Care Home: Gilby House Care Home

What the care home does well The manager of the home understands the needs of the people living in the home and the staff group. There is a needs assessment process at the home which is robust and thorough, enabling people who choose to use the service to be confident that their needs can be met. A detailed plan of care is provided for each individual and this is regularly updated. People are involved in the care planning process and are regularly consulted. The people living in the home said that they felt well cared for and that the staff were kind and helpful, but the best thing was that they were listened to. They are given the opportunity to make decisions about their lives and the day-to-day running of the home and said that the manager and staff ask them what they think about things, through individual discussion, surveys and service users meetings. Administration, handling and storage of medicines is well managed. What has improved since the last inspection? There has been some refurbishment to the home improving the environment and making it more pleasant and comfortable for the people living there. People living in the home have been involved in this and have contributed to the choice of colours and furnishings in the home. The two requirements made at the previous key inspectionin October 2007 have been addressed, which were in relation to the cleanliness of the corridor carpet and the redecoration of a bedroom ceiling that had experienced a leak. The carpet has been replaced with flooring and the ceiling of the room redecorated. Further refurbishment including the purchase of new furniture, new washing machines, redecoration in different areas and repair and redecoration of windows have also been completed. The downstairs shower room and toilet have been replaced. Similarly a random inspection of the service in July was undertaken to look at the arrangements in place for the financial management of monies that belong to people living in the home, and monitor compliance of the home in meeting Regulation 17(2) Care Home Regulations(2001). At that visit four good practice recommendations were made.Two of these have been addressed.This included the nurse in charge signing across the seal of the envelope holding the safe key between shift changes. The second, related to extending the practice of signing for the medication key, so the nurse in charge signed for the safe key.Staff have received safeguarding training as well as training on Mental health conditions, the Mental Capacity Act and Deprivation of Liberties training. What the care home could do better: In order to comply with the requirement made by the Environmental Health the flooring in the kitchen needs to be replaced as the previous repair made has not been successful. As people are no longer attending college or community based adult education classes, a structured activities plan needs to be developed to ensure that people have a range of meaningful activities to engage in. This could be further supported by training and guiding staff in how to motivate and engage people, in order that the staff team can support people effectively in this. People living in the home said that they would like more activities and outings made available to them. It was identified that a small group of staff appear to be causing some `undercurrents` within the home. In order that staff morale is improved and the people living in the home are not affected by this, further action needs to be taken promptly to deal with this. Key inspection report Care homes for adults (18-65 years) Name: Address: Gilby House Care Home High Street Winterton Scunthorpe North Lincolnshire DN15 9PU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Wilma Crawford     Date: 2 5 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 29 Information about the care home Name of care home: Address: Gilby House Care Home High Street Winterton Scunthorpe North Lincolnshire DN15 9PU 01724734824 01724734824 info@prime-life.co.uk info@prime-life.co.ukwww.prime-life.co.uk Prime Life Ltd care home 22 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) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: One named service user over the age of 65. This individual can continue to be accommodated in the home until there is a change in their individual circumstances which means the home can no longer meet their assessed needs. Date of last inspection Brief description of the care home Gilby House is registered to provide nursing care to adults who experience mental health problems. The home is a converted Victorian building in the centre of the village set in its own grounds The home is situated in Winterton, a village close to Scunthorpe. Its location gives service users good access to local shops, pubs and other facilities within the village community. There is also a regular bus service into the town of Scunthorpe. The home has a web site and email address that has been included in this report. 