Care Home: Helena House

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Helena House 1 Brownlow Road Reading Berkshire RG1 6NP The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Stephen Webb Date: 2 9 0 9 2 0 0 8 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. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 37 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: Helena House 1 Brownlow Road Reading Berkshire RG1 6NP 01189587000 01189560716 manager.hhr@prospects-uk.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Prospects For People With Learning Disabilities Name of registered manager (if applicable) Mrs Sophie Mwiinga Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 10 0 care home 10 learning disability Additional conditions: Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 37 A bit about the care home Helena House is registered to offer 24hour residential care to ten adults of both sexes who have learning and associated disabilities. The house is owned and the care provided by Prospects for Living, a Christian voluntary organisation. The home is a large two-storied old house, with bedrooms on both floors. It is situated in a residential area of Reading, close to the town centre. The property has a large secluded garden at the rear. There are two parking bays at the front of the house where the service keeps its own vehicles. Public transport services are close by. Care Homes for Adults (18-65 years) Page 5 of 37 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: Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 37 How we did our inspection: This is what the inspector did when they were at the care home This inspection included an unannounced site visit from 10:15 until 18:00 on the 29th of September 2008. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversation with the manager. Residents provided some verbal feedback and the inspector also observed the interactions between residents and staff at various points during the inspection. Inspection surveys were completed on behalf of nine of the ten residents (completed by staff of the home in conversation with individuals), and by two staff members. The inspector examined the majority of the premises, including some of the residents bedrooms, with their consent. Feedback via the resident surveys was positive, though no detailed opinions were recorded by the staff who assisted/undertook their completion. Feedback from the surveys completed by two staff members, was also mostly positive, though two additional comments suggested that some staff might be unhappy or unsatisfied in their roles. Fees range between 611 and 1019 pounds per week. Care Homes for Adults (18-65 years) Page 7 of 37 What the care home does well The service provides appropriate information to prospective service users and others to enable them to make an informed decision about its suitability for their needs. The needs of prospective service users are assessed prior to admission to enable an appropriate plan of care to be developed. Residents are supported to make decisions in their daily lives and take some part in daily routines. They are enabled, subject to risk assessment, to undertake some activities with an element of risk. Residents have opportunities to take part in a range of activities within the home and local community, including regular day service provision, and have opportunities to fulfill their spiritual needs. Relationships and contact with friends and family are also supported. An appropriately varied diet is provided and residents can choose to be involved in the shopping and meal preparation aspects. The service has a satisfactory written complaints procedure in place. Care Homes for Adults (18-65 years) Page 8 of 37 What has got better from the last inspection What the care home could do better Care plan formats need to be reviewed to ensure that all documents are fully completed, dated and signed and are subject to appropriate review; in order to ensure that residents changing needs, wishes and preferences are identified, recorded and acted upon. All records documents also need to be securely held to prevent possible loss. The home must improve the way it manages residents medication in accordance with current professional guidance. Recording systems should enable medication to be properly Care Homes for Adults (18-65 years) Page 9 of 37 accounted for. Additional medication training may be needed, together with improved monitoring systems. The effectiveness of the homes complaints procedure in use could not be evaluated, due to the absence of any recent recorded complaints. Any concerns or complaints made should be recorded appropriately within the complaints log, together with details of the action taken and outcome. Consideration should be given to to the provision of more accessible versions of the complaints procedure. The apparent lack of staff training on safeguarding vulnerable adults could put residents at risk due to a lack of awareness of appropriate procedures, on the part of staff. Though some stability has been offered by the use of regular bank and agency staff, there is a need to recruit permanent staff to the remaining vacant posts to maximise consistency and continuity of care. Appropriate and rigorous recruitment procedures for new staff must always be followed, to avoid putting residents at risk. The manager/provider must ensure that all mandatory training is provided to all employed staff with appropriate frequency, by appropriately qualified trainers, to maximise their abilities to meet the needs of residents and protect Care Homes for Adults (18-65 years) Page 10 of 37 and promote their health and safety. Management overview of the systems within the home, by both the unit management team and the provider, need to be improved. An effective quality assurance process needs to be put in place to ensure the opinions of service users and other relevant parties are central to the homes development. The provider must ensure that statutory monthly monitoring visits to the home on behalf of the provider are undertaken every month and the resulting reports provided to the manager for action and filing within the service. Weekly fire alarm and associated testing should be undertaken and recorded to protect residents and staff from the risk of fire. