Care Home: Eleanor House Care Home

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What the care home does well The atmosphere was very relaxed and the people that use the service were seen to be very happy and comfortable in their surroundings. The staff appeared to be very friendly and they knew about the care that the people that use the service needed. The staff spoken to by the Commission said that they enjoyed working in the home. Most of the staff have worked at the home for a long time. This means that they know all of the people that live there and understand how to look after them properly and safely. People that live at the home said that they were happy and liked their individual rooms. What has improved since the last inspection? The staff training and supervision programmes had improved since the last inspection. This means that the staff that they need to make sure that they have the knowledge and skills to be able to care for the people that they are responsible for. In some areeas of the home the environment has improved creating a more homely and safe environment for the people that use the service and for thioose people that work at the home. What the care home could do better: The service could provide more detail in their assessments of need and care plans. This will help to make sure that peoples needs are supported in a way that is acceptable to them and that anyone reading the documents can follow the details in a similar way as the last person. The bathrooms of the home should be re-fitted to allow better access to support people that are using these areas and to create a more modern, comfortable and safe environment. The manager needs to keep the Commission informed of any serious events that happen in the home. This will help to safeguard the people that use the service. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Eleanor House Care Home 19 Eleanor Street Grimsby North East Lincs DN32 9DT     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: Stephen Robertshaw     Date: 1 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.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: Eleanor House Care Home 19 Eleanor Street Grimsby North East Lincs DN32 9DT 01472359330 01472359330 L.robinsoner@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Kalbro Investments Ltd Name of registered manager (if applicable) Miss Lynne Susan Robinson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 17 The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Mental disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Eleanor House is a care home providing personal care and nursing including accommodation for up to 17 adults with mental health problems. The home is located near to the centre of Grimsby and is close to local shops and there is good access to the public transport system. The accommodation is provided over two floors, a passenger lift is available to the first floor. The home provides double occupancy and single occupancy bedrooms. None of the bedrooms have en-suite facilities. Bathrooms and toilets are provided within close proximity to rooms. Information about the home Care Homes for Adults (18-65 years) Page 4 of 33 care home 17 Over 65 0 17 Brief description of the care home and services that it provides can be found in the homes statement of purpose and service user guide, both these documents are available from the manager at the home. The current weekly charge for services is between #522.00 and #650.00 per week; there are additional charges for hairdressing, private chiropody treatment, toiletries, newspapers and magazines etc. Some individuals are also expected to pay a top up charge of #63 agreed though third party arrangements. More current information about fees and charges can be obtained from the manager of the home. 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 site visit was unannounced and took place on the 10th March 2009. The Commission were at the home for approximately seven hours. We gathered other information used for this inspection report from a variety of different sources since the time of the last inspection. This included an Annual Quality Assurance Assessment that was returned to the Commission by the homes management before the site visit took place, and we case tracked soemn of the people that lived at the home. The Commission also spoke with six of the people that live at the home, three of the care staff and the manager of the service. The Commission also looked around the home and looked at lots of the paperwork that involved the people that use the service. This included looking at asessments and care Care Homes for Adults (18-65 years) Page 6 of 33 plans, staff supervision and training records. The Commission would like to thank everyone that took the time to talk to us during this inspection. Their comments and input have been a valuable source of information and this has helped to determine the outcomes for this report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 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 9 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This means that the people that use the service have their needs assessed before they are admitted to the home This means that the home only admits people that are inside their registration and that they can safely care for. Evidence: The manager of the home stated that new pre-admission assessment material that had been established since the last inspection had been the assessment format used for all new prospective people to live at the home. Although this appears to be an improvement in form the previous pre-admission assessments the inform nation recorded was still very basic on some of the files that were observed by the Commission. Care Homes for Adults (18-65 years) Page 10 of 33 Evidence: We looked at the care files for three of the people that were living at the home. They had all recieved an assessment of their needs before they had been admitted to the home. This helped to make sue that the home could safely deliver their care needs to them. These assessments that were observed were a combination of the homes preadmission assessments and where appropriate care management assessments had also been included in individuals care files. The home needs to use their assessment materials to identify personal needs and include the support that they would require to help them with any difficulties. It would also help the service to develop more person centred approaches to care. All of the records seen