Care Home: Elm Road

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What the care home does well Good systems are in place to support anyone considering moving into 23 Elm Road North. These include staff ensuring the person receives sufficient information about the home and is able to visit several times. In addition systems are in place for staff to gather information about the person`s support needs and their choices. This all helps everyone to decide if it is the right place for the person to live and helps staff plan how they will support the person successfully. The people living at 23 Elm Road North told us that they make everyday decisions for themselves and that routines are flexible. We observed that people clearly view the house as their home and are comfortable with making decisions and deciding routines by themselves, with staff support if needed. Staff provide a good level of support for people so they can lead as independent a lifestyle as possible. People are supported to be involved in everyday tasks such as cooking and shopping as well as to see their friends and family and to follow their religion, if they wish to do so. The staff team know the people living at 23 Elm Road North well and are knowledgeable about how to support them and communicate in a way they can understand. People told us that staff discuss their support with them and that they get help when they need it. This is backed up with clear care plan and risk assessment records, which help to ensure that staff have clear guidance to follow and also provide a good way to quickly identity and meet any changes to the support people need or choose. The people living at the home told us that they know how to raise any concerns that they may have and are confident that staff would listen, act on what they say and support them. This helps people to feel safe whilst living there. 23 Elm Road North has clear management structures in place. People told us that they have confidence in the manager and get the support they need from her. We noted that she is motivated and enthusiastic in her role and has clear plans in place to continue to improve the service offered. This helps to ensure that people get support that meets their needs and choices and is based on current good practice. What has improved since the last inspection? This the first inspection we have carried out at 23 Elm Road North since Potensials took over as the new owners in May 2008. What the care home could do better: The support provided to people in managing their money needs to be clearer. Records and explanations should be available on people`s files to demonstrate why their money is managed for them. These should also clearly show the ways in which the money is managed and that the person has agreed to this. This would not only help to ensure people`s money is managed safely, it would also provide people with more information about the support they receive and with more control over their everyday lives.Medication records for the people living at 23 Elm Road North are not always accurately maintained. Inaccurate information is sometimes recorded that may lead to people not getting their medication as prescribed by their doctor, which could have an impact on their health. Staff need to ensure that all medication records are checked regularly and that any alterations made by the person`s doctor are clearly recorded and amended, if needed. This will help to lessen the risk of medication errors occurring. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Elm Road 23 Elm Road North Prenton Birkenhead Wirral CH42 9PB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lorraine Farrar     Date: 0 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 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 32 Information about the care home Name of care home: Address: Elm Road 23 Elm Road North Prenton Birkenhead Wirral CH42 9PB 01512002444 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Potensial Limited care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home only Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Learning Disability. Code LD maximum number of places 6 Date of last inspection Brief description of the care home 23 Elm Road North is registered to provide support and accommodation for six adults who have a learning disability. Their statement of purpose states that the service currently only supports men, who have a learning disability. The house is owned and run by Potensials, a company who provide care and support services across the country. Located in the middle of Prenton, Elm Road North is well located for accessing local, shops, transport and other amenties. Parking is restricted to on street residents parking, with non restricted street parking available a short walk away. The house is a mid terrace that fits in well with other domestic properties in the local Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home area. Everyone living there had thier own bedroom and there are sufficient communal rooms and space for everyone to comfortably share. Staff are available twenty four hours a day to provide support to the people living there. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means that the people who live at the home experience adequate quality outcomes. We gathered information for this inspection in a number of different ways. Before we visited we sent the manager a self assessment form, which she completed and returned to us. This gave us information about the support provided to the people living there, staffing matters and record keeping. It also provided us with information about where the manager feels the service is doing well and future plans for improvement. We sent comment cards to some of the people who live and work at the home. Three of the people living there and five members of staff completed and returned these to us. Care Homes for Adults (18-65 years) Page 6 of 32 We also reviewed any information that we have received about 23 Elm Road North since it was registered with Potensials as the new owners in May 2008. All of this information was used by us to plan our site visit and in writing this report. We carried out an unannounced visit to 23 Elm Road North on 6 February 2009 and were there for over six hours. We met the people living there and spoke with four members of staff including the manager. We also spent time reading records and looking around the building. We looked in detail at the support being provided to three people living at the home. This included meeting with them, reading their care plans and other records. We also discussed the support they receive from staff in all areas of their life including their health and personal care and with their chosen lifestyles. This provided us with a picture of what it is like to live at 23 Elm Road North. The basic fee for living at 