Care Home: Fraser Drive

What the care home does well Peoples needs are assessed before they are offered a place at the home to ensure their needs can be met. People have Person Centered Plans, risk assessments and Health Action Plans. These were very comprehensive, accessible and can support staff to meet peoples full range of needs. The people who use the service were supported by staff to tell us about the decisions they made, these included, choosing the decor in their bedrooms, choosing the times they got up and retired, choosing what they ate, via pictorial menus, how they spent their money etc. We also saw evidence that people had chosen their summer holiday destinations and day trips. There was evidence that most people are involved in meaningful daytime activities of their own choice, which, had been planned in accordance with their wants, needs and capabilities. This is what people who live at the home told us, "I go to wood work groups, to work at the allotment and I brought some lettuce and radishes home the other day that I had grown. I`m doing a course at college a BTEC in IT skills. I really enjoy it". Staff also told us they supported people to hold coffee mornings, to enable people to invite friends over. Some people would be involved in baking cakes for the event. This was a really positive way of enabling people to maintain and develop new networks. People told us they were encouraged to go shopping with staff to buy food for meals at the local supermarket. We checked three peoples medication sheets and found that a system was in place which identified the medication prescribed, the dosage, reason for use and review dates. This was good practice and ensured that staff were made aware of these details. We asked people whether they liked living at Fraser Drive and this is what they said or signed, One person nodded their head, and grabbed the hand of the support worker and smiled. Another person said, "Yes, the staff are good". The home was clean and tidy, homely and safe. The kitchen was clean and tidy. We asked people what they liked about their homes and this is what they told us, "My bedroom is good. I like the garden".On the day of our visit there were four support workers on duty and the Team Leader was in charge to offer support to twelve people who lived at the home. One support worker came on duty on a day shift to take a person out. This staffing level was observed to be to meet peoples needs on the day of the visit. What has improved since the last inspection? The medication systems had improved. Information had been recorded appropriately by staff to protect peoples welfare. What the care home could do better: Peoples support plans must be reviewed on a regular basis to ensure they are still appropriate to meet their needs. This will protect peoples welfare. Peoples risk assessments must be reviewed on a regular basis to ensure they are still appropriate to meet their needs. This will protect peoples safety. The registered person must ensure that all confidential information about people is stored in a secure manner to protect their confidentiality. People with more complex needs should be supported to access more meaningful day time and leisure activities and should have more access to community activities. This would enhance their lifestyles. Peoples health care needs must be reviewed on a regular basis and records of all appointments must be recorded to protect people`s health. Water temperatures in the home must be maintained at an appropriate temperature between 41-45c to ensure peoples safety. Adequate washing and bathing facilities must be available to people and therefore the bathroom identified must be repaired to ensure it is fit for purpose and adequate to meet peoples needs. Staff training records should be checked to ensure staff have the opportunity for refresher mandatory training as required to protect peoples welfare. 50% of the staff team should be supported to achieve the NVQ2 care awards to ensure the staff have the appropriate knowledge and skill base to support people appropriately. This will benefit people who live at the home. The providers need to ensure that there is adequate management time allotted to the service to ensure people can benefit from a well run service. The registered manager needs to look in to the concerns raised by staff about the relationships between them and the junior management teams approach towards them. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Fraser Drive 9 & 11 Fraser Drive Woodseats Sheffield South Yorkshire S8 0JG     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: Shelagh Murphy     Date: 2 0 0 5 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 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Fraser Drive 9 & 11 Fraser Drive Woodseats Sheffield South Yorkshire S8 0JG 01142745033 01142745033 none 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) : Dimensions (UK) Ltd care home 12 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 12 Fraser Drive is a purpose built home for adults with learning disabilities aged between 18-65 years. The home is in a residential area of Sheffield with good access to public services and amenities (e.g. bus services, shops, libraries etc). People live in two separate detached houses that share the same grounds. Each house has six single bedrooms, based on the ground floor, a communal lounge and dining room and a domestic style kitchen. Number 11 Fraser Drive also has an activity room well stocked with books and games. Each house has combined bathroom and shower room and a further unassisted bathroom. The garden encompasses both houses at the back of the property and is well tended and secure. There are accessible lawned and paved areas, a variety of seating and a greenhouse. There is a small car park to the front of the building. Care Homes for Adults (18-65 years) Page 4 of 35 Brief description of the care home The houses are well presented and well maintained. Information regarding the services provided was included in the homes