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 11 of 37 If you want to speak to the inspector please contact Stephen Webb 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 12 of 37 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 13 of 37 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 . The service provides appropriate information to prospective service users and other parties, compiled in consultation with existing service users, to enable them to make an informed decision about its suitability for their needs. The needs of prospective service users are assessed prior to admission to enable an appropriate plan of care to be developed, though some information could be sought at an earlier stage to better inform the decision making process. Evidence: The service has an appropriate Statement of Purpose and Service User Guide, which detail the facilities available and refer to appropriate principles of care, including meeting the spiritual needs of residents. However, both documents were last updated in June 2007 and were overdue for review. The manager indicated that she had begun this process, and that four of the service users had been involved in the previous review, when an attempt was made to make the documents more accessible. The pre-admission documents relating to the most recent admission to the service, were examined in the course of this inspection. Written pre-admission information had Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: come solely from the funding local authoritys assessment format. This document was rather problem-focused, with little information provided on how the identified issues should be addressed, or reference to the wishes and preferences of the service user themself. The service had, however, gathered this information later as part of compiling the Essential Lifestyle Plan after admission. The benefits of gathering additional information regarding the wishes and preferences of prospective residents ahead of admission, by means of an organisational assessment document, should be considered. This would enable such information to inform the initial decision about whether the individuals needs can be met. The manager indicated that the most recently admitted service user had visited the service on several occasions, prior to moving in, as part of a planned transition, and this had included both an overnight and a weekend stay. Care Homes for Adults (18-65 years) Page 15 of 37 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The degree to which the changing needs and wishes of residents are reflected within care plan documentation, is compromised to some degree by the absence of dates on some documents and of some key information, as well as a lack of evidence of regular review and updating. There is evidence that residents are supported to make decisions in their daily lives, though evidence that past choices have been periodically reviewed with the individual is inconsistent. Evidence from risk assessments indicates that residents are supported to take part in activities which include an element of risk. Evidence: Two service user files were examined in detail in the course of this inspection. The files contained a detailed format called All About Me, together with an Essential Lifestyle Plan, which if fully completed and regularly updated would provide staff with much of the everyday information they need to meet the needs of residents with due regard to Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: their individual needs and preferences. However, the documents examined were not always fully completed, with some key information not included, and in one case some of the records had become separated and were in danger of being mislaid. Some records were also misfiled. In one file the names of the residents deceased parents had not been recorded, only the comment deceased was entered. There was also no up-to-date photo of the resident. Various entries were also undated, making it impossible to know whether they were current, and when they were due for review. Other key information was included within the Essential Lifestyle Plan on each file, but again one of these was not dated and did not contain evidence of recent review or updating. Copies of the minutes of periodic review meetings were on the files, though not since May 2006 for one resident, and there was inconsistent evidence that review information led to updates of the care planning tools for staff to follow. The residents files did contain details about the needs of the individual, including some information on their wishes and preferences, where these had been identified, and also included details of the financial arrangements for the resident, and a copy of their placement contract. The files also include an activities plan and details of significant contacts outside the home. The Things You Need to Know About Me formats contained some useful information about individual likes and dislikes. Risk assessment documents were on file, including those relating to behavior management issues, and these included information for staff on how to address the identified issue. Some records of daily routines were also identified, which included details of how staff should support residents in these, though again the evidence of periodic review with the service user was not consistent. Within the completed AQAA, the manager had already identified the need for better management of the All About Me files. Overall there was a need to review the various formats to ensure that all are fully completed, secured, dated and subject to regular review, and that the current relevant information for staff on how to support individuals, is readily available to them. There was some information within the files indicating that residents are supported to make decisions, and in one case a copy of a completed consent format which determined that the individual did not have the capacity (under the Mental Capacity Act), to give consent in the particular situation. The information formats used also suggest that residents views on their care are sought, though the inconsistent dating and review in some instances, reduces their usefulness. In conversation, the manager also indicated that various