23 Elm Road North is six hundred and thirty eight pounds weekly. This may increase depending on the persons individual support needs. What the care home does well: What has improved since the last inspection? What they could do better: The support provided to people in managing their money needs to be clearer. Records and explanations should be available on peoples files to demonstrate why their money is managed for them. These should also clearly show the ways in which the money is managed and that the person has agreed to this. This would not only help to ensure peoples money is managed safely, it would also provide people with more information about the support they receive and with more control over their everyday lives. Care Homes for Adults (18-65 years) Page 8 of 32 Medication records for the people living at 23 Elm Road North are not always accurately maintained. Inaccurate information is sometimes recorded that may lead to people not getting their medication as prescribed by their doctor, which could have an impact on their health. Staff need to ensure that all medication records are checked regularly and that any alterations made by the persons doctor are clearly recorded and amended, if needed. This will help to lessen the risk of medication errors occurring. 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 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 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. There is a thorough process for assessing people and gathering information to make sure that Elm Road would be the right home for a person and that their needs could be met there. Evidence: The people living at 23 Elm Road North told us in their comment cards and during our visit that they like living there. Their comments included, I like living here it is good and nice and I like doing activities, meeting people and I like living here. We have ups and downs but it is always sorted out and we end up laughing. Nobody new has moved into 23 Elm Road North since Potensials became the new owners, therefore we were not able to practically assess the support that they would be offered. However we discussed this with the manager who was able to describe the processes she would follow. She explained that an initial assessment would be carried out for the person. If this indicated that 23 Elm Road North may be a suitable place for them to live, then a more comprehensive assessment process would be undertaken. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: This would include meeting with the person and if applicable, their family. They would be invited to visit 23 Elm Road North several times, meet everyone there and stay overnight if they wished. Information would be provided to them, their family and social worker about the services provided by 23 Elm Road North. We saw copies of the service user guide for the home that would be given to people. This gives clear information and includes the use of photos to help people understand the contents. This clear planning process would help everyone to decide if 23 Elm Road North is the right place for the person to live. It should also provide staff with sufficient information to plan how they can meet the persons needs and choices. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The individual needs and choices of the people living at 23 Elm Road North are generally recognised so they receive the support they need to manage these. Evidence: Individual care plans are in place for all of the people living at 23 Elm Road North. During our visit we looked at three of these to see what peoples needs were and how these were being met. During our visit we spoke with people who live at the home and the told us they know about what is in their care plan and that staff discuss these with them. One person told us staff, go through the help and guidance (in the plan) and what you need to get on. Care plans were up to date. They provided clear information and guidance for staff to follow in supporting the person with their health and personal care as well as with their Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: hobbies and interests. They also contain clear information about how the person communicates and any cultural or religious needs they have. The care plans contain a section on supporting people with their cultural or religious beliefs and staff will provide this support if needed. For example one of the people living there regularly receives support to go to church. This all helps to ensure people receive the support they need, in all areas of their life. The people living at 23 Elm Road North told us in their comment cards that they make their own decisions whilst living there. One person told us, dont ask, just do it and another that, just do anything myself when I want. This was confirmed during our visit when people said they make their own decisions about everyday things such as meals and routines. Potensials acts as appointee for some peoples benefit money. The people living at Elm Road told us that they are aware their money is locked in a safe in the office and they can access this when they want. One person who lives there told us, I would like to try and look after it myself. I am big enough. The manager explained to us that the company gives the person a set amount of their benefit money each week but holds back a small amount as savings for larger things they may wish to buy, such as clothing. There was no assessment about the persons ability to manage their money or signed agreement from them about the money being saved. This may mean that people are not getting all of the support they need to become as independent as possible and make decisions for themselves. Care plans contain a series of up to date risk assessments and risk management plans. These cover areas such as going out and about, managing appropriate relationships and support with personal care. They help to identity any risks to the person and the actions to take to minimise these whilst supporting the person in their everyday lives. Care Homes for Adults (18-65 years) Page 14 of 32 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. Staff support the people living at 23 Elm Road North to lead a lifestyle of their choice and help them so they can learn and maintain everyday living skills and become part of their local community. Evidence: During our visit to the home we saw that the people living at 23 Elm Road North were out and about throughout the day. Some people went out locally, supported one to one by staff, whilst others attended local colleges. The records we looked at confirmed that people get support from staff to go out and about regularly. This includes support to use local facilities such as attend church, go for lunch or shopping as well as support to attend colleges and day services. One of the people living at Elm Road