22 Over 65 1 Care Homes for Adults (18-65 years) Page 4 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection report is based on information received by the Care Quality Commission (CQC) since the last key inspection of the home on 16th of October 2007 and the two random inspections of 19th May and 31st July 2009 including information gathered during a site visit to the home by two inspectors Mrs Wilma Crawford and Mrs Jane Lyons. The site visit to the home was unannounced and took place on 25 November 2009. Ten people living in the home and five staff were spoken with during the visit. The manager was available throughout the visit. The main method of inspection used was called case tracking which involved selecting five people living in the home and tracking the care they receive through the checking of their records, discussion with them, the care staff and observation of care practices. The premises were looked at and the records of five people living in the home and three staff were inspected. An Annual Quality Assurance Assessment (AQAA) document asking for information Care Homes for Adults (18-65 years) Page 5 of 29 about the home was sent out before this visit and information from this was included as part of the inspection process of this service. Twenty four surveys were sent out to people living in the home, professionals and staff, twelve of these were completed and returned. The comments from these and from discussions during the site visit are also included in the report. The range of fees charged is £367 - £900 per week. These fees are based on a standard fee and an additional package of care based on the individuals needs. People living in the home pay for their own newspapers, chiropody treatment and hairdressing. We have reviewed our practice when making requirements,to improve national consistency.In future if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 6 of 29 What the care home does well: What has improved since the last inspection? What they could do better: In order to comply with the requirement made by the Environmental Health the flooring in the kitchen needs to be replaced as the previous repair made has not been successful. As people are no longer attending college or community based adult education classes, a structured activities plan needs to be developed to ensure that people have a range of meaningful activities to engage in. This could be further supported by training and guiding staff in how to motivate and engage people, in order that the staff team can support people effectively in this. People living in the home said that they would like more activities and outings made available to them. It was identified that a small group of staff appear to be causing some undercurrents Care Homes for Adults (18-65 years) Page 7 of 29 within the home. In order that staff morale is improved and the people living in the home are not affected by this, further action needs to be taken promptly to deal with this. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 29 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. A full needs assessment is carried out and people are given enough information about the home and its facilities before admission, for them to be confident that their needs can be met by the service. Evidence: The home has a statement of purpose and a service user guide, which provides information about the home. A sample of five care plans were examined during the inspection process and were found to contain assessments of need and care plans completed by the local authority. The assessments were a combination of those completed by the placing authority and the homes pre - admission information. Where appropriate they were also supported with risk management plans and assessments from other health professionals. There have been a number of admissions to the home since the last inspection visit and records available in the home demonstrated that detailed assessment procedures had been followed by the home and there had been consultation with other professionals involved in supporting the individual to ensure that their needs could be met by the home.The assessments also identified the individuals social and health care needs and Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: were regularly reviewed and updated to reflect changes in need. Interviews with the staff, staff training records,information from surveys and discussions with people living in the home all supported the evidence that the home has the capacity to meet the assessed needs of the service users. Each individual has a statement of terms and conditions with the home, which is signed by the individual or their representative and includes details of any third party payments due to the individual themselves in relation to the service and care provided to them. The manager or the deputy manager visits prospective service users and a full assessment is completed. People who are considering moving into the home also have the opportunity to visit, have a meal or an overnight stay before making a decision about moving in. Staff and people living in the home were able to confirm that this admission process took place. Care Homes for Adults (18-65 years) Page 11 of 29 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. People who use this service experience good quality outcomes in this area. People using the service are able to make decisions and everyday choices as part of an independent. Evidence: The care plans sampled were personalised and detailed how individuals needs should be met within the home. Each care plan had been regularly monitored and evaluated and where appropriate new or changed care plans had been implemented. People spoken with by the inspectors stated that the staff were able to look at their care plans and that they believed that all of their care plans were being followed by the staff. The staff complete a record of the daily lives for each person, detailing any patterns of behaviour or concerns around mental health problems. Any concerns are raised with the manager or qualified staff in order that appropriate support can be sought for the individual promptly. There was clear evidence to demonstrate that people were supported to achieve their personal aspirations and when this identified a potential risk,they were fully involved in the risk assessment process.Where risks were Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: identified in the daily lives of individuals, their care plans were supported with risk assessment and risk management plans. The risk assessments were found to be detailed and covered all areas identified within their care plan