Care Home: Hall Bank Mews

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What the care home does well The service takes time to make a decision before offering a place to someone new. This enables all parties to make an informed decision about whether it is the right place and can meet people`s needs. The staff understand the needs of the service users and communicate with them effectively to enable people with high dependency levels to make decisions and choices as far as they are able. People enjoy busy lifestyles and access the community where they are able to pursue their individual interests and hobbies. Staff are well trained, well supported and are motivated. New staff are recruited safely to ensure any risk to vulnerable people is minimised. The service has a zero tolerance approach to abuse and action in the event of any concern is swift. What has improved since the last inspection? Since the last inspection a number of improvements have been made. It is very positive that all three requirements we issued in April 2008 have been met and fourteen out of fifteen recommendations have also been met. In essence steps have been taken to ensure staff have a better understanding of cultural needs and how to meet these. Also much has been done to ensure people are better protected. Beds and unsafe bedrails have been replaced, complaints and protection is discussed openly in a variety of forums with staff and people who live there. Medication has been audited by a pharmacist and her recommendations for the better management of medication have been acted on. Ways that people may have been restricted have been reviewed and one person has been supported to stop wearing restrictive pyjamas enabling her to have greater independence, dignity and liberty. Most significantly for the people living there, staff morale has improved. The teething problems and staff grumbles we found at the last inspection from the changes involved in setting up this new service have resolved and the staff team is now focussed and cohesive. The atmosphere therefore is better for the people living there. What the care home could do better: The environment is of most concern. It is clean and bright and people`s personal space such as bedrooms and ensuites are spacious and are equipped well to meet needs. Communal space is much less so. Internal communal space is at a premium in Hall Bank 1, particularly considering the number of people who use wheelchairs indoors and is not equipped with either enough easy chairs or easy chairs that meet people`s physical needs to enable them to relax in the company of others. To compound this the rear garden area has been greatly reduced since we last visited which has reduced both the available space and potential for development. On the day of inspection, managers have agreed to review internal space and furniture with an Occupational Therapist.Since inspection, the service has told us that it intends to make some structural changes to the premises inorder to address shared concerns about space. By losing a bedroom, this would increase communal living space by 19 square meters. The creation of an additional garden is planned too. It is advised that these plans are discussed in advance with our registration department. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Hall Bank Mews 1 - 3 Hall Bank Mews Pontesbury Shropshire SY5 0RF     The quality rating for this care home is:   three star excellent 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: Deborah Sharman     Date: 2 4 0 4 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 31 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 31 Information about the care home Name of care home: Address: Hall Bank Mews 1-3 Hall Bank Mews Pontesbury Shropshire SY5 0RF 01743872250 01743874815 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) : Condover College care home 10 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Additional conditions: 10 10 The maximum number of service users to be accommodated is 10. The registered person may provide the following category of service only Care Home Only - Code PC To service users of the following gender Either Whose service users on admission to the home are within the following categories: Learning Disability (LD) 10 Physical Disability (PD) 10 Date of last inspection Brief description of the care home 1 to 3 Hall Bank Mews is a detached property that has been converted for purpose from a building which was previously the Doctors surgery. The building is divided into 3 houses, known as numbers 1, 2 and 3. There are eight bedrooms on the ground floor. Five of these are in house 1 and three are in house 2. House 3 is on the first floor and is home to 2 people who are mobile as there is no passenger lift. The ground floor is wheelchair accessible and when complete, it is hoped that external garden space will be more readily accessible for use by people using wheelchairs. Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home There are ten bedrooms so each person living there is afforded a personalised room of their own with spacious en suite facilities equipped with either a bath or shower as chosen by the occupant. Each person who needs it has overhead tracking hoists that run between the bed and the en suite. Each bedroom has a TV aerial and internet access, a lock and a call bell. Telephone lines could be installed in individual bedrooms. A small lounge area is enhanced by an adjacent conservatory, which provides more communal space and light. Pontesbury is in a rural area on the outskirts of Shrewsbury. It has a village feel and staff and managers are pleased with how warmly they have been welcomed by the local community. Weekly fees range from 800 pounds to 2200.00 pounds Care Homes for Adults (18-65 years) Page 5 of 31 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: three star excellent 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: One Inspector carried out this unannounced key inspection over two days. On the first day we inspected from 3.00pm until 6.30pm. On the second day we inspected between 10.00am and 