #630.00 Additional charges are made for hairdressing, personal toiletries, podiatry and magazines. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. This visit was unannounced, which means the manager and staff were not told we would be visiting, and took place on 28th October 2008 commencing at 9.15am. The inspection of Edward House included a look at all available information received by the Commission for Social Care Inspection (CSCI) about the service since the last inspection in October 2007. We also sent the manager a form before the visit for them to complete and tell us what Care Homes for Adults (18-65 years) Page 6 of 33 they thought they did well, and what they need to improve on. The manager completed this. We considered the responses and information provided and have referred to this in the report. We call this form the Annual Quality Assurance Assessment (AQAA). Edward House was inspected against standards that cover the support provided, daily routines and lifestyle, choices, complaints, comfort, how staff are employed and trained, and how the service is managed. Comment cards were sent prior to the inspection for distribution to staff and posted to specific residents to obtain their views of the service, the views expressed in returned comment cards and those given directly to the inspector are included in this report. We found our information at the visit by observing care practices, talking with people staying at Edward House, talking with the manager and staff. A sample of care, employment and health and safety records were looked at. The main focus of the inspection was to understand how Edward House was meeting the needs of residents and how well the staff themselves were supported to make sure that they had the skills, training and supervision needed to meet the needs of residents. The care service provided to three residents were looked at in detail to help form an opinion of the quality of the care provided. A brief explanation of the inspection process was provided to the manager on our arrival at Edward House. Since the last inspection at Edward House we have not received any complaints, concerns or safeguarding matters. The weekly range of fees charged by the home range from range from 587.63 to 630.00 Additional charges are made for hairdressing, personal toiletries, podiatry and magazines. What the care home does well: What has improved since the last inspection? In the months since the last inspection service users no longer smoke in the house. A smoke shelter has been erected outside and this is now used. One service user said that they are able to use both lounges now which is much better for them The lounges have been decorated and look fresh and clean. The menus have been reviewed and reflect the choices and decisions service users said they wanted to the meals. The activity service users take part in is included in the care planning. This means that you can see what sort of activity or occupation service users take part in. Residents meetings are now held approximately four or five times a year. This is how often service users want to meet with staff to discuss the development of Edward Care Homes for Adults (18-65 years) Page 8 of 33 House. All staff whatever job they have now have access to induction training , supervision and protection of vulnerable adults training. This was recommended on the last inspection. The manager said that they were on track for a minimum of fifty percent of staff obtaining NVQ training. The manager said that she continually keeps under review the staffing levels over the weekend ensuring any additional staff are recorded on the staff duty roster. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get Care Homes for Adults (18-65 years) Page 9 of 33 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users needs are assessed and they or their representatives, are able to visit before a decision is made that the home is right for them. Evidence: A selection of service user files were looked at. We looked at some of the service users who had been admitted to Edward House since the last inspection. The ones we looked at contained evidence of an assessment having been undertaken by an appropriate professional. Each service user has an individual pre admission assessment carried out to see whether the service can meet their needs. This is usually carried out by the service users community Psychiatric nurse or social worker. Once this information is received the manager assesses this to check whether the home is the right place for them. Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: At this stage the manager would go out to see the person and carry out their own assessment. If all goes well then arrangements are made for the person to visit Edward House perhaps for a meal then longer visits can then be arranged. This the manager said was dependent on the individual. The manager said the introductory visits can take place over any period of time dependent on the person and how, when and how often they want to. One service user told us that they came over a long period of time and met with the other service users and staff and had meals, overnight stays then longer stays to check out the home. Service user comment cards returned to us confirmed that they had enough information to decide to move into Edward House.It was not possible to tell from the comment cards returned to us how long ago each respondent moved into Edward House. Care Homes for Adults (18-65 years) Page 13 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users health, personal and social care needs are met by the use of the homes policies and procedures. Service users are involved in decision making about their lives, including taking informed risks. Evidence: A selection of service user files were looked at. All had a written plan of care and had recent reviews some with community based professionals. There was evidence that staff had monitored service users care and support and these were recorded in the service users files seen. There was also written evidence that service users as well as professionals were involved in the planning of their care. Service users who were spoken with said that they talk regularly with their key workers and also attend meetings to discuss their care and support. Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: Staff spoken with confirmed they have up to date information on service users needs to enable them to provide care and support. Staff said they promote equality and diversity through daily communication with service users, activities appropriate to individuals and meeting with service users. Care plans identify religious or cultural requirements which support service users to live the life they choose. All service users spoken with were positive about the support they receive. A service user said, they had been told by staff, if you ever need anything just come to us. Case records looked to be well maintained. Staff who were spoken with said they felt that the written records and the verbal information exchanged at handover, made them aware of the current care and support needs of each person at Edward House. The manager said, we encourage and support all service users to be involved in changes in their support plan and make informed decisions from advice given to them on how they would like to be supported. Service users are deemed to have capacity unless otherwise indicated in their care files and are supported in taking risks as part of their independent lifestyle. Observations and discussion with service users confirmed that service users are free to leave and return to Edward House. Service users in their comment cards indicated that they made decisions about what to do each day, and could do what they want to do. One service user said that the best thing about Edward House, you can come and go as you like. Another said, you have your own room and your own things. The risk assessments were completed in detail to demonstrate that risks are minimised, without taking away the persons right to take informed risks. A risk assessment relating to a service user administering their own medication detailed the steps taken to protect themselves and other service users from accessing that medication. Care Homes for Adults (18-65 years) Page 15 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have opportunities for personal development through taking part in pastimes in the community and are able to maintain personal relationships. Service users health and wellbeing is promoted by the provision of good food. Evidence: It was reported in the AQAA that, We ensure that each service user has access to any educational facilities, courses, classes and that they are supported to attend and develop themselves in which ever way they choose to. We encourage positive risk taking to enable service users to undertake activities they may not have had the opportunity to undertake in the past. Service users told us about the range of activities in the community which people living at Edward House could and did, take part in. These included computer courses, Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: visiting the library, attending keep fit classes, arts and drama. Taking part in specific past times are not compulsory, but if appropriate through the care planning process are encouraged. We observed the interactions between staff and service users which were appropriate there were obvious mutual respect between service users and staff. Visitors are allowed at any reasonable time. One service user said their family come when they feel like it. Service users should have as part of the basic contract price the option of a minimum seven day annual holiday outside the home which they help to choose and plan. The manager said that the funds have not been available to arrange this. Oner service user said they hadnt been away on holiday for about two years. Service users spoken to were complimentary about the food available to them. A service users told us they get there own breakfast and staff make the rest of the meals. One service user said he made a meal for everyone in the house monthly and others commented on enjoying these meals. A resident said they have vegetarian meal options and that they were nice. The manager said that the service users had discussed the menus and the menu had been complied from their suggestions. Edward House has a four week menu. The menu didnt detail the choices staff told us were available to service users at lunchtime. There was only one meal indicated. We were told that there was always a choice from two with baked potatoes or sandwiches always being available in addition to the menu. Records of food eaten by individual service users was not routinely kept. This was discussed with the manager who said more detailed records would be kept if their was specific problem for an individual service users in connection with eating. Care Homes for Adults (18-65 years) Page 17 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users physical and emotional health needs are met in a way they choose. Edwards Houses procedures in medication administration are implemented to benefit the service users. Evidence: All service users we spoke to were happy about the support they received from staff. Comments included, Staff are fantastic, we get on really well, they help me keep on trackwere some of the comments made. As mentioned previously in the section individual needs and choices there was evidence of service users being involved in the way their care and support is planned and provided. The care plans we looked at had information about service users health, personal care and support needs. Service users are encouraged to complete their own personal care routines and are given support where needed. Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: Service users are encouraged to make their own choices about a variety of things including what time they go to bed, whether to take a bath or a shower. Service users are supported to complete daily routines when they are able for example laundry, keeping their rooms tidy and clean. Staff support some service users with health care appointments. Staff are aware of the importance of service users dignity and respect ensuring that this is promoted in everything that they do to support service users. Interactions between service users and staff were observed to be relaxed and appropriate as well as being respectful and promoting the persons individuality.For example service users were informed who the inspector was what she was doing and asked if they minded sharing time with her. Evidence was also observed where personal things were dealt with sensitively and discreetly. Service users are registered with a local GP which enables them to visit their doctor when they need to without too much inconvenience. Service users said they were able to access support from health care professionals. Many service users routinely received support from community and hospital based mental health workers. There was also written detail that service users were able to access chiropodists, opticians and dentists. This was recorded in the service users individual file. One service user said they were supported to go to see the doctor for a check up. Edward House uses a pre dispensed monitored dosage system to administer service users medication. Medication was seen to be securely stored. The team leader undertakes