told us that Potensials, the company that runs the home, is taking over a day service and he is looking forward to going there. The manager also explained that she has requested Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: they run courses there that will be of benefit to the people living at 23 Elm Road North. This will provide people with further options on how to spend their time, as well as a good resource for learning everyday living skills, including more about building relationships with others. One of the people living at 23 Elm Road North told us that staff talk with him about how to get on with other people. Records confirmed this and showed that staff support people, through care planning and risk assessment to learn how to maintain appropriate relationships. Records also showed that staff support people to maintain relationships with their family and friends. This was confirmed by one of the people living there who told us they had arranged for a friend to visit the following day. During our visit to the home we observed that routines in the house were flexible and that staff respected peoples right to privacy. For example staff asked for and obtained permission before entering anyones bedroom. All of the people living at 23 Elm Road North have a key to their room so that they can lock their door if they wish. The people living at the home confirmed that there are no set routines, explaining for example, that they can get up or go to bed when they choose. We also noticed that people spent their time at home engaged in activities of their choice and used both the private and communal areas of their home as they wished. For example one person was watching TV in their bedroom, whilst others were sitting in the dining kitchen, socialising, whilst meals were prepared. The people living at 23 Elm Road North told us that they like the meals provided, with one person describing them as, nice, very nice. They also told us they can make a drink or snack when they wish, help staff to prepare the main meals and that if they do not like the menu meal they always get an alternative. We noted this during our visit, when staff and one of the people living there had prepared the evening meal and made something different for one of the men who did not like the planned menu. Menus are planned and food shopping carried out at local shops, by the people living there, with staff support if needed. This provides people with day to day opportunities to become a part of their local community and also to learn and maintain everyday living skills. Care Homes for Adults (18-65 years) Page 16 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of the people living at 23 Elm Road are identified accurately to make sure that these needs are met. Medication recording is not always accurate, so there is a risk that people may not be receiving their medication correctly, which could have an effect on their health. Evidence: The people living at 23 Elm Road North told us that they get support from staff with their personal and health care. One person told us that if they are unwell staff, automatically book you in to get checked, explaining that staff always accompany them to appointments. In meeting the people living at 23 Elm Road it was evident that staff had provided them with support around their health and personal care, where needed. This was backed up with care plans and records that showed personal care is provided whenever needed. Records confirmed that routines are flexible around personal care and that staff will support people during night times hours, for example by making them a drink if they cannot sleep. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: Care plans and health actions plans are in place for all of the people living at 23 Elm Road North and these provide clear guidance for supporting the person to remain healthy or deal with any health issues that arise. They clearly show that people are supported to make and attend regular health appointments, such as seeing the optician and chiropodist as well as more specialist appointments such as consultant visits. Staff we spoke with had a good understanding of peoples health and personal care needs and were able to explain how they provide support with these. Records confirmed that staff take appropriate action if someone is unwell and that they obtain and follow advice from health professionals. The clear care planning and record keeping along with staff knowledge helps to ensure that the people living at 23 Elm Road North receive the support they need. It also helps to ensure that any issues can be quickly noted and dealt with. People living at the home told us that staff look after their medication and they are happy with this. They also told us that they always get their medication on time. Recently staff have undertaken an assessment of everyones ability to manage their own medication. A member of staff we spoke with was able to explain the outcome of this and how they intend to work with one person to gradually support them to look after their own medication, over a period of time. This is good practice as it enables people to have more control over their everyday lives and learn new skills safely. A locked cabinet is provided to store peoples medication and during our visit we could see that medication is stored correctly. Staff have received training in dealing with medication, which should help them to recognise and deal with any potential issues that may arise. However the recording of medication was not always clear enough to provide a good audit trail and ensure that people are receiving their medication as prescribed. For example, several entries on medication recording sheets (MAR sheets) were handwritten and not signed. It is good practice for staff to sign a handwritten entry, and for the entry to be checked for accuracy, to lessen the risk of a recording error. MAR sheets contained some entries that we were advised by staff were not accurate. For example, one MAR sheet recorded the person as using a cream daily; this had not been signed for and we were advised that they no longer used it. Another person had a handwritten entry for medication to be taken once a night. The MAR sheet had been crossed out on two out of every three days and a member of staff advised it was only to be given every third day. We counted this medication and it tallied with the recorded signatures of every third day. However is was not clear why it was recorded to be given every night or if and when a GP had altered this. This inaccurate recording Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: could lead to people not receiving their medication as prescribed which could have an adverse effect on their health. We also looked at an entry for painkillers for one person. Handwritten entries said they were to be given one to two