6.30pm. As the inspection visit was unannounced this means that no one associated with the home received prior notification and were therefore unable to prepare for our inspection on the first day. The service was aware of our intention to complete the inspection two days later. As it was a key inspection the plan was to assess all National Minimum Standards defined by us as key. These are the National Standards which significantly affect the experiences of care for people living at the home. Care Homes for Adults (18-65 years) Page 6 of 31 Information about the performance of the home was sought and collated in a number of ways. Prior to inspection the Care Quality Commission had been provided with written information and data about the home in an annual return or Annual Quality Assurance Assessment known as an AQAA. We had sent surveys to people who live and work at Pontesbury Surgery and also to independent health professionals who have contact with the home. At the time of inspection, it was our policy not to send surveys to relatives and as many live at a distance we were not available to speak to relatives on the day of inspection. During the course of the inspection we used a variety of methods to make a judgement about how service users are cared for. The manager was available to answer questions and support the inspection process as was the a senior manager, the Responsible Individual on the second day. We also spoke to six staff and observed practice including at tea time when we could see how people with high dependency levels are supported to eat and enjoy their meals. Many people who live at Pontesbury Surgery are unable to communicate their views to us verbally. However we were able to observe their demeanour and talk to staff about their needs and preferences. We assessed the care provided to two people using care documentation. This included looking at how someone new to the home had been supported to move in and settle. We sampled a variety of other documentation related to the management of the care home such as training, recruitment, staff supervision, maintenance and complaints. We toured the premises and we were able to observe the care of residents during this time. All this information helped to determine a judgement about the quality of care the home provides. What the care home does well: What has improved since the last inspection? What they could do better: The environment is of most concern. It is clean and bright and peoples personal space such as bedrooms and ensuites are spacious and are equipped well to meet needs. Communal space is much less so. Internal communal space is at a premium in Hall Bank 1, particularly considering the number of people who use wheelchairs indoors and is not equipped with either enough easy chairs or easy chairs that meet peoples physical needs to enable them to relax in the company of others. To compound this the rear garden area has been greatly reduced since we last visited which has reduced both the available space and potential for development. On the day of inspection, managers have agreed to review internal space and furniture with an Occupational Therapist. Care Homes for Adults (18-65 years) Page 8 of 31 Since inspection, the service has told us that it intends to make some structural changes to the premises inorder to address shared concerns about space. By losing a bedroom, this would increase communal living space by 19 square meters. The creation of an additional garden is planned too. It is advised that these plans are discussed in advance with our registration department. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering using this service and their representatives have the information needed to choose a home that will meet their needs. Evidence: We looked at how one person newly admitted since we last inspected had been supported to move and settle in. We could see that sufficient information from a range of sources was obtained about the person in good time before they moved in. This enabled the service to accurately decide if they could meet this persons needs before they were offerred a place. We could see too that the person was given adequate opportunity to decide if they wanted to move in by visiting and staying overnight. We could also see that a contract of residence has been issued explaining the persons rights and responsibilities including information about fees and extra charges. This has also been made available in an easy read version and has been signed by all parties including the person themselves. The new placement had been reviewed twice in a timely way and had involved Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: relatives of the person who are recorded as saying they were very happy with the work being done. We could see that the persons need for bedrails had been assessed before he moved in and that his moving and handling needs were considered and reviewed during the overnight visit. All available evidence reassures us that the person has been supported appropriately and has settled in very well. Care Homes for Adults (18-65 years) Page 12 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are known and are met safely and they are supported by staff who communicate well and encourage them to make choices. Peoples rights are respected and they are supported to develop. Evidence: In practice, peoples needs are known and they are cared for very well. Since we last inspected, steps have been taken to ensure staff are more aware of a residents cultural needs and from discussion with staff we could see they are better informed. For example staff have liaised with her family and are now better aware of her dietary needs, how to promote her dignity when swimming in a public place in accordance with cultural expectations and what to do in the event of death. We could see that staff buy halal meat for her having found places locally that source it. Staff are supported by detailed information in care plans and in written risk Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: assessments which are reviewed and updated but would benefit from a more