by the Commission supported that all people that use the service and received nursing care had an assessment completed by a National Health Service registered nurse from the local Primary Care Trust, to determine the level of nursing input required and to determine the amount of financial support they would receive. The Commission interviewed care staff, management and people that use the service. All of these interviews supported the evidence that the home has the capacity to meet the needs of the people that live there. The staff training records that were observed also supported that the the staff receive the mandatory training that is required. However some of this training needed to be refreshed for several members of Team. The staff that were interviewed stated that they are provided with a great deal of training to help them support the needs of the people that use the service. Information given by the manager and observation indicates all of the current people that use the service are white/British. However the manager of the home was confident that if required the home would be capable of supporting individuals with specific cultural or diverse needs. Individual assessments of need also identified if people that use the service had any particular religious or cultural needs. Care Homes for Adults (18-65 years) Page 11 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This means that the individual care plans and risk assessments are available for the people that use the service. However some of the care plans need to include clearer information to make sure that the care that is being provided is person centred and is appropriate to their individual needs. Evidence: The Commission looked at all of the information held by the service in relation to three of the people that were living at the home. This included looking at all of their care plans and daily records, speaking to people about their care plans and identifying if the care staff and the managment understood the individual needs of the people that use Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: the service. The individual care plans that were observed by the Commission had improved since the last inspection. The homes care plans that were observed varied in quality and content, however there was evidence that the care plans are being updated when they are reviewed and now provide a more person centred focus to make sure that individual needs are supported in ways that are acceptable to them and are within safe working practises. At the last inspection there was little evidence to support that people that use the service or their representatives had been included in the development of the care plans, however all of the care plans observed on this occasion had been signed by the individuals themselves or by their representative. This helped to identify that they were in agreement with the care plans. One person told us when I had a review I was asked what I wanted, and if I was happy here. A visiting nursing professional to the home on the day of the site visit commented that the home provides excellent support to all of the people that I have placed here. The staff are very good and understand the needs of the people that they care for. There needs to be a more consistent approach in the development of individual care plans to make sure that everyone living at the home has their care needs appropriate planned and monitored. The care plans had been evaluated on a more regular basis to make sure that they were still appropriate to the needs of the individuals that they concerned. There was evidence to support the fact that when needs change a new care plan is put in to position to support the changing needs. Where appropriate care plans had been supported with risk assessments, this included areas such as medication, smoking and use of public transport. However some of the risks assessments had not been evaluated for a considerable length of time to make sure that they were still appropriate. It is important that risk assessments are kept up to date to provide staff with the necessary information to support the people that use the service safely and in the best interests of their health, safety and welfare. The Commission observed that Care management teams review their care plans and assessments with Eleanor House. However some peoples care had not been regularly reviewed by the local authority. The manager of Eleanor house stated that it was sometimes difficult to arrange the care managment reviews and often had to chase up the appropriate people to have this review completed. People that use the service that were spoken to by the Commission stated that they Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: are able to make choices about things that matter to them and said staff respected their rights to make their own decisions. One person informed us that he had stayed with friends last night and that the home supported him to do this. Care Homes for Adults (18-65 years) Page 14 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This means that people that use the service are encouraged and supported to keep in contact with family, friends and the local community. Evidence: As part of the site visit to the service the Commission spoke with seven of the people that live at the home and they all said that they have a good quality of life there. Information recorded in peoples care files supported the evidence that they are Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: encouraged to maintain their personal lifestyles and access the local community as often as is practicable and safe to do so. One person said I go out to the shops and the sea front when I want another person said I go out to the bank to get my money on my own then go shopping. Care staff that were interviewed by the Commission stated that the routines of the home are planned in advance. They stated that this was done to make sure that people knew when anything was taking place and could choose whether or not to get involved in it. Direct observations on the day of the site visit supported the evidence that the staff had a good working understanding of the needs of the people that they were caring for, and understood the level of support that individuals required to help them participate in any activities. None of the people that use the service expressed any cultural or religious needs to us, however one person said I think if I wanted to go to church the staff would help me to get there. The activities in