tablets daily. However the actual number of tablets given was not recorded each day, therefore it was not possible to establish whether it was given correctly. It would also be difficult to find sufficient information to assess the persons level of pain over a period of time if no accurate record of their actual use of painkillers is maintained. Care Homes for Adults (18-65 years) Page 19 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at 23 Elm Road North know about the complaints processes for the home so they are confident that any concerns they have will be listened to and acted upon. Lack of documentation means that it is not always possible to show that the money of the people who live in the home is being managed in their best interests. Evidence: Information is made available to the people living at 23 Elm Road North about how to raise any concerns or complaints that they may have. This is provided in an easy to understand format to support people to understand as much as possible about the contents. The manager told us in the information we were sent before the visit that monthly residents meetings are held, which also provide people with a way to raise any concerns they may have. She told us that family and friends are offered a leaflet on the companys complaints procedure, so that they are aware of how to raise any concerns that they may have. In the comment cards the people living at 23 Elm Road North sent to us, they told us that if they had any concerns or wanted to raise a complaint they know who they can talk to. During our visit they confirmed this. They explained that they would talk with a member of staff and were confident that staff would support them. A record of complaints made about 23 Elm Road North is kept on the premises. This Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: recorded two minor complaints raised, one regarding meals and the other regarding cigarette ends. Clear records showed that the manager had dealt with and responded to these quickly and effectively. Staff receive training on safeguarding adults from abuse. In discussions with them during our visit they displayed a clear understanding of the indicators to look for and the actions they would take to ensure people are protected. This all helps to ensure that people feel safe whilst living at 23 Elm Road North. Potensials acts as appointee for the benefit money of most of the people who live at 23 Elm Road. We checked samples of records and amounts of money held in the home for people and found that these tallied with clear records kept of monies spent. However no explanation was available as to how the organisation manages peoples benefit money or what accounts it is paid into. This would help to ensure that people are supported to manage their money safely and well. It would also help to ensure they are as informed as possible about the support they receive. Care Homes for Adults (18-65 years) Page 21 of 32 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. 23 Elm Road North is well maintained so that people have a safe, comfortable home and can live an ordinary lifestyle in their local community. Evidence: The people living at 23 Elm Road North told us in their comment cards that their home is always fresh and clean. One person explained, every day (it is) hoovered and cleaned whilst another described it as, spot on. During our visit we could see that all areas of the house we looked at were clean, tidy and looked felt homely. 23 Elm Road North is a large double fronted house in a residential area of Prenton in Birkenhead. It fits in well with other family properties in the area and is not distinguishable as a care home. There is no off road parking at the house and parking on the road outside is limited to people who have a residents permit. There is however street parking available nearby and the house is close to public transport. Everyone living at 23 Elm Road North has their own large bedroom, which they are able to personalise as they choose. In addition people share a downstairs lounge, large dining kitchen and small upstairs lounge that is used by people who live there who smoke. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: Outside there is a good sized, enclosed back garden that provides places for people to sit in warmer months. This is accessible via a series of wide steps only. There is a separate laundry room at the rear of the house that is reached via the garden. The room was was clean and tidy with systems in place for dealing with laundry. Records showed that staff have received training in infection control. This all helps to prevent or quickly deal with any potential outbreak of infection. Upstairs there is a bathroom with toilet provided and additional separate toilet. Downstairs an accessible shower with adaptations including a shower chair, grab rails and toilet rails is provided. Again there is also a separate toilet. This provides sufficient bathroom facilities for people to use and to get the support they may need with their personal care. Care Homes for Adults (18-65 years) Page 23 of 32 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 people living at 23 Elm Road North are supported by an experienced, well trained staff team so they can be confident that they will receive the support they need in the way they prefer. Evidence: The people living at 23 Elm Road North told us in their comment cards that staff treat them well and listen to what they say. They confirmed this when we spoke with them during our visit to the home. Throughout our visit we observed staff spend time talking with the people living there and responding positively to any requests for support. We also observed that staff have built good, friendly and respectful relationships with the people living there. Records we saw showed that before any member of staff starts work at 23 Elm Road North a series of checks are carried out on them. These include obtaining written references, checking with the protection of vulnerable adults register and obtaining a Criminal Records Bureau (CRB) disclosure. These checks help to ensure that staff are suitable to work with people who may be vulnerable. In the comments cards staff sent back to us, most said that they get training that Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: helps them to support the people living at 23 Elm Road North effectively. The staff we spoke with during our visit confirmed this. One member of staff described the organisation as, very hot on training, whilst another told us, if you ask you will get it explaining that this particularly relates to training that would benefit the support provided to the people living at Elm Road. Over 50 percent of the staff team hold a nationally recognised qualification in care, (NVQ). In addition records showed that staff undertake a variety of different training courses. These range from basic health and safety courses, such as fire safety and food hygiene, to courses applicable to working in the field of care such as medication and safeguarding vulnerable adults. In addition staff receive more specialist training such as learning disability awareness and equality and diversity. In the information we were sent before our visit, the manager explained that she intended to introduce training for all staff in health care planning for people with learning disabilities. She had a good knowledge of this approach, which has been introduced by the local Primary Care Trust and was clear about the benefits it would have for the people living at 23 Elm Road North. This proactive approach to training for staff helps to ensure that they are up to date with current good practice in how to support people safely and well. Care Homes for Adults (18-65 years) Page 25 of 32 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. 