statement of purpose and service user guide. Items not included in the fees are hairdressing, chiropody, toiletries, clothing, TV license and outings. There are other items that people are expected to pay for which include, holidays and decoration and refurnishing of individual bedrooms. Care Homes for Adults (18-65 years) Page 5 of 35 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 people who use the service experience adequate quality outcomes. Shelagh Murphy carried out this unannounced visit to the service over one day and the total time spent on site was 6.5 hours. In the report we make reference to us and we. When we do this we are referring to the inspector and the Care Quality Commision. According to information received the weekly fees can range up to £1199 depending on each persons assessed needs. We used a variety of information as well as our findings from the visit to assess the Care Homes for Adults (18-65 years) Page 6 of 35 quality of service offered to people who live at this home. On the day of the site visit the Annual Quality Assurance Assessment or AQAA report was given to the inspector. This report detailed what the home was doing well, what had improved since the last inspection and any plans for improving the service in the next twelve months. Some information from the AQAA is included in the main body of the report. Some time was spent with the people who use the service. It was difficult to conduct conventional interviews with some people, due to their learning difficulties. However, most people were able to let us know their feelings with support from key workers, using their specific ways of communication to let us know their thoughts about the home and the staff. We observed three people who had communication difficulties to gauge, how staff at the home supported them. It gave us some insight into how staff interacted with people, how people are supported by the staff and also an indication of peoples well being. We spoke to two people who live at the home. Four staff attended interviews with us, comments and feedback from these stakeholders have been included in this report. On the day of the site visit opportunity was taken to make a partial tour of the premises, inspect a sample of care records, check records relating to the running of the home and check the homes policies and procedures. The inspector checked all key standards and the standards relating to the requirements outstanding from the homes last key inspection in June 2008. The progress made has been reported on under the relevant standard in this report. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The inspector wishes to thank the people living in the home, staff, Team leaders and relatives for their time and co-operation throughout the inspection process. What the care home does well: Peoples needs are assessed before they are offered a place at the home to ensure their needs can be met. People have Person Centered Plans, risk assessments and Health Action Plans. These were very comprehensive, accessible and can support staff to meet peoples full range of needs. The people who use the service were supported by staff to tell us about the decisions they made, these included, choosing the decor in their bedrooms, choosing the times they got up and retired, choosing what they ate, via pictorial menus, how they spent their money etc. We also saw evidence that people had chosen their summer holiday destinations and day trips. There was evidence that most people are involved in meaningful daytime activities of their own choice, which, had been planned in accordance with their wants, needs and capabilities. This is what people who live at the home told us, I go to wood work groups, to work at the allotment and I brought some lettuce and radishes home the other day that I had grown. Im doing a course at college a BTEC in IT skills. I really enjoy it. Staff also told us they supported people to hold coffee mornings, to enable people to invite friends over. Some people would be involved in baking cakes for the event. This was a really positive way of enabling people to maintain and develop new networks. People told us they were encouraged to go shopping with staff to buy food for meals at the local supermarket. We checked three peoples medication sheets and found that a system was in place which identified the medication prescribed, the dosage, reason for use and review dates. This was good practice and ensured that staff were made aware of these details. We asked people whether they liked living at Fraser Drive and this is what they said or signed, One person nodded their head, and grabbed the hand of the support worker and smiled. Another person said, Yes, the staff are good. The home was clean and tidy, homely and safe. The kitchen was clean and tidy. We asked people what they liked about their homes and this is what they told us, My bedroom is good. I like the garden. Care Homes for Adults (18-65 years) Page 8 of 35 On the day of our visit there were four support workers on duty and the Team Leader was in charge to offer support to twelve people who lived at the home. One support worker came on duty on a day shift to take a person out. This staffing level was observed to be to meet peoples needs on the day of the visit. 