the home have improved in frequency since the last inspection, however the activities need to be developed further to include more mental and physical stimulation for anyone that wishes to access them. Three meals are provided each day and a varied menu is available. People said that if they didnt like what was on the menu then a alternative meal would be provided for them. Fresh fruit is also left out available for people to take whenever they want some. Peoples care plans included dietary likes and dislikes. None of the care plans identified any specific ethnic or cultural dietary requirements. Care Homes for Adults (18-65 years) Page 16 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This means that the people that use the service receive health care support in the way that they believe is supportive of their needs. Evidence: As part of the site visit the Commission looked at the case file information for three of the people that live at the service. This also included interviews with the people that they involved and the care staff. Direct observations supported the evidence that people are treated with privacy, dignity and respect at all times at the home. Observations of the health care plans had improved since the last inspection, however Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: some of them remained very generic. These all need to be developed to include a more person centred approach to their health care needs. This will help people that use the service feel comfortable in respect as to how their health care needs are met. A professional health care visitor to the home stated that the staff are very good and do an excellent job of maintaining peoples general health care and social needs. The case files that were observed by the Commission supported the evidence that health care records are maintained for when people were seen by outside health care professionals including district nurses, general practitioners and psychiatrists. Interviews with managment, care staff and people that use the service support that their mental health needs are being monitored by regular consultations with their psychiatrist and staff support individuals to attend outpatient appointments. One person said I go to the hospital on my own, I dont need staff to go with me. The service has a clear medication policy and procedure. This includes a copy of staff signatures for the staff that are authorised to administer medication to individuals that use the service. The Commission looked at the medication administration records (MAR) for three of the people that use the service. All of these records were up to date and Had been accurately recorded. All of the prescribed medication was also appropriately stored. There were no controlled drugs in the home at the time of the visit. However the home maintains a controlled drugs book and appropriate lockable facilities to store controlled drugs. The medication is currently stored in a medication cabinet in the managers office. The manager stated that consideration is being given by the homes providers to create a specific area in the home to safely secure the medication outside of the managers office. Good practise continues at the home with patient information leaflets of medication being included with individual medication records. A photo of the person receiving medication was also on the medication records. Again this is seen as good practise. The Commission observed medication being administered to people that use the service during the lunch period. The correct policies, procedures, legislation and good working practises were followed. This included the staff that was administering the medication witnessing the prescribed medication being taken by the people that they were meant for. Care Homes for Adults (18-65 years) Page 18 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This means that the service has clear policies and procedures for concerns, complaints and protection, and the staff have a clear understanding of their responsibilities in relation to these policies and procedures. Evidence: The Commission identified that no formal complaints have been made to the service since the last inspection. The homes records also supported this evidence and no complaints had been received directly by the Commission. The manager stated that the people that use the service were reminded that they have the right to complain. All of the people spoken to by the Commission were aware of how to Lodge a formal complaint in relation to the services that they receive, however none of them had ever felt that they needed to do this. The service also has policies and procedures to cover safeguarding adults and the prevention of abuse, whistle blowing, management of challenging behaviours and management of residents money and financial affairs. No adult protection referrals Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: have been made in relation to the service since the last inspection. Some of the staff training records showed that they had received some adult protection training. The manager stated that adult protection formal training was going to be provided to the staff in relation to the local authorities policies and procedures and reporting procedures. This training will be provided through the local authority. Staff employment records supported the evidence that they are only employed after appropriate security checks to make sure that they are safe to work with the people that are living at the home. Care Homes for Adults (18-65 years) Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that the environment of the home is generally suitable to the needs of the people that live there. However there are areas of the home that need improvement to provide a homely and safe environment for the people that use the service. Evidence: On the day of the site visit the Commission made a tour of the premises. The exterior of the home was much improved. The windows of the home were observed to include restrainers to minimise the risk of people falling through them, or through unauthorised people entering the building. Since the last inspection the external doors had been replaced. The manager stated that some of the homes improvements and maintenance had been delayed due to the unforeseen problems with the homes water boilers and having to get them replaced. This was a quite expensive venture, however the manager Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: confirmed that it was the services intention to improve the