decisions, such as around taking less frequent part in various activities, had been taken by individual residents themselves. Some instances of decision making by residents were also noted during the inspection. Care Homes for Adults (18-65 years) Page 17 of 37 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 . Residents have opportunities to take part in a range of activities within the home and local community, including regular day service provision, and have opportunities to fulfill their spiritual needs. Relationships with friends and family are supported to ensure they can be maintained, and residents are supported to make day-to-day decisions regarding their participation in the household routines and activities. An appropriately varied diet is provided and residents can choose to be involved in the shopping and meal preparation aspects. Evidence: As noted above, each file contains a daily activities plan detailing the planned activities throughout the week. During the day much of the planned activity is provided via a local day service provider, though one resident no longer chooses to access day Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: services, and instead takes part in some activities provided from the home. On the day of inspection eight residents attended the external day services and two remained at home, one of whom was not feeling well enough to attend. Residents may take some part in shopping for the homes food and some go out for meals and to visit places such as garden centres in the local community. Others enjoy car rides, visiting local clubs for people with learning disabilities, listening to music, looking at magazines, puzzles and other hobbies. One resident enjoys feeding the birds and and a bird feeder has been sited in the garden for them. One of the residents attends college for cookery and crafts and one undertakes two days per week paid work at the providers head office and also does some voluntary office work within the home. Within the completed AQAA, the manager identifies some areas for further development in this area. Helena House is a provider working from a Christian ethos. The Statement of Purpose notes that the spiritual needs of residents will be met. The care plan documents make reference to how the spiritual needs of residents are addressed, and attendance at places of worship is noted within records. Residents can also attend a locally run Christian club. Eight of the residents attend church regularly, one will attend sometimes, and one now declines to attend, having done so in the past. This decision is respected. The service has two vehicles available to support residents access to the community. Residents have been supported to go on holidays to various places, including Devon, the Isle of Wight and Butlins in Minehead this year, and some have been on more than one holiday. Residents are supported to maintain links with friends and family via letters, and telephone where possible, and staff support is provided at times for individuals to visit family. Some residents have very regular family contact or visits, including one who stays with family on alternate weekends and another who goes to stay with relatives for two weeks, four times a year. The needs of residents are such that none is able to go out into the community unsupported, but the routines and staffing levels enable each to have some opportunities to access the local community, and residents choices and preferences with regard to participation in planned activities are respected. Resident involvement in the food shopping and meal preparation is variable with some choosing to take part and others having no involvement. One resident makes their own breakfast and lunch, and others will make their own sandwiches with support. Menus are varied and residents preferences are taken into account in their planning. One of the residents cooks their own evening meal one night per week. The manager indicated that she had plans to introduce more variety to residents through starting a series of cultural evenings with foods from diverse origins. The manager also notes within the AQAA that a dietician had been consulted for nutritional advice for some residents. Care Homes for Adults (18-65 years) Page 19 of 37 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The degree to which residents receive personal support relevant to their current needs and personal preferences could be compromised by the inconsistencies noted within the care planning documentation. Residents fundamental physical and emotional healthcare needs are met by the home. At present the home does not manage residents medication in accordance with current professional guidance, and existing recording systems do not enable medication to be properly accounted for. Evidence: The care plan documents available provide information on how to support residents to meet their needs and some information about individual preferences. However, as already noted, there were some shortfalls in this information in terms of completeness and whether it was always up-to-date, and the manager has acknowledged the need for improvements to these systems. Feedback obtained from nine residents via the inspection surveys, (completed with the help of keyworkers), was positive about the support received. From the limited observation possible during this inspection, staff interacted respectfully with residents and enabled them to make choices about such Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: things as activities and attendance at day services. There was evidence that the service had met some specialist needs appropriately. For example, arrangements had reportedly been made for one resident to receive bereavement counselling following the death of a parent, which is good practice. Three of the residents have keys to their bedrooms to maximise their dignity and privacy. The care files examined contained records of health care appointments. In one case it was noted that a resident has refused to visit the dentist, though it was not clear whether the possibility of a dentist visiting them at home, had been explored. In one file an assessment format had been completed, regarding capacity to give medical consent under the Mental Capacity Act. One resident had