and were specific to each individual, with clear guidance to staff on how to minimise any perceived or actual risk. These were found to have been regularly evaluated to make sure that they were still relevant to the care of the individual. The majority of the care plans examined were current and contained well documented daily recording, however one care plan did not contain the date the individual had last seen a dentist.Another care plan seen,contained some recording which could be improved upon, where inappropriate terminology had been used. Formal reviews are held on an annual basis or more frequently should the need arise, evidence of this was seen in individuals care plans. Direct observation by the inspectors and examination of documents in the home supported the evidence that the people living in the home are provided with choice throughout their daily lives. Regular service users meetings are held and minutes of these provided evidence that they are asked for their views on how the services provided in the home should be improved. People living in the home informed the inspector that they decide for themselves what time to rise from and retire to bed, they also said that they could choose to eat wherever they wanted. All of the confidential information held in the home was stored in accordance with the Data Protection Act 1998. Direct and indirect observations during the course of the site visit supported that when confidential information was being discussed between staff, or between staff and service users confidentiality was appropriately maintained. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have limited opportunities to access a variety of leisure activities,and spend their time in a meaningful way. People are supported to maintain relationships with their families and have their nutritional needs met. Evidence: People living in the home stated that they are supported through a variety of ways to maintain and develop their social, emotional, communication and independent living skills. The care plans observed by the inspectors supported that these areas were being addressed for all of the individual service users. This included identification of service users personal, religious and cultural needs. Part of this information included the recognition of the service users last wishes in the event of their deaths including the type of religious or non - religious service that they would require. At the previous inspection visit,although none of the service users were involved in maintaining jobs (due to the problems associated with their mental health problems) Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: they were supported to continue with community based training and education.This included adult education classes for art, craft, adult literacy and computer skills.These opportunities are no longer available. There was no structured plan of activities availble within the home.Although people were observed engaging in a variety of activities: knitting,playing pool,reading magazines,some spoken with said that they would like different things made available and that it was not always possible to cater for everyone at the same time. Individual ideas had been recorded at service users meetings,however, staff spoken with said that the people living in the home were not always motivated to get involved in anything much. In view of the the adult education classes and college placements no longer being accessed a requirement was made to look at providing a structured plan of activities based on individuals needs and preferences, to give people the opportunity to engage in appropriate and meaningful activities both in the home and the local community. A recommendation was also made to make training available to staff to assist them with motivating people. The home is situated in the centre of the local community and there are good relationships between the people living in the home, staff and business people in the area. This includes a local cafe that some people like to visit, and the local public house that contact the staff at the home if they have any concerns for any individual. Individual records and discussions with the inspectors supported the evidence that they are encouraged and supported to maintain their relationships.A regular visitor to home, who visited at least once a week,described how they were always made to feel welcome and was kept up to date about their relatives care. They were also supported to go out in the community with them and to speak to them on the telephone on a daily basis. Individual care plans record individuals likes and dislikes and menus are planned to accomodate these. On the day of the site visit an inspector had the opportunity to observe the meal being served, and alternatives being provided for some individuals who wanted a lighter meal.The majority of people chose to have their meal in the dining area, but one individual chose to have their meal in the conservatory. Staff also had a meal at the same time, but rather than engaging with the people living in the home and asking to sit with them, they chose to sit exclusively together.We asked the manager to look into this practice. Care Homes for Adults (18-65 years) Page 15 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have their health care needs met and guidance from healthcare professionals is followed. Medication is well managed. Evidence: The home receives good support from outside agencies and can obtain consultant appointments immediately if required urgently. People living in the home have their health care needs met through the nurses that are employed at the home and support from their GPs and other healthcare professionals that are based in the community. Each person living in the home is registered at the local health centre. The people