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. Care Homes for Adults (18-65 years) Page 9 of 35 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 35 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 35 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. People who use the service have their needs assessed, to try to ensure that the staff can meet their needs before they are admitted to the service. Evidence: We checked that everyone who lived at the home had needs assessments. The Team leader on duty confirmed this to be the case. We also saw evidence that as some people had lived in the service for over ten years, their needs had been reassessed during this time. Care Homes for Adults (18-65 years) Page 12 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are involved in making decisions about their lives, and can play a part in planning the care and support they need and want. Peoples needs and the risks associated with the support plans had not been all been reviewed. These must be reviewed on a regular basis to ensure peoples safety. Evidence: Evidence taken from he AQAA report stated that, Each individual has a detailed support plan with care and support needed for each individual. Regular PCP reviews, in a person centred way involving people who are involved in their life. We checked three peoples care plan files, these had been devised using a person centred approach to enable the involvement of the individuals. We saw evidence that one PCP had been reviewed in March 2009. However, we found that although overall the other two contained a lot of relevant information to enable staff to support people, there was very little evidence that the other two had been updated for several years, Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: for example one had been devised in June 2007 and there was no recorded evidence it had been reviewed. A requirement was made to address this at the inspection and a week later we were advised by the manager that each persons PCP had been reviewed and signed and dated. We made this requirement with a timescale of a week, to ensure peoples current needs were still appropriately recorded in order for staff to support people appropriately. One concern we had was that every ones support plans and care files were stored in unlocked cabinets in the dining areas of both houses. Staff explained this was to ensure people had access to their files, however, this could breach peoples confidentiality and these records must be stored in a secure manner to protect peoples rights. The team leader was made aware of this and was advised to address this as a priority. We asked how people are supported to make decisions about their lifestyles. The people who use the service were supported by staff to tell us about the decisions they made, these included, Choosing the decor in their bedrooms, choosing the times they got up and retired, choosing what they ate, via pictorial menus, how they spent their money etc. We also saw evidence that people had chosen their summer holiday destinations and day trip activities. Staff also told us that people were offered one session per week of one to one staff time to enable them to choose one outing or activity per week where they got complete one to one support and choice over their activities. This was very positive especially for people with complex needs. From observations of the staff and people who live at the home we saw evidence that the staff encouraged people to make everyday decisions and listened to peoples requests and were empowering in their approach to people. It was also clear that the staff knew people really well and were able to communicate with people who had communication needs and to interpret their needs and wants. Overall, people had comprehensive risk assessments, which covered issues such as risks associated with outings, car travel, road safety, behaviour which challenges, bathing, swallowing assessments etc. Staff told us that three of the risk assessments we checked were still appropriate to meet peoples needs however, only one persons assessment had been recorded as reviewed over the last year. One moving and handling assessment had not been signed as reviewed since February 2007. This could place people at risk and therefore the manager was asked to address this as a priority. A requirement was made to address this at the inspection and a week later we were Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: advised by the manager that each persons risk assessments had been reviewed, amended as required and signed and dated. Care Homes for Adults (18-65 years) Page 15 of 35 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. People who use the service were treated with dignity and respect. Staff supported people to be able to make choices about their lifestyle, and they were supported to develop social, recreational and general life skills. Some people needed more support to access more activities. The home provided people with suitable diets to meet their individual needs and choices were respected. Evidence: Throughout our visit we observed staff interactions with people, which were at all times respectful, empowering and friendly. The staff were positive and enthusiastic and there was a very calm and confident approach to their support of people. There was evidence that some people are involved in meaningful daytime activities of their own choice, which, had been planned in accordance with their wants, needs and capabilities. Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: This is what people who live at the home told us, I go to wood work groups, to work at the allotment and I brought some lettuce and radishes home the other day that I had grown. Im doing a course at college BTEC in IT skills. I really enjoy it. This is what people told us, with support from staff, I do baking at home, I have a massage and I go out to the park. Some of the staff we spoke to said, We have arranged a lot of activities for people and when there are enough staff on duty we go all over with people, shopping, swimming to the cinema etc. However, after discussions with staff and observing what activities people had it was clear that people with the most complex needs, need more support to have opportunities for more meaningful activities at home and access to more community activities. We discussed this with the manager, who advised us that staff sickness and absences over the last six months had contributed to this but they agreed that this needed to be addressed and that plans were in place to enable more one to one staff sessions for people. People who live at the home were supported to maintain and develop relationships. We asked people and checked peoples care plans and found evidence that staff supported people to make regular phone