23 Elm Road North is well managed so it is run in the best interests of the people who live there. Increased quality assurance systems would benefit the service further. Evidence: The manager of 23 Elm Road North, Angela Bain, is registered with the commission as the manager of this home. She also manages another nearby home belonging to Potensials. She told us that she works approximately twenty four hours a week at 23 Elm Road North and is supported there by a full time team leader. She is experienced in working with adults who have a learning disability and holds qualifications in management and care. The questionnaire we received was well completed by the manager and showed that she has clear plans in place to further improve the service provided at 23 Elm Road North. The people who live and work in the home that we spoke with during our visit displayed confidence in the manager. One person who lives there told us that he would talk to her about any concerns he had and was confident she would support him. Staff Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: told us that they get the support they need from her, feel that they can express their opinions and are listened to. We found that the manager was knowledgeable about the needs and choices of the people living at 23 Elm Road North. She also displayed a clear understanding of current good practice in supporting adults with a learning disability and how to introduce positive changes to the service. There are several systems in place within 23 Elm Road North to check the quality of the service provided there. These include regular reviewing of peoples care plans and regular residents meetings. In addition weekly and monthly checks are carried out within the home. These cover areas such as health and safety, staff training and medication. These checks provide a clear way to quickly identity and deal with any issues that may arise. The regulations for care homes require a representative of organisations that run homes to visit their care homes monthly and provide a written report on their findings. These visits can be delegated to staff within the organisation, but not working within the home. The monthly visit should include speaking with the people living and working at the home as well as reviewing the premises and records. These visits provide a clear way for an organisation to check the quality of the services being provided and plan future improvements as well as deal with any issues that may arise. The last recorded visit we saw was dated January 2008, before Potensials became the new owners of 23 Elm Road North. The manager told us that a senior manager from the organisation does visit the home regularly. However there were no records in the home to confirm this and the lack of written records about these visits may mean that issues within the home are not noted and acted upon as quickly as possible. It may also mean that the representatives of the organisation are not as aware of how the home operates as they should be. The information the manager sent us before our visit showed that regular safety checks are carried out at 23 Elm Road North. During our visit we looked at a sample of these records and certificates and found them to be up to date. This included checks on the gas and electrical installations at the home, temperatures and fire safety precautions equipment. These checks help to ensure that 23 Elm Road North is a safe place for people to live, work and visit. Care Homes for Adults (18-65 years) Page 27 of 32 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 28 of 32 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 7 12 Individual assessments must 03/04/2009 be carried out for the people living at 23 Elm Road North with regards to their ability to manage their own money. Their views must be taken into account and recorded. This will help to ensure people receive the information and support they need to be as independent as possible. 2 20 13 An audit of all medication 13/03/2009 administration record sheets must be carried out. Any inaccurate entries must be noted, discussed with the pharmacist and GP if applicable and arrangements made to ensure all entries are accurately recorded. This will lessen the risk of errors occurring which could impact on peoples health. Care Homes for Adults (18-65 years) Page 29 of 32 3 23 20 An explanation must be 03/04/2009 available as to the support people are offered with their benefits money and bank accounts. This must include which account the money is paid into and if not paid direct to the person then an explanation of how soon it is transferred. This will help to ensure that people are supported to manage their money in a way that is both safe and in their best interests. 4 39 26 A representative of Potensials must visit 23 Elm Road monthly to check how it is being run and provide a written report of their findings. This will help to ensure that they are aware of how the service is operating. It will also help to quickly identify and address any issues that may arise as well as providing a clear format for planning future changes. 03/04/2009 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 20 All entries made on the medication administration sheets should be signed by the staff giving out the medicines, and checked to make sure they are accurate, to lessen the risk of a mistake occuring. Where a medication is prescribed with a variable dose, eg Care Homes for Adults (18-65 years) Page 30 of 32 one or two tablets, a note should be made on the MAR sheet of the actual amount given. This will help to provide a clear audit trail and also to monitor the persons medication needs. Care Homes for Adults (18-65 years) Page 31 of 32 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 © (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. Care Homes for Adults (18-65 years) Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!