spoken to by the inspectors said that when they were seen by health care professionals they were always seen in private unless they asked for one of the care workers from the home to support them. Where care plans identified individual problems where people may choose to decline medical checks or assistance, there are clear guidelines in place for staff to follow to support the person and additional information of where they can access additional support in order that people can have their health care needs met.Individuals care plans identified when there had been any changes in their health care needs and the support that they now required in maintaining as much independence as possible. Comments made by visiting Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: professionals spoken with were The Manager of the home is professional in his attitude,knowledgeable about the people in the home and their individual care needs. Staff who come to the surgery are knowledgeable and supportive,whilst respecting peoples privacy and dignity Our instructions are always followed and any queries are quickly followed up. None of the people living in the home administer their own medication. The nurses that are employed there, administer all of the prescribed medication. This is supported further by weekly audit checks of all medications by the home manager.Care staff receive medication training to ensure that they understand the effects that the medication can have on the people using them.The medication room was well organised and the medication fridge and room temperatures were monitored on a daily basis. Medication records were all up to date and had been accurately recorded. This included the records for the controlled drugs in the home. The staff were observed administering medication to the people living in the home by an inspector and all appropriate legislation and good working practice guidelines were followed. The home also has access to an optician and chiropodist who will visit the home if people are unable to access community based services. Each of the individuals that were case tracked by the inspector had their last wishes in the event of their deaths identified. This will ensure that all of the social, religious and cultural needs of the service users will be met through the home. Care Homes for Adults (18-65 years) Page 17 of 29 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 using the service feel able to air their concerns without any fear of repercussions. Evidence: The home has a clear complaints procedure and the people spoken with and feedback from surveys, stated that they understood how to make a complaint if they had any, in relation to the care that they receive at the home. Examination of the complaints record demonstarted that complaints were responded to promptly and what action had been taken by the home to resolve these. One recorded complaint had been passed onto the organisations Human Resource Department for further action. Although other records showed that a representative from the HR department had visted and spoken to the staff team, there was no records in the complaint log to reflect what action had been taken. A recommendation was made in espect of this. A random inspection of the service in July 2009 was undertaken to look at the arrangements in place for the financial management of monies that belong to people living in the home, and monitor compliance of the home in meeting Regulation 17(2) Care Home Regulations(2001). At that visit four good practice recommendations were made.Two of these have been addressed.This included the nurse in charge signing across the seal of the envelope holding the safe key between shift changes. The second, related to extending the practice of signing for the medication key, so the nurse in charge signed for the safe key.The arrangements for the management of the finances within the home were confirmed to us by the registered manager and the nurse in charge. Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: The following safeguarding arrangements will stay in place until the outcome of current legal action is known. The current registered manager continues to have no involvement in the management of finance within the home.It was stated that he is supernumerary to the registered nurses on duty and he does not hold any keys to the medication systems or the safe in the managers office. Debbie Mogg, the manager of Stoneleigh, with the assistance of the funding co-ordinator for Prime Life continues to oversee finances at Gilby House. The registered nurses at Gilby House manage the day to day finances of the people living in the home, and the company accountant visits the home regularly to audit all financial records. On a daily basis, the nurse in charge is given a pre-arranged amount of money which is held in a locked cupboard in the medication room. This is then given out as and when requested by service users and a daily log is completed showing; who has received money or given money to the staff, any cigarettes or tobacco purchased from the company by a service user, and the signatures of two members of staff.A daily reconciliation of monies is made at the end of each shift and checked and signed for by the nurses at handover.Additional records are also available detailing the amount of money each person has in their bank account, should they wish to know this. Training records evidenced that staff have now undertaken training on safeguarding adults from abuse.The previous requirement made in respect of this is now considered to be met. Care Homes for Adults (18-65 years) Page 19 of 29 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. People living in the home are with a comfortable environment that is clean and has been decorated to a reasonable standard, with both private and communal space