recently begun to use a wheelchair and a new bed and hoist had also been obtained to support their changing needs. The completed AQAA indicates that weight charts are maintained where appropriate. The home manages the medication on behalf of all of the residents via a monitored dosage system. The manager indicated that in the past, one resident had managed their own medication when they were first admitted, but this was not now appropriate. One resident does still administer their own prescribed creams. Examination of the current medication administration record (MAR) sheets indicated a number of gaps in records of administration. There was no evidence that these had been identified or addressed with the relevant staff, though the manager undertook to address this, following the inspection. The quantities of medication received by the home are also not recorded on the MAR sheets or elsewhere, so there is no effective audit trail for the medication, as required within professional guidance. (See CSCI professional website and Royal Pharmaceutical Society guidelines). Separate records are kept of non-prescribed medication (homely remedies), though a brief examination of these records indicated that some paracetamol products could not be accounted for. It is suggested that any non-prescribed medication products should be agreed as appropriate on an individual basis by the residents GPs. It is also suggested that paracetamol-containing products should be noted as having been administered within the residents MAR sheet to reduce the risk of overdosing and act as a reminder to staff to check the individuals prescribed medication first, in case this includes prescribed paracetamol products. Care Homes for Adults (18-65 years) Page 21 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The service has a satisfactory complaints procedure in place, though it was not possible to verify its effectiveness in operation due to the absence of any recent recorded complaints. The degree to which residents are protected from abuse and harm has been potentially compromised by the lack of regular staff training on safeguarding issues. Evidence: The home has an appropriate complaints procedure in place, though the current accessible version in symbol format would be likely to be too complex for some residents. The manager indicated in her AQAA that staff are regularly reminded of the procedure within staff meetings and handovers, in order to enable them to support service users to make complaints. The manager also indicated that in the last year staff have gone through various documents, including the complaints procedure, with residents individually, to explain them, and that the details of the local authority complaints contact person have now been included within the procedure. Within the AQAA, the manager stated that one complaint has been received about the service in the previous twelve months. However, no complaints had been logged in the homes complaints log since 2004, so it was not possible to examine the effectiveness or accessibility of the procedure in practice. The missing complaint needs to be recorded together with appropriate details of the action taken to address it and the outcome. It is suggested that the advice of a speech and language therapist be sought on any possible further improvements to the accessibility of the procedure. The Commission Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: has received no complaints for forwarding to the service for their investigation in the past year. The service has a copy of the local multi-agency safeguarding procedure for vulnerable adults and the manager reported that no safeguarding incidents had arisen in the previous twelve months. The Commission has not been notified of any safeguarding issues relating to the home in the past year. According to the training records supplied by the manager some of the staff have not received safeguarding training since 2001, and two have no dates listed for this training, (one of whom is a recent starter). Others last received the training in 2003 or 2006. Although the manager reported that refresher training on safeguarding had been booked and confirmed for one individual in October 2008 and was booked. (but not yet confirmed), for a further nine in November, such long gaps between updates in this key area, could put residents at risk of harm. The manager should ensure that all staff receive refresher training on safeguarding issues, from a competent source, with appropriate frequency, in order to ensure that staff remain up-to-date with current good practice. Care Homes for Adults (18-65 years) Page 23 of 37 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 . The improvements to the fabric and decor within the building now provide a more pleasant and homely environment for residents, and standards of hygiene were good. Evidence: The original long-term plan for the service was for comprehensive redevelopment of the existing site and buildings to improve provision, but this had to be abandoned following planning objections. Instead, the provider sought to identify a new site on which to build or redevelop new premises into which the service will move. The manager indicated that such a site had recently been identified on which a new home will be built. In the meantime, the last inspection raised significant issues about the decor and maintenance within the existing building, which led to a requirement for an action plan regarding the works necessary to improve the standard of the existing accommodation. Since the last inspection extensive redecoration has taken place in the majority of areas of the building, though an ongoing problem with a roof leak has prevented the work to convert an old sensory room into a new bedroom for one of the residents. One of the bathrooms was recently refurbished after some delay, and the staff office has been moved to the first floor to provide an additional ground floor bedroom. The service provides single bedrooms for ten residents, now with five bedrooms each on the ground and first floors. Bedroom doors are lockable, though only three of the current residents hold their own key. Each floor provides a lounge, a small kitchen, and an assisted bathing facility. Hoists had been serviced