quality of the environment throughout the home. Some of the individual bedrooms did not have any curtains and this impacts on the privacy and dignity of the people that use the service. The bedding in some of the rooms was also very old and looked like it should be replaced. The corridor ceilings that had previously been identified with a large hole in it where there had been a water leak had been repaired. The bathroom and toilets in the home continue to generally need to be decorated and consideration should be given to replacing most of the bathroom suites. All areas of the home that were observed by the Commission were seen to be clean, tidy and were free of any offencive odours. Several people invited the Commission to look at their bedrooms and these were observed to be clean and tidy. There was also evidence to support that the people that use the service are encouraged to personalise their own rooms to their own tastes and preferences. One person said I like my room, Ive got all my own things in here. The care staff that were spoken to by the Commission said they had good access to all of the specialist equipment they needed to make sure that they could support the people who use the service. This included a hoist and additional moving and handling equipment and good supplies of protective clothing. The records for the maintenance of these pieces of equipment were also up to date. Care Homes for Adults (18-65 years) Page 22 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This means that the staff have the necessary skills and knowledge to be able to safely support the needs of the people that use the service. Evidence: Direct observation of the care staffs interactions with people that use the service supported the evidence that they have knowledge and skills to safely care for the people that they are responsible for and that they clearly understood their own roles and responsibilities. Although it would appear from the homes rotas that adequate staff are available at all times, this seems to be compromised through their domestic chores, especially the time it takes to hand wash all of the dirty dishes in the kitchen. This time would be better spent carrying out activities with the people that use the service or offering individuals more one to one time. Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: The home has a clear recruitment and selection policy and procedure in position. The Commission observed the personal files for four of the staff working at the home. These all included Protection of Vulnerable Adult register checks, Criminal Records Bureau checks, two written references, health care checks and past work histories. However the home did not keep records of any visas that were required for overseas workers. This must be rectified to ensure that anyone working at the home has the right to be employed there and to confirm that they are safe to work with the people that use the service. The home continues to have a commitment toward National Vocational Qualification (NVQ) training. Seven of the twelve care staff have completed an NVQ level 2 in care or an equivalent qualification. This means that approximately 58.3 of the staff have reached the minimum requirement for NVQ training. The manager of the home stated that the service is also using the Skills for Care common induction standards for all new staff. The manager had developed a training plan to incorporate all of the mandatory and specialist training and updates required by the staff. She had already made plans to fill any gaps in individual staff members training needs. Staff confirmed to the Commission that their training needs were met through the serviced. One member of staff said were always training, but thats a good thing. Since the last inspection the manager of the home has introduced a formal recorded staff supervision programme and each staff member has been allocated a supervisor. Staff interviews supported the evidence that all of the staff working at the home are now receiving the recommended minimum for formal recorded supervision. Care Homes for Adults (18-65 years) Page 24 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that the overall management arrangements for the home makes sure that the people that use the service and staff benefit from a consistent, well managed, inclusive and safe service. Evidence: The manager of the home is qualified as a Registered Mental Nurse (RN13). She has also completed the Registered Managers Award and a clinical leadership course. The manager stated that she has regular supervision with the provider, however there were no written records to support that this happens. It is important that the manager of the service receives formal recorded supervision to demonstrate the support that Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: she receives and to identify ant training she needs to develop her managment skills. This is an outstanding requirement from previous inspections. The care staff and people that use the service that were spoken to by the Commission supported the evidence that the manager of the service is approachable, friendly and listens and acts on what people told them. Most of the people that use the service and encouraged and supported to maintain their own finances. The home also keeps small amounts of money for people that do not wish to care for it themselves. The records for these were all up to date and had been accurately recorded. When the registered person visits the home regulation 26 reports are completed, however the manager of the home stated that it was her responsibility to write these reports for the proprietor to sign. Quality assurance in relation to the homes services is now being formally assessed, however there is still room for growth in this area. It is important that the home gathers information from other people in relation to how they see the services provided by the home. This should then lead to any improvements needed in the service, or identify how services should be maintained. The manager of the home was reminded about the importance of reporting notifiable events to the Commission through regulation 37 reports. Observation of service and maintenance documents were observed for the servicing of health and safety equipment at the home. These were all up to date and seen to be in position. Care Homes for Adults (18-65 years) Page 26 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 2 14 The registered person must 30/05/2008 make sure that all of the preadmission assessments completed by the home include enough personal detail so that care plans can be developed from them to support individuals needs in the way that they would expect. 