being suitable for their needs. Evidence: At the previous key inspection visit two requirements were made,the carpet in the corridor outside the managers office which was heavily stained and unsightly and in need of a thorough clean or replacement, in comparison to the clean carpets and flooring throughout the remainder of the home. A bedroom ceiling had experienced a leak and although the leak had been repaired the area had not been re plastered or re decorated.The carpet has now been replaced with new flooring and the ceiling of the identified bedroom redecorated.The requirements made are now considered to have been met. Further improvements have also been made including:repair and redecoration of window frames, purchase of industrial washing machines, a new shower room, new furnishings and redecoration of some communal and bedroom areas.Although this has improved the environment, there are still areas which do not appear homely, for example the dining room and the smoking room. However there are other areas that are homely and comfortable. A tour of the building found bedrooms that were personalised and decorated to suit individual tastes. Each bedroom has a suitable lock that can be used for privacy. Some individuals had their Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: own televisions and kettles installed in their rooms. In depth risk assessments had been completed for the use of kettles. Many individuals had personal belongings and furnishings in their rooms, making them feel homely and reflect the personalities of the occupants. Two of the bedrooms are for two people, with privacy screens in place. The service users stated that they were happy with their individual rooms and several of the service users invited the inspectors to visit their rooms. One individual does not have what may be considered as conventional furniture and fittings in their room, however their care plan documented that this was their personal choice and the placing authority were satisfied with this arrangement. The washing machines at the home are all programmable to disinfection and sluicing standards and the machines have automatic feeds on them so the laundry staff do not have to have any contact with any caustic materials. Policies and procedures are available for the control of infection. There is also a smaller laundry in the home where the people living in the home can do their own washing to maintain their independence skills, or to improve their skills with the hope that this will lead them on to more independent living. A recent Environmental Health Inspection awarded the home a three star rating. This identified a number of actions to be completed, including replacement of shelving, replacing the fridge/freezer,and repairing part of the flooring. All of this work has been completed, but the flooring has began to come up again and needs to be replaced or replaced to comply with the environmental health requirements. The home has several outside sitting areas, in well maintained gardens, which are accessible to the people living in the home. Care Homes for Adults (18-65 years) Page 21 of 29 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. People living in the home are supported by staff who are supervised and undertake training. The staff vetting procedure is sufficiently robust to ensure the safety of the residents. Although management are taking action to resolve a current staffing situation, further action needs to be taken to resolve this, so that outcomes for people using the service are not affected. Evidence: On the day of the site visit there were adequate staff available to meet peoples needs in a relaxed and calm manner.The home manager is supernumary to the rota and a qualified nurse is rostered each shift. Staff surveys detailed that there was considered to be enough staff on duty to meet the needs of the people living in the home.The staff rotas indicate that there are always appropriate numbers of staff available within the home. The staff spoken to by the inspectors had all received a clear job description and interviews with the staff showed that they understood their own roles and responsibilities and those of their colleagues. New starters have an induction plan that follows the requirements of the Sector Skills Councils workforce strategy targets and all new staff to the home undertake an induction to the home, which must be completed within three months of their appointment. Night staff are expected to work on day shifts to give them the opportunity to get to know the people living in the Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: home before starting their night role. Staff training records and interviews with the staff show that they are effective in meeting the needs of the service users. Training completed includes both mandatory and more specialised training including, Fire Safety, First Aid,Moving and Handling,Food Hygiene,Conflict Management (NAPPI) and Mental Health Conditions, to provide them with a better understanding of the needs of the people living in the home.More recently Deprivation of Liberty and the Mental Capacity Act training has been completed. Five staff returned questionnaires to the Commission, these were all positive in relation to the care of the people living in the home and the management of the home. Two appropriate references and a POVA first check had been received for a newly appointed staff member, current Criminal Reference Bureau (CRB) checks had also been completed. Staff supervision is held regularly and documented, the manager supervises the nursing staff and they in turn supervise the care staff. Service user and relatives opinions of the capabilities of the nursing and care staff were that they were good and had a good understanding of their needs.Comments includedI feel the home does very