systematic approach to review in the event of any changes as we found some issues overdue for review. However, this has not affected outcomes for people who are supported safely and who inspite of their limited communication are understood exceptionally well by staff who are to be commended for their ability to understand and act on peoples expressed needs and wishes. It was very positive to see that within a few days of asking to do their own weekly food shopping, two people were supported to do this and this is now an integral part of their routine. Another person has been supported to stop using restrictive pyjamas and instead now is wearing pretty ordinary pyjamas which better promote her dignity and freedoms. Review minutes record a third party professional as delighted with the decrease in her behaviours and associated increase in her independence. Care Homes for Adults (18-65 years) Page 14 of 31 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 have busy lives and they enjoy taking part in a range of activities that suit their interests and preferences. Peoples dietary needs are understood and acted upon. However dining furniture should be reviewed to ensure everybody can eat together. Evidence: We looked in detail at the lifestyles of three people who live at 1 to 3 Hall Bank Mews and concluded that peoples experiences have improved. We could see that systems are in place to help staff to know what each of these people likes to do and we could see that they are supported to follow their interests daily. One person who likes swimming went four times in March 2009. Another person who enjoys football watched a game on the television and staff were excited to describe his reaction when they had taken him recently to a local match. Favourite activities are complemented by a wide range of additional activity such as eating out, bowling, shopping, socialising, contact Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: with families and trips to local places of interest. People do not have to join in however and we could see that people are offerred activities but decline occasionally and their wishes are respected. We talked to staff and could see they are aware of one persons food allergy and cultural dietary needs. They could describe what foods the person could and couldnt have. We also observed a meal time. We could see that peoples meals were generous in quality and presented well. There were sufficient staff to support more dependent people to eat their meals on a one to one basis and the support they provided was at the right pace. The meal time was relaxed and enjoyable. Our concern was the size of the dining table in unit 1 as it was not big enough to accomodate all the people living there at the same time and their supporters. We observed one person having to wait for a space at the table before having his meal. The arrangements should be reviewed to ensure everyone can be included. Care Homes for Adults (18-65 years) Page 16 of 31 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. Peoples health needs are known and met. When peoples health changes, medical advice is sought. Medication is managed well in practice although we have suggested some minor changes to how controlled drugs are recorded. Evidence: Appropriate equipment is provided to support peoples personal care ie tracking hoists. Two showers have been replaced with baths in response to peoples personal preferences and everyone we met presented as well cared for, clean and tidy, with their own individual sense of style and dress. We looked at how two peoples health needs have been supported. We could see that they have had routine health screening and also that medical attention has been sought when their health has changed. Staff have received training and refresher training to help them to respond to peoples health needs. We talked to staff who could describe the health needs of people whose care we were looking at. Their descriptions tallied with information we had read in care Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: plans and we could see that prescribed medication described to us by staff was available. We can see that steps have been taken to improve how medication stocks are managed and a controlled drugs cabinet is also now available. We audited the controlled drug and found it accurately accounted for and a controlled drug held in stock tallied with prescribing and administration. Boots pharmacy has carried out an inspection of medication management and the manager has acted on the findings. We have since however clarified with our pharmacy Inspector that Buccal midazelam has been recategorised to a schedule three Controlled Drug. Whilst this means that this drug does not need to be stored in a Controlled Drugs cabinet, as a schedule 3 it is recommended that the receipt, administration and disposal are recorded in a Controlled Drugs register. We were informed by the manager at inspection that earlier that morning and the day before one person had not been given a medication in error. Prompt action was taken to seek the advice of the GP, report to Social Services and to make the situation safe whilst the matter was more fully investigated. Care Homes for Adults (18-65 years) Page 18 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected from abuse in a service that has a zero tolerance policy and an open culture where individuals feel safe and supported to raise any concerns. Evidence: There have not been any complaints but the service has taken steps to proactively ensure that staff and people living there know how to report any concerns they may have. We can see that complaints and protection issues are regularly discussed in resident and staff meetings and staff are given relevant training and support in their one to one meetings with their managers. Pictorial complaints information is available on peoples bedroom walls with a detachable help card for people to use if they need to signal the need for help. Staff feel that people are happy and safe and are confident that they understand peoples body language well enough to recognise indications