recently. A Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: shower with an integral seat is available for residents who prefer this to bathing. The redecoration had resulted in significant improvements to the environment which was brighter, more homely and attractive. Two of the residents commented about how nice it was now, and one was very happy about their redecorated bedroom. The bedrooms seen were individualised appropriately to reflect the interests of their occupant. One of the bedrooms has an en-suite bath and toilet and another has an en-suite toilet. The hallways and stairs have also been re-carpeted and some bedroom flooring changed. The majority of the fire doors are fitted with appropriate hold-back and self-closing devices which are integrated with the fire alarm, to ensure they close in the event of the alarm sounding. A few doors are still fitted with battery powered hold-backs, which also allow the door to close on sounding of the alarm. Standards of hygiene on the day of inspection were generally good, and there were no unpleasant odours evident. The manager indicated that the home now has twenty hours of dedicated domestic support for cleaning, which has improved standards. Care Homes for Adults (18-65 years) Page 25 of 37 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 . Though some stability has been offered by the use of regular bank and agency staff, the absence of a more complete permanent staff team has impacted on some areas of the homes systems and operation including staff training, and has impacted on aspects of the continuity of care and support offered. The degree to which recruitment systems can protect residents has potentially been compromised by a failure to fully adhere to recruitment procedures in all cases. From the records available, mandatory training has not been provided to all employed staff to maximise their abilities to meet the needs of residents. Evidence: The home has a staffing complement of a manager, two deputies, two team leaders and ten support workers, though at the time of inspection a part-time team leader post for 22.5 hours per week was reportedly vacant and not currently covered. A parttime team leader had recently been appointed to the other post. Three staff had left in the previous twelve months and two new staff have been recruited recently to replace them, with a further four awaiting CRB clearance to start. However vacancy levels have been, and remain, high and reliance on agency and bank staff has been correspondingly high. Eleven of the 25 care staff identified in the completed AQAA were either agency or bank staff. The proportion of staff who have attained at least an Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: NVQ level 2, is also low, with only four staff having attained a qualification at this level, and a further four working towards this. (Taken from the AQAA, completed in July). However, within the AQAA, the manager also stated that the service had retained a core of experienced, long-term staff who were supporting and acting as mentors for new recruits. The keyworker system was said to have helped to reduce the potential effects of staff changes and shortages, on the residents. The home also tries to use known bank and agency staff wherever possible to maximise consistency. However, some of the shortfalls identified earlier in this report with regard to care planning documentation and medication records suggest that the permanent staff are currently over-stretched, though they seem to be focusing on maintaining the face to face support of residents personal care, activities, holidays, etc. The current staffing rota format is confusing and does not detail the names of all of the staff who work each shift. The availability of the manager on site is also not included. The rotas identify some shifts as not covered but do not clearly identify how they were staffed, making it hard to establish actual staffing levels, without cross-referencing them with the homes diary, where the names of staff on shift are recorded. Copies of an older rota system were also on file and provided a much clearer and immediate indication of those on duty at any specific point, without the need to cross reference with another document. The manager stated that the usual staffing pattern is for two support workers to cover each floor with an additional staff member (sometimes a senior), working flexibly according to needs, but mainly based on the ground floor where the residents require greater levels of support. The manager indicated that the recent appointment of a part time team leader has enabled some consolidation of the management team, though the remaining shortfalls in the permanent staff complement also need to be filled in order to maximise the consistency and continuity of care. As new staff complete their probationary period, induction and foundation training, there will also be a need for additional staff to begin their NVQ to work towards the Government target of a minimum of 50 of care staff having NVQ level 2 or equivalent. The recruitment records for three recent recruits were examined in the course of this inspection. The majority of the required elements of a rigorous recruitment and selection procedure were present but two shortfalls were noted. In one case only one reference was present, and this was the spiritual reference confirming active involvement in the Christian faith, and not one from the most recent employer. A minimum of two written references must be obtained on an applicant as part of the recruitment process and one of these should be from the most recent employer, wherever possible. In another case there was no completed application form on file. The manager said that the organisation had for a period, opted not to use application forms, and relied upon CVs instead, but that they had recently reverted to application form use again. A fully completed and signed application form is good practice as it allows the provider to dictate the information they require from the applicant, including a detailed employment history, (with dates), and a signed declaration regarding any prior criminal record, and confirming the accuracy of the other information provided, which can be tested at interview as required. Copies of interview records and evidence