well in monitoring us and we are very well cared for. I feel that the quality of care available at the home is of a very high standard and I am more than happy that my wife is living there Approximately 48 of the of care staff working at the home have achieved NVQ 2 or equivalent. During the visit there were obsrvations made by the inspector, where a small group of staff were seen to question the nurse in charge when care tasks were being allocated and not interacting with the people in the home. They were seen taking frequent smoking breaks and taking meals together exclusively,even though staff breaks were clearly identified and on display in the staff room. When this was raised with the home manager and the nurse in charge, they were aware of the situation and explained that there had been some unrest within a small group of the staff. Actions had been put in place to address this, but further work was required to resolve this issue. Care Homes for Adults (18-65 years) Page 23 of 29 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. The home is generally well run in the interests of the people living in the home. Evidence: The registered manager is a qualified Registered Mental Nurse and Registered General Nurse and has completed the Registered Managers Award. The manager of the home also attends all of the mandatory training with the staff group. Staff interviewed by the inspector,feedback from surveys and discussions with people living in the home supported the evidence that the management of the home is open, positive, inclusive and service user focused. Regular staff and service user meetings are held by the management to allow both groups to be able to offer their views on the development of services in the home. One person living in the home spoken with said he is a good man, he listens to us and gets things done. Staff spoken to confirmed that they received regular supervision and were involved in hand overs and staff meetings. Direct and indirect observations made by the inspector during the site visit showed that the manager of the home does not restrict himself to an office, he walks around the home on a regular basis and integrates with the people living in the home. He was Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: seen to be well received by all of the individuals that he approached.Two people spoken with by one of the inspectors (together) stated that the manager is very good, he has changed a lot of things here for the better, Tom is a good man. The homes quality assurance and monitoring system is undertaken corporately and the results are returned to the home. The companys quality assurance rated the home as having a 65 excellent feedback rate from surveys completed and returned from relatives, staff and professionals. The information for the report includes questionnaires returned by service. An action plan is developed from the results of the surveys, to improve any identified areas further. A follow up report is then completed to demonstrate what action has been taken to address these. Policies and procedures are produced corporately. A small handbook with prompts in relation to the policies and procedures are also made available to all of the staff. The maintenance records in the home were found to be up to date and correspond to the information submitted within the AQAA.The gas systems in the home all had up to date safety certificates. The fire systems are regularly monitored and serviced and all of the mobility aids in the home are regularly serviced and maintained. The management of the home ensures, as far as is reasonably practicable, the health safety and welfare of the service users and the staff. Care Homes for Adults (18-65 years) Page 25 of 29 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 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 14 16 A plan of activities must be provided to ensure structured activities areprovided for individuals to meet their individual needs and preferences. This would give people the opportunity to engage in meaningful activities. 26/02/2010 2 24 23 Regulation23 (2)(b)The flooring in the kitchen area must be replaced as identified within the homes most recent environmental health report. This will ensure that the kitchen area will be well maintained and safe. 26/02/2010 3 32 12 The registered provider should ensure that the registered manager is supported to maintain good professional relationships within the staff team. 26/02/2010 Care Homes for Adults (18-65 years) Page 27 of 29 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 This would ensure that all of the staff team are working effectively to support individuals within the home. 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 7 Daily recording in all care plans should be made objectively using descriptive words to reflect and show peoples choices, preferences and any decisions that they have made, rather than subjective comments based on the carers views and opinions. Details of individuals access and use of health services should be kept up to date,in all care plan records. Staff should be offered training to assist them with supporting and motivating people to engage in appropriate meaningful activities. Staff should give people living in the home, the choice to eat with them, rather than eating together exclusively. When a complaint has been passed on to a higher level by the home manager, it would be good practice for the person dealing with the complaint, to record the timescales and what action has been taken to resolve the complaint. Continue to ensure that care staff have access to NVQ level 2 training to meet the standard of having 50 of the care staff with this qualification. 2 3 7 14 4 5 17 22 6 32 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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