of distress. There has been one incident since we last inspected involving neglect by an agency staff member who fell asleep whilst responsible at night for all the residents. The allegation was reported to the local authority as soon as managers were told and a robust investigation followed in which the service played a full and cooperative role. The allegation has been upheld and measures have been taken to ensure this is not repeated. There was a slight delay in informing managers. However we are satisfied that prior to and since the allegation the service had done all it could to protect people Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: and ultimately staff contributed to this by implementing the whistle blowing policy. We looked at three peoples financial records and could see that record keeping is robust and accountable and that monies were available for all three people. The risks of managing finances have been formally assessed and discussed with staff in a staff meeting. Systems are in place to manage the associated risks. However we have advised the manager to discuss with the bank that staff are supporting people to use their bank cards and have access to PIN numbers as this may be contrary to banking regulations. This practice may not protect peoples money in the event of a theft or other discrepancy. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and modern home where their bedrooms and ensuites are homely and spacious and equipment is provided to meet their mobility needs and preferences. Communal space is restricted and does not provide all the people who live there with the opportunity to relax whilst in company. Evidence: Peoples bedrooms are equipped to meet their needs and people who require bedrails are now using these safely as new beds with built in rails and bumpers have been provided. Bedrooms are spacious with ceiling tracking hoists which lead to to spacious ensuites. A manual hoist although not used is available as a contingency. Where people have expressed a preference for alternative bathing facilities this has been listened to and provided. For example two people have had their showers replaced with baths. The new baths however, have showers over them so choice has not been removed. Peoples bedrooms are bright, clean and personalised. People have photos and personal items around them. We are concerned however about the lack of communal space and easy furniture for people to relax in. In the lounge which is used by up to 8 people there are only two tub style chairs. We were told that only one of the five men living in that unit is able to Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: use these chairs and later we saw him sitting in it. There are no suitable easy chairs for the other people living there who are wheelchair users who as a result, have to sit in their wheelchair or go to their bedrooms to relax. We observed three people watching football on the television from their wheelchairs and this all but filled the space in the lounge. We have referred to lack of space at the dining table earlier in this report under National Minimum Standard 17. Communal space has been further compromised since the service was registered and since our last inspection by changes to the rear garden. The landlord has learned that it does not own much of the land at the rear as originally thought. So land that was going to be levelled has now been fenced off and is not for use by the people living at 1 to 3 Hall Bank Mews. Plans to develop and style the garden have not materialised due to unanticipated financial restriction. However the manager assured us that monies have been located and areas of ground are to be weeded and grassed. Since inspection the service has told us that it intends to make structural changes to increase living space in number 1 Hall Bank Mews. This would mean losing a bedroom and reducing the numbers of people they are registered to accomodate. The intention is also to develop a further garden from car park space. Managers should discuss these plans with our registration department. Steps have been taken to improve infection control practices. Clinical waste is now stored well and laundry particularly soiled laundry is no longer laundered on the premises. A vision panel has been fitted to the laundry door as it opens into the corridor. This will limit the risk of collision and the manager said the Fire Service do not have any concerns about it. A leak last year in the conservatory which is used as a dining area has not been satisfactorily fixed. The manager explained they have continually tried to resolve this with the landlord. Care Homes for Adults (18-65 years) Page 22 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff work as part of a motivated, competent and cohesive team which understands and responds to peoples identified needs. Staff are well trained, well supervised and are recruited well too ensuring that people living there are cared for safely. Evidence: Staff that we spoke to and observed during the course of the inspection demonstrated that they understand peoples needs well and are respectful, motivated and competent. Steps have been taken to ensure they are more aware of peoples cultural needs. The teething problems we found in the team at the last inspection appear to have resolved themselves with many people now telling us that the team has grown and developed together and is now cohesive with high morale. Shifts are focussed and well lead. Records verified what people had told us. Staff meetings are held weekly, individual staff supervision is sufficiently regular and training is provided appropriately for new staff and kept updated for staff with longer service. We could see that staff receive training in subjects which help them to understand peoples conditions. One staff member told us that they do so many training courses, its unreal. Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: Staff rotas are effective and show us that there are enough staff on each shift to meet peoples needs. We can see that agency staff are being used less, other than for night shifts and new staff are not part of the minimum staffing ratio. This enables them to shadow more experienced people, learn about their role and peoples needs before being responsible for providing care. We looked at how new staff are recruited and safeguards in place are excellent. The service also seeks assurances about temporary staff supplied from the agency it uses. It is very positive to see people who live at the service so engaged in the interviewing of potential staff. Care Homes for Adults (18-65 years) Page 24 of 31 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 management and administration of the home is based on openness and respect. The skills of the manager and staff team have developed and people have confidence in the care home because it is run and managed appropriately. Evidence: The registered manager feels well supported by her managers, peers and her team. She is qualified to a national standard to fulfil her job role and has done extensive training and refresher training since we last inspected to help her to understand the needs of the people living there and to manage the service effectively. She is aware of her strengths and needs as a manager and explained that she has time to reflect on her practice in the regular supervisions she has with her manager. We spoke to four staff about the management of the home and all four said they feel the home runs smoothly and the manager is approachable, provides direction and is effective. Team grumbles identified at the last inspection have resolved and morale is now good and the team is cohesive. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: In their annual return to us, we could see that the service has a good understanding of the service, where it has improved and where further improvements are necessary. Surveys to ask for feedback about performance are sent out annually. We can see that the service uses a clear action planning system using inspection outcomes and the results from other audits to enable the service to develop and improve. The service should now prioritise using the results of surveys in their plans for service development to ensure developments are influenced by the people living there, their representatives and other stakeholders. It is very positive however and reflects very well on the service that at this inspection, we have judged all three requirements issued for improvement and fourteen out of fifteen recommendations to have been fully met. The remaining area for improvement is to review the current range of policies in light of the Mental Capacity Act. Managers have undertaken training in new legislation relating to Deprivation of Liberty and demonstrated a good understanding of its principles. No one is currently restricted and where some restrictions were identified last year, the service has worked proactively to review and remove these providing good outcomes for people. Staff are currently waiting for this training. Considerable effort has gone into improving how people are protected. Beds and bedrails have been replaced and are monitored, peoples skin integrity has been assessed as has financial vulnerability. Protection issues are raised in staff and residents meetings to remind people how to raise concerns if they need to. Environmental risks have been assessed and have been recently reviewed. Also steps have been taken to protect written information about people as the cupboard in which they are stored, although still in a communal place, has been fitted with locks. We looked at a considerable number of service certificates to ensure facilities and equipment are safely managed. Everything we asked for was up to date with the exception of missing service documentation for one vehicle, although we were assured the service had taken place, infrequent monitoring of food temperatures to prevent the risk of food borne illness and service maintenance by a qualified person of the beds purchased a year ago. Weekly and monthly checks of beds are being carried out by staff but we have advised the manager to seek guidance from the bed manufacturer or supplier about any required service schedule. The Fire Service visited the service on 9 April 2009. Although a report wasnt available at the time, the manager reported that they found fire safety to be satisfactory and did not ask for the home to take any remedial actions. Care Homes for Adults (18-65 years) Page 26 of 31 Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 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 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 17 A review of dining arrangements should be conducted to ensure there is sufficient space for people to eat together should they want to. The service should seek to use the views of the people living there, their representatives and stakeholders as part of the annual development plan for the home. New recommendation April 2009 2 39 3 40 Steps should be taken to review the current range of safeguarding policies in light of the Mental Capacity Act and to ensure they fully cross reference, embed the principles of safeguarding and comply with recognised professional standards e.g to recognise the need to report to government barring lists, to recognise that bullying and harrassment includes service users rather than just staff, recognising that abuse can include incidents between service users, friends and family. Outstanding recommendation from April 2008. Also to develop policies in relation to Deprivation of Liberty. New recommendation April 2009 Care Homes for Adults (18-65 years) Page 29 of 31 4 42 The registered manager should ensure that hot food temperatures are checked and recorded sufficiently to protect people from the risk of food borne illness. New recommendation April 2009 5 42 The registered manager should enquire about service maintenance requirements with the manufacturer or supplier of beds and implement any advice given. New recommendation April 2009 Care Homes for Adults (18-65 years) Page 30 of 31 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. 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