confirming identity were however on file, which is good practice. The manager Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: indicated that one resident had opted to be involved in the interview process in the past but declined to do so for the most recent interviews. Further exploration of how to engage residents in the recruitment process would be beneficial. The manager must ensure that all required evidence relating to recruitment checks is on file and available for inspection for all of the recently employed new staff, and any future appointees. An overview of the current position regarding staff training was not available during the inspection. The manager provided some information immediately following the inspection, with regard to a few areas of training. In the completed AQAA, the manager had stated that training had been provided on fire safety, first aid, food hygiene, safeguarding, supervision and minute taking. The manager also said during the inspection that a training audit had been undertaken in August 2008, which had identified some gaps in staff training, and that some courses had been booked in response, but the specific details were not available, although details of some intended training targets during 2008/9 were available during the inspection. The training information supplied following the inspection pertained only to safeguarding, fire safety, and dementia, and indicated ongoing significant shortfalls in training in these areas. Information regarding other mandatory training including food hygiene, manual handling, first aid, Physical intervention/behaviour management (if required), health and safety; and other training in accordance with Skills For Care guidelines, was not provided. Within the AQAA the manager identified the establishment and completion of an up to date training matrix as one of the plans for improvement in the next twelve months. The manager must provide to the Commission, comprehensive details of the current training status of all employed staff with regard to all mandatory training. This should include the dates when each individual last received training in each mandatory subject, and of upcoming confirmed places on relevant courses. It would be helpful if this information was also provided on other relevant training which is part of the providers induction and training package, in order to establish the overall picture. Care Homes for Adults (18-65 years) Page 28 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The best interests of residents are potentially not being optimised by the current operation of the home. There are shortfalls in systems, recording and permanent staff recruitment, and there has been insufficient management overview in key areas. There was no evidence of an effective quality assurance process to demonstrate that the opinions of service users and other relevant parties are central to the homes development, and there remain significant shortfalls in internal monitoring systems, both within the home and at provider level. The health and safety of residents is potentially compromised by the apparent lack of up-to-date training for all staff in related areas, and ongoing failures in terms of weekly fire alarm testing. Evidence: The home manager has been in post for almost five years, having been promoted within the service. She has an NVQ Level 4 and Registered Managers Award, but has not had a full management team in place recently, with one part-time team leader newly appointed and the other post not currently covered. As noted elsewhere within Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: this report, the inspection of a number of systems, including care planning documentation and review, medication management, staff training and recruitment, has identified shortfalls (addressed elsewhere), which suggest that the management team have yet to establish a thorough overview of all aspects of the day-to-day operation of the home. Some of the stated aims and achievements of the manager, within the completed AQAA have also yet to be fully realised. Within the AQAA, the manager has, however, already identified some of the issues arising from this report as areas for future improvement. Although there has been improvement in the level of provider support via an increased frequency of monthly monitoring visits, and the provision of reports from each of these, they are still not taking place on a monthly basis as required. A representative of the provider must visit the home at least monthly to monitor the standards of care and must provide a written report of their findings, to the manager. The provider must forward copies of the Regulation 26 reports for October, November and December 2008, to the Commission. In a period where permanent staffing levels have been low, the homes management have also been more involved with participating in and maintaining the day-to-day care and routines, alongside the permanent care staff, working with significant numbers of bank and agency staff. The provider has developed a new management audit tool, which was shortly due to be used for the first time, and this should enable a full internal audit of the systems in the service and identify the shortfalls, to enable them to be addressed. However, the manager stated that the provider does not have a comprehensive quality assurance tool in place. So there is no regular cycle of questionnaires to residents, advocates, care managers and other interested parties in order to seek their feedback about their experience of the homes operation. The manager did say that relatives and care managers had opportunities to raise any concerns during periodic reviews, but evidence cited earlier suggests that these may not always have been held with appropriate frequency, and in any event quality assurance is not their primary focus. Informal opportunities also exist for families to raise any concerns during telephone contact and visits, but the absence of any recorded issues in the complaints log since 2004, might suggest that this opportunity is not regularly taken up. In-house, there were minutes indicating that residents meetings had been held in May and August of this year, though the most recent minutes prior to this were from 2005. The manager said that the views