2 6 15 The registered person must 30/06/2008 ensure each service user has a care plan(s) setting out how all their care needs are to be met. Plans must be sufficiently detailed to ensure staff known what care is needed, when it is needed. When the needs of service users change plans must be updated to reflect these changes. (Previous timescale of 30/04/07 was not met) The care plans must also be reviewed on a regular basis to make sure that they are still appropriate to meet the individual needs of the people that use the service. 3 9 13 The registered person must 30/06/2008 ensure moving and handling risk assessments are kept up Page 27 of 33 Care Homes for Adults (18-65 years) to date and that are sufficiently detailed to provide staff with necessary guidance to support service users safely. Where the needs of service user change, risk assessment must be updated to reflect these Previous timescale of 30/04/07 was not met). 4 17 16, (2), (i) The registered person must 20/04/2008 make sure that the people living at the home are provided with a varied and nutritional menu to support the health of the people that use the service. 5 19 12,13 The registered person must make sure that all contact between people that live at the service and outside professionals is fully recorded including any outcomes from the contact itself. This means that any follow up treatments will always be identified for the individuals concerned. 30/04/2008 6 20 13, (2) The registered person must 15/03/2008 make sure that when medication is administered is if given to the person that it is prescribed for and is observed to be taken before recording it in the medication records. This will make sure that the person who the medication is prescribed for receives it. Care Homes for Adults (18-65 years) Page 28 of 33 7 23 13(6) 21 The responsible person must 30/07/2008 ensure staff are provided with adult abuse training. (Previous timescales of 30.4.05, 31.9.05, 8.11.06 and 31/05/07 were not met). The registered person must 30/05/2008 produce a maintenance and renewal of the fabric and redecoration plan for the home together with dates for completion of any identified work. This is needed to ensure service users live in a safe, comfortable and attractive home (Previous timescale of 30/04/07 was not met). 8 24 23 9 24 23 The registered person should 30/05/2008 repair all of the damaged ceilings and walls in the home to provide a suitable environment for the people that use the service. 10 27 16, (2), (j) The registered person must 30/04/2008 make sure that infection control policies and procedures and adhered to at the home. This will support the health and safety of the people that live and work in the home. 11 28 13, (4), (c) The registered person must make the trip hazard in the downstairs corridor safe for anyone using it. 30/05/2008 12 33 18 (1), (a) The registered person should 30/04/2008 provide the Commission with Page 29 of 33 Care Homes for Adults (18-65 years) details of how they have assessed the staffing levels for the home, the consultation that they included in the process and how the new levels will be monitored to support the health, safety and welfare of the people that use the service. 13 36 18 The registered person must ensure the manager is provided with formal recorded supervision and an annual appraisal. (Previous timescales of 31.1.07 and 30/04/07 were not met). 30/06/2008 14 36 18 The registered person must 30/06/2008 ensure that a staff supervision programme is implemented ensuring that all staff have access to a minimum of six sessions per year. (Previous timescales of 31.3.04, 31.8.06 and 30/04/07 were not met). The registered person must develop and implement a structured QA programme. (Previous timescales of 31.1.05, 31.7.05, 30.4.06, 31.1.07 and 31/07/07 were not met). 30/06/2008 15 39 24 16 39 26 The registered person must 30/05/2008 ensure regulation 26 visit reports are completed and copies of reports must be left in the care home (Previous timescale of 30/04/07 was not met). 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 9 The registered person must provide the manager of the home with formal recorded supervision This will make sure that the manager of the home has all of the skills and knowledge to safely manage the service. 31/05/2009 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 2 The registered person should make sure that the preadmission assessments completed by the home include clearer detail of how people need to be supported with their needs. This will help to develop care plans that are more person centred. The registered person should make sure that all of the individual care plans in the home are developed to include more person centred information this will help to support their health and safety of the people that use the service and make sure that their care is delivered in a way that is acceptable to them. 2 6 Care Homes for Adults (18-65 years) Page 31 of 33 3 9 The registered person should;d make sure that the risk assessments for individuals are evaluated on a more regular basis to make sure that they are still appropriate to the needs of the people that use the service. The registered person should make sure that the activities that are made available to the people that use the service are physically and mentally stimulating. This will help to improve their quality of life at the home. The registered person should make sure that the environment of the home creates a homely, safe and comfortable atmosphere for the people that live and work in the home. The registered person should consider updating the bathroom suites as part of the homes maintenance programme. This will help to create a more homely, comfortable and safe environment for the people to live in. The registered person should consider purchasing a dish washer for the kitchen to allow the care workers to have more time to give to the people that use the service. The registered person should continue to improve the services quality assurance and monitoring system. This will help to identify and improvements that are needed for the service. The registered person should make sure that all reportable incidents and sent to the Commission through the use of regulation 37 reports. 4 14 5 24 6 27 7 33 8 38 9 41 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. 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