calls to relatives and also to support them to have visits and to and from relatives. Staff also told us they supported people to hold coffee mornings to invite friends over and some people would be involved in baking cakes for the event. This was a really positive way of enabling people to maintain and develop new networks. From our observations and from some records we could see that mealtimes were arranged around peoples needs and wants. We observed one lunchtime and saw people asked what they wanted for lunch, then to be supported to eat their meals in a safe and calm environment. Some people had soft diets and we saw staff following the guidelines of the swallowing assessment plans. The staff confirmed that people are offered a choice of meals. The menu was in pictorial format and everyone had a chance to choose their favourite meal for the menu each week. We checked to see if people were offered a varied and nutritious diet and menus showed that this was the case. Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: People told us they were encouraged to go shopping with staff to buy food for meals at the local supermarket. Care Homes for Adults (18-65 years) Page 18 of 35 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 that people receive was based on meeting their individual needs. However, some records showed that either people had not been attending regular health appointments or this had not been recorded accurately. Evidence: We asked the staff for three people, with communication needs, if people are offered appropriate appropriate support from staff with personal care tasks. This is what they told us, In each persons PCP we identify with people and their families how best to support their personal care needs and record things like if people like a bath or a shower, whether they need specific toiletries or cream treatments and how to care for their skin and hair. Staff went on to tell us, In some peoples care plans it advises whether we just need to prompt people or whether other people need our support to wash, bathe and dress themselves. All of the people who live at the home were observed to be well dressed and their Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: clothing was age appropriate. We observed several people to be asked by staff whether they wished to use the toilet and to get changed. This was done discreetly and their wishes were respected by the staff. The AQAA report stated that everyone had a health action plan or HAP. We saw evidence of these, but found two had not been kept up to date or reviewed over the last year. This could mean that peoples health needs go unmet. We then asked staff for their views about how they supported people to meet their health care needs, this is what they told us, We support people to see dentists, GP and opticians. From the care plans it was evident that some people had attended regular health appointments. For example that people had seen the dentist, the G.P. and a chiropodist on a regular basis. However, although we were told by staff that one person had seen an optician, the date of this had not been recorded in their care file. This was only recorded in the homes diary. His could mean that important information about peoples health needs may go missing. Staff told us that other specialist health professionals were also supporting people who had more complex needs. For example speech and language therapists, psychiatrists, district nurses and social work input and this had been recorded in their care plans checked. We made a requirement for the registered manager to update peoples health action plans as a priority. To ensure peoples health needs were being met. This was carried out over one week after our visit and we were advised in writing by the registered manager that this had been completed. We checked to see if three people had moving and handling assessments in place, they did, however, one checked had not been signed and dated as reviewed since 2007. This could place people at risk as their needs may have changed. The staff on duty told us that none of the people who lived at the home were able to administer their own medication. Therefore, the staff on duty were responsible for these tasks. We checked three peoples drug sheets and found that a system was in place which identified the medication prescribed, the dosage, reason for use and review dates. This Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: was good practice and ensured that staff were made aware of these details. The medication procedures were checked. The home used the Nomad dosage system, which the local pharmacist delivers on a regular weekly basis. The medication was stored in clean, lockable drug cabinets. Care Homes for Adults (18-65 years) Page 21 of 35 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. People were protected by the safeguarding policies and procedures as the staff knew how to respond to allegations of abuse. Peoples rights were protected by this. There were procedures to ensure all allegations of abuse are thoroughly investigated. People who use the service were able to express their concerns and have access to a complaints procedure. Evidence: We asked people whether they liked living at Fraser Drive and this is what they told us, One person nodded their head, and grabbed the hand of the support worker and smiled. Another person said, Yes, the staff are good. The AQAA report stated the home has a complaints procedure for people. The Team Leader told us this was in an accessible format. There were also copies seen in each persons care file checked. This helps to protect peoples rights. The Team Leader on duty told us that no complaints had been made at the home since the last inspection. Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: All of the staff we spoke to said they were aware of the adult safeguarding procedures and they said they had completed training on this subject. The staff training records confirmed this. They also advised that a copy of the new local area safeguarding adults procedure was also available. The Team Leader said the home has a whistle blowing procedure. To enable staff to report any concerns about how the service is run. The Team Leader informed us that over the last year no adult safeguarding referrals have been made to the local safeguarding adults team. Care Homes for Adults (18-65 years) Page 23 of 35 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. Overall, the accommodation offered to people was of a good standard. People had been supported to personalise and make their houses homely in order to meet their specific needs. The bathroom in House 11 needs to be made fit for purpose to ensure people have access to adequate bathing facilities. Evidence: At the time of the visit twelve people lived in the home. Six people in each house. The home was clean and tidy, homely and safe. The kitchen was clean and tidy. We asked people what they liked about their homes and this is what they told us, My bedroom is good. I like the garden. One person took us to their room and nodded positively when we asked if they had chosen their furniture, bedding and decor. One other person showed us their room, which was well decorated, personalised and furnished to a high standard. They told us that they liked their bedroom and were happy with how it was furnished and decorated. Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: The bathrooms were checked in each house, all were clean. One in House 11, was closed off, as a specialist bath had been installed from another service, but did not work appropriately. The water temperature of this bath exceeded 43c and was 66c at the last test and therefore was out of order and no one was able to use the bathroom. This meant that six people were having to use one bathroom and the staff said this had led to people having to wait for a bath or shower. This was reported to the Team leader on duty who said they were awaiting for a maintenance visit to address the problem. We advised that this must be addressed as a priority. We were advised by the registered manager that the bath had been repaired within a week of our visit. Outside there was a communal garden area with patio furniture. The garden was well maintained and attractive. Staff were building a patio area for people to sit out on. There was a greenhouse and one person was supported to grow plants. The staff said there was adequate washing and drying facilities in the home to keep peoples laundry clean and dry. There was evidence that staff had completed infection control training and that measures were in place to wash soiled laundry safely. Care Homes for Adults (18-65 years) Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, people were supported by a staff team who were mostly appropriately trained, skilled and experienced to meet their needs. However, some staff do not have confidence in a junior manager and this will need to be addressed. Staff need more opportunities to be formally supervised to discuss their concerns. Some staff needed refresher training and NVQ support. People who live at the home were supported by the homes recruitment practices. Evidence: On the day of our visit there were four support workers on duty and the Team Leader was in charge to offer support to twelve people who lived at the home. One support worker came on duty on a day shift to take a person out. This staffing level was observed to be to meet peoples needs on the day of the visit. Two members of staff told us, they received regular mandatory training from the service. The Team Leader said and some of the other staff confirmed, that they had completed induction training and completed most of the required mandatory training. We checked Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: the staff training files and found that the following numbers of staff had completed training in, Fire safety, 15 out of 21 staff in the last six months. First Aid, all staff in the last three years. Food hygiene, all staff over the last three years. Moving and handling, all staff over the last three years. Infection control, all staff over the last three years. Most of the staff had completed the training required at the intervals for refresher training required. But some staff were identified as needing refresher training according to the training register and this was fed back to the registered manager to address. Only 28 per cent of staff had completed an NVQ2 in care award. This is an area which needs to be addressed to ensure that the recommended 50per cent of staff have achieved this award. This will help to protect peoples welfare. Two members of staff told us, they were not being offered frequent supervision and did not always feel able to take any concerns or problems they had to the management team. When we enquired why this was we were advised that since the manager had not been working full time at the service, they were there for 30 hours a week, that staff support from the Team Leaders was not always adequate. The staff interviewed told us, the relationship with the manager and most Team Leaders were really good. However, one Team Leader did not have the confidence of some of the staff we interviewed. We discussed this with the registered manager who advised that this would be addressed as a priority. Staff told us they have regular staff meetings and feel most of the line management team are approachable and will listen to them. From our observations we saw a lot of good staff practice. For example staff were very tuned in to peoples communication styles, and they were supporting people with complex needs in a professional and safe manner. We also observed the relationships between staff and people who lived at the home. This showed that staff had positive regard for all of the people who lived in the home, they were informal but respectful in the way they spoke to and of people. This was very positive to see as the people who lived at the home responded positively to the staffs approaches. Two staff recruitment records were checked. We found these contained the information required including CRBs, application forms, proof of I.D, two references. Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: We checked a sample of supervision records, which showed that staff were not being regularly supervised. This didnt enable the manager to monitor staff development and accountability. Care Homes for Adults (18-65 years) Page 28 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Relationships between the support staff and junior management team need to be addressed to ensure that they do not negatively impact on people. The present management structure of the service needs to be reviewed to ensure the registered manager role is adequately covered at all times to protect peoples welfare. Evidence: The manager of the home was registered. She was appropriately qualified for this role. The staff reported that the manager was supportive and listens to them. From observations and discussions with people who live at the home we found that their opinions were listened to and acted upon appropriately. However, the manager is only at the service on a part time basis, as they are acting as regional manager on a temporary basis. It appears that this is having a detrimental effect on the staff team as the junior management team need more support and direction to ensure the smooth running of the service. Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: For example we found that some care plans or PCP, Health Action Plans and risk assessment plans and records were not up to date. We were told by some staff they were demoralised by the actions of a junior manager and that this could lead to peoples needs not being met as there was a lack of trust and poor communication within the staff team. This could affect the outcomes for people if not addressed as a priority. This was discussed with the registered manager after our visit. The AQAA report from the home detailed the way in which peoples views underpin, the reviews and self monitoring of the service. This was positive. We saw evidence that the service had health and safety policies and procedures in place, this ensures peoples safety and welfare. But the manager needs to ensure the procedures are implemented appropriately for example mandatory training is completed and updated as required. The manager said the regional operations manager visits the home to carry out regulation 26 visits, and records of these were shown to the inspector. However, it was a concern that out of date records were not picked up via this system and therefore the system may need to be reviewed to prevent this re-occurring. As part of the site visit we examined some of the maintenance and servicing records, these included, Fire detection and fighting equipment, last checked in May 2009 by Burns Electricals. Fire drills, last checked in as undertaken 6 monthly on 15 February 2009. Fire alarm, last checked weekly tests undertaken on 14 May 2009. Wheelchair checks, last checked as done weekly. Water temperatures, are checked weekly. Last check was on 18 May 2009. All temperatures were o.k. except laundry room and closed bathroom hot water taps which, were identified as over 43c. A requirement to address this was made during the visit. Baths and hoists, the staff said there were none in operation at the service. Care Homes for Adults (18-65 years) Page 30 of 35 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 6 15 As a minimum the care plans 30/09/2008 must be reviewed every six months. (Requirement first made on 27/04/05 and a further requirement timescale was 01/07/06) The registered person must ensure that the health and safety issues mentioned in the text of the report are addressed: (Security of the building. (Hot water temperatures. (Accessibility of the laundry areas when unoccupied by staff. (Specific emergency lights not working in one of the homes. (Lack of notifications to the Commission. 08/08/2008 2 42 13(4) Care Homes for Adults (18-65 years) Page 31 of 35 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 1 19 13 The registered person must 20/06/2009 ensure that peoples health care needs are reviewed on a regular basis and records of all appointments must be recorded. To protect peoples health and welfare. 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 6 17 The registered person must ensure that all confidential information about people is stored in a secure manner. To protect their right to confidentiality. 20/06/2009 2 6 15 The registered person must ensure that peoples care plans are reviewed on a regular basis. To ensure the care plans are accurate and still appropriate to meet their needs. 20/06/2009 3 9 13 Peoples risk assessments must be reviewed on a regular basis. 20/06/2009 Care Homes for Adults (18-65 years) Page 32 of 35 To ensure they appropriate to meet their needs. 4 32 18 The registered person must ensure that staff training records are checked to ensure staff have the opportunity for refresher mandatory training as required. To protect peoples welfare. The registered person must ensure there is adequate management time allotted to the service. To ensure people can benefit from a well run service. 6 42 12 The registered person must 20/06/2009 ensure that the temperature of hot water taps is maintained at between 41 & 45c. 20/11/2009 5 37 12 20/06/2009 To protect people from harm. 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 13 The registered person should ensure that people with more complex needs are supported to access more meaningful activities and community facilities. The registered person should ensure that 50 of the staff team achieve the NVQ2 care awards to ensure staff have been assessed as having the appropriate skills to meet peoples needs. 2 35 Care Homes for Adults (18-65 years) Page 33 of 35 3 39 The registered person should look in to the concerns raised by staff about the relationships between them and the junior management teams approach. Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 35 of 35 - 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!