of residents about their day-to-day lives and their care were also sought through the one-to-one meetings with keyworkers. A service cannot obtain a realistic picture of its performance, through reliance solely on self-audit tools. The provider must establish an appropriate quality assurance process, which should lead to the production of a summary report of the outcomes which is made available to participants, and which is used to inform the services annual development plan for the following year. The manager indicated that she had produced an annual development plan for 2008/9. Feedback was obtained from two staff members via completed surveys, which was broadly positive though two comments were made suggesting that some staff were not happy or fulfilled in their role. In terms of health and safety related training for staff, the picture is not yet clear as information on these areas of training has for the most part, still to be provided. The Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: training information so far supplied indicates that some staff received fire safety training this year, but that some staff do not appear to have received this training at all. A requirement has already been made for the manager to supply information to the Commission on the current training status of all staff with respect to health and safety, manual handling, and other mandatory areas. Fire drills had taken place three times in the previous year. The manager said that following a previous inspection requirement, fire alarm and related checks were now being carried out weekly and recorded, though the available records still did not fully support this, though there had been some improvement in recorded regularity. As noted earlier, fire doors are fitted with appropriate devices, where necessary, which enable them to be held open to facilitate mobility, but enable them to close should the fire alarm sound. These door closers should also be tested as part of weekly fire alarm testing. Examination of a sample of health and safety-related service certification indicated appropriate service intervals for hoists, gas safety, fire alarm, fire extinguishers and electrical installation, though the manager was unable to locate a record of a recent test of electrical appliances, which should be located and filed with the other health and safety records. Copies of completed accident forms were found on individual files as part of their care history, and the manager has a collective record for monitoring purposes. Care Homes for Adults (18-65 years) Page 31 of 37 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 37 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 Description 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 Description Timescale for action 1 6 15 13/01/2009 Each resident must have a written care plan, based on appropriate consultation with the resident or their representative, which identifies how their health and welfare needs are to be met; and the care plan shall be kept under regular review. In order to ensure that staff have up to date information on how the health and welfare needs of the resident are to be supported, with due regard to the residents wishes. 2 20 13 The manager shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. 13/11/2008 Care Homes for Adults (18-65 years) Page 33 of 37 In order to protect residents from potential harm, and to provide a proper audit trail for medication coming into the home. 3 22 17 The manager must ensure that a record is maintained of all complaints about the operation of the care home, and of the action taken to address them. 14/11/2008 In order to demonstrate that the complaint has been addressed appropriately, and identify any actions taken to remedy the issue. 4 23 13 The manager must confirm when all of the staff have received updated safeguarding training. 12/12/2008 In order to safeguard the residents prom potential harm by ensuring that all staff are aware of current good practice. 5 32 18 The provider must make 15/01/2009 continued efforts to recruit permanent staff to remaining vacant posts, to increase and maintain the proportion of permanent staff. In order to ensure that the continuity and consistency of care to residents is maximised. 6 34 19 The provider must ensure 15/11/2008 that evidence of the required recruitment checks having Page 34 of 37 Care Homes for Adults (18-65 years) been carried out, is available on file for the recently recruited staff. In order to demonstrate that a sufficiently robust recruitment and checking process has been undertaken to protect residents. 7 35 18 The manager must provide 15/11/2008 to the Commission, details of the dates of most recent receipt of all manadatory training for all of the permanent staff, together with the dates of any confirmed places on upcoming courses. In order to demonstrate that staff employed to work at the home, have received the necessary training to maximise their ability to meet residents needs. 8 39 24 The provider must establish 16/01/2009 a process for reviewing the quality of care within the home with appropriate frequency; which is based on seeking the views of residents and other interested parties. In order to demonstrate that the views of residents and other interested parties are taken into proper account in the development of the service. 9 39 26 A representative of the 07/01/2009 provider must visit the home at least monthly to monitor Page 35 of 37 Care Homes for Adults (18-65 years) its operation and must produce a report of the findings of the visit, which must be provided to the manager, and filed at the home. Copies of the reports for October, November and December 2008 must be provided to the Commission. In order to maintain an appropriate overview of the operation of the home and its day to day management. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 6 20 All resident records should be secured to prevent loss and should be dated and signed to enable effective review. The manager should consider whether the need for additional medication training is indicated and/or whether a system for more effective monitoring of medication recording should be instigated. Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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