a weekly audit of the medication and records her findings of that audit. A record is made of her observations from that audit and the action taken to address any shortfalls. This ensures that any omissions or errors are quickly identified and action taken with staff. The manager explained some of the actions that they have taken to ensure service users medication is administered by staff safely and as prescribed. We looked at the medication administration records which were being used by staff to record service users medication. This record started on the week of the inspection. The records were completed in line with procedures.The staff also keep a separate record in relation to medication to inform other staff if there have been any problems or if there are any messages in relation to medication to be passed on. There was a record on the day of the inspection visit that some medication had been found discarded. We Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: talked with the manager about this. We were told that staff do observe service users take their medication but this is not always enough as some service users may discard medication when it appears they have taken it. The staff had a good idea where this medication was from and were monitoring this. Service users had a photograph on the medication administration records which is considered to be best practice to avoid the possibility of mistaken identity. Some medication was handwritten on the medication records by staff. This is usually when new medication has been prescribed since the medication records have been printed by the pharmacist. Best practice is to ensure that this record is signed by the person who copies the detail from the prescription and also signed by a second person to verify the entry as correct. This gives a further safeguard to service users and they are given the right amount of medication at the right time.This needs to be arranged at Edward House. Care Homes for Adults (18-65 years) Page 20 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are confident that any complaint would be dealt with and are protected from abuse by the policies and procedures in place. Evidence: Edward House has a written complaints procedure which was found to be appropriate on the last key inspection. This was not looked at at this inspection visit. Service users spoken to were confident that any comment or complaint would be taken seriously by the staff and management. The comment cards completed by service users said they knew who to talk to if they were not happy. The atmosphere in the house was relaxed. One service user said she had told staff that there radiator wasnt working and staff had arranged for a contractor to come to the house and repair the radiator. The service user said they were pleased at the quick response. There were no records of any comments or complaints in a central record. The manager said that comments and complaints are dealt with as they come up and are often recorded in case notes or at handover or at residents meetings. We looked at some of these records and we werent able to easily see this. Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: It would be better if these comments and complaints were recorded together so it would be easier to see if for example there were any patterns to complaints and this would also assist in the development of the service as it could be also used in the managers quality audit. The training information provided indicated that staff had attended protection of vulnerable adults training as part of their induction training.Staff spoken with confirmed this and showed from conversation that they had an understanding of what constitutes abuse and what action was needed if abuse was alleged. Staff understood the need to be aware of the possibility of vulnerable adults being abused or exploited. One staff member was confident that if necessary they would whistle blow. All service users spoken to at Edward House felt safe and those who were asked thought other service users were also safe. Care Homes for Adults (18-65 years) Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Edward House is appropriately maintained, decorated and cleaned to enable service users to live in a pleasant and safe environment. Evidence: There have been no major structural changes to the environment since the last inspection. Health and safety training is in place. Policies and procedures are in place for keeping the house clean, safe and tidy. Health and safety records show checks of the building both inside and outside. Up to date safety certificates were in place. Service users no longer smoke in the house and the lounges have been painted since changes in legislation which indicated that smoking couldnt take place in the house. A smoke shelter has been erected outside and service users were seen to use this and other outside areas to smoke. One service user who didnt smoke said they felt sorry that the smokers had to go out in the cold weather to have a smoke. One service user told us that they were able to use all areas of the home now people smoked outside which they couldnt do before because of the cigarette smoke. Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: Service users who were spoken to said they liked where they lived and it was always clean and fresh. Edward House presented as clean and tidy with no unpleasant odours. Service users said this was how it always looked at that it was nice. The manager told us that it is planned that the next job in the house was to spruce up the inner hallway and this is scheduled within next years budget. This should improve the institutional appearance of this area. Care Homes for Adults (18-65 years) Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The number and skill mix of staff on duty promotes the independence and well being of service users. Recruitment and selection procedures are in place to protect service users. Evidence: Staff have clearly identified roles and information available to them to support them to meet service users needs. Staff spoken with were very clear on the individual care needs of the service users they support. New staff go through a selection procedure to make sure they re suitable for the position. This includes completing a job application form, having an interview,providing references and having a criminal record bureau disclosure (CRB) undertaken before they start work at Edward House. Staff files viewed confirmed this. New staff have induction training before they start work.This is as it should be. Staff then have the background and the basics to start working with vulnerable people. Most of the staff have either completed or have started NVQ level 2 or 3 in care.This gives them the necessary skills and abilities to do there job well. Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: Service users and staff were observed to interact positively and had a respect for one another. The atmosphere at Edward House was relaxed and pleasant. Staff who were spoken to or completed comment cards said the manager was very supportive of staff taking part in training. Some staff were not recorded as having taken part in recent training in food hygiene or first aid training. The manager sent us an e mail after the inspection and said that she was trying to get staff places on food hygiene and firsd aid courses on 18th and 19th November 2008. If they are unable to get all the staff who need this training on these particular dates they will have a new training calender by January 2009. Care Homes for Adults (18-65 years) Page 26 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are able to voice their opinions, promoting ownership in the home. Evidence: Service users and staff spoken to were very positive about the managers approach and competency. The manager was reported as having appropriate qualifications for the role. Proof of qualifications was not asked for at this inspection. Service users reported being involved in their care planning and felt listened to. Service user meetings were also arranged. The manager said they were as often as the service users wanted as any more often the manager said then service users wouldnt come. Minutes and notes of meetings were seen. These meetings offer a opportunity where service users views can be aired. The manager reported in the AQAA that the homes health and safety and other policies had been reviewed in the last twelve months. This is to keep up to date with any changes in practice or to reflect changes in rules or legislation. These were not looked Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: at during this inspection. A selection of records relating to fire detection and alarm systems were looked at and presented as being correctly maintained. Other necessary routine maintenance and checks were reported as being ongoing. No obvious risks to health and safety were observed during this visit. A monthly visit should take place to the home by the registered person or a representative to look at specific things in line with the regulations. A report must be done of this visit. We asked to look at the reports and these were provided. The last report was dated June 2008. The manager said that there had been some senior management changes and this has affected the monthly visits. These visits do need to start again as it is a requirement of the legislation that these are done to make sure that everything is as it should be. While we were at Edward House we noticed that three of the fire doors on the ground floor were wedged open. These doors should close in an emergency when the fire alarm sounds. This will not happen if they are wedged open . This practice compromises the safety of service users and staff. We discussed this with the health and safety officer who said they would speak to the fire service for guidance on this to ensure the safety of people at Edward House. A fire risk assessment was in place which didnt indicate that this was the practice. The manager said that doors are kept open so that service users could get about easily. Whilst we appreciate this their safety could be compromised. The front door of the house is bolted at night before retiring to bed. This practice needs to be discussed with the fire authority, as it may delay exit from the house in an emergency situation. Edward House have annual questionnaires which they give out to service users. The manager said that these had been distributed but she was unable to find the report of the results of the survey. These have to be published and people who have made comments told of the outcome. The comment cards are not currently sent out to everyone who is involved in service users care for example social workers, community nurses, doctors for example. This would provide the manager with another way of checking how Edward House is achieving goals for service users. Care Homes for Adults (18-65 years) Page 28 of 33 Care Homes for Adults (18-65 years) Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 37 26 Undertake the unannounced 27/12/2008 monthly visits by the representative of the company so they can be assured that the home is run and managed effectively and they are accountable for what is happening at the home. This will ensure that the company undertake their responsibility under the regulations 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 14 Provide service users as a part of the basic contract price the option of a minimum seven day annual holiday outside the home, which they help to choose and plan To indicate that service users have a choice of meals at each meal time clearly indicate the choices for all meals available on the menu. When medication is prescribed after the medication records are printed or if something is missed of the printed sheets. Page 31 of 33 2 17 3 20 Care Homes for Adults (18-65 years) Ensure when staff handwrite medication on the medication records this is signed by them and also signed by a second member of staff who has checked and can confirm and verify that the entry is correct. 4 22 To further demonstrate the comments, complaints and incidents identified by service users, their advocates or their families record these in a central complaints/comments record and detail the action taken to remedy the compliant and the outcome for the complainant. Provide staff with first aid and food hygiene training at the right time so they are up to date with safe and acceptable priactice which in turn will safeguard themselves and service users. Extend the quality assurance surveys to include service users families for example, their advocates, social workers, community nurses, doctors or other stakeholders who have involvement with the service user.Produce a report each year from all the comments received and send a copy to the Commission for Social care Inspection (CSCI) Discuss with the Fire Authority the arrangements for locking the front door of the house to ensure this complies with fire procedures and does not compromise the exit route in the event of an emergency situation. Take advice from GM fire service in relation to the practice and routine of wedging open fire doors, to see if there are other ways which the doors can be left open but would close on the sounding of the fire alarm. 5 32 6 39 7 42 8 42 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) 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. 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