Care Home: Holgate House

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What the care home does well The service provided a comprehensive therapeutic care programme for people who were recovering from drug or alcohol addiction and wished to be rehabilitated back into the community. The programme was designed, by the use of intensive group and individual discussion within a structured and supportive environment, to enable people to explore emotional and psychological issues, which underpinned past and current difficulties with addiction. People interested in using the service were provided with detailed information, so they could make sure the service was right for them. People were encouraged to visit the service and meet the staff and other residents before they made the decision to stay. People`s needs were thoroughly assessed, which helped to ensure the registered manager and staff understood their needs and did not admit anyone whose needs could not be met. People using the service were involved in all aspects of planning their recovery. Staff encouraged them to set their own goals and review their progress at regular intervals during group and one to one discussion. Staff helped people using the service to identify and manage risks of relapse they faced during their daily lives. During their stay in the home, people`s lifestyles were restricted by the house rules, which were fully explained and agreed on admission. People were happy with the way the menus were chosen and how the cooking was organised. People were involved in the planning and preparation of meals, which enabled them to learn new skills. People were provided with a clean, pleasant and homely environment. A good percentage of staff had achieved an appropriate qualification, which enabled them to carry out their role effectively. People using the service were very complimentary about the therapeutic programme and the staff, one person said "It`s an amazing place to be, the staff are very supportive and it`s the best decision I ever made to come here" and another person commented, "I love it here, it is so peaceful, I can`t find any fault". People who completed questionnaires were equally as positive, comments included, "The staff are brilliant and very friendly. They are very supportive and are helping me in every way" and "Holgate House is helping me remain abstinent from drugs and alcohol and it`s helping me live my life again drug and alcohol free". What has improved since the last inspection? Since the last inspection, the registered manager had arranged time during a morning group discussion for people interested in using the service to discuss the home with the people currently participating in the recovery programme. This enabled people to ask about the expectations of the programme and how the home operated. A full time group facilitator had been employed to enable more group work.Free time had been introduced on the timetable on a Friday afternoon. This enabled people who had been at the home for 12 weeks to submit a risk assessment for a suitable activity and for those people who had not lived at the home for 12 weeks to go on an afternoon walk with a member of staff. Various improvements had been made to the premises to promote the comfort of people using the service. For instance, all areas of the home had been redecorated and many rooms had been fitted with new carpets, a new kitchen had been fitted and new furniture had been purchased for the kitchen and the group lounge. Two staff had completed training in the signs and symptoms of mental health conditions. This gave them more insight into the needs of people with a dual diagnosis of substance misuse and mental health illness. What the care home could do better: Improvements must be made to some aspects of the management of medication. This includes the development of risk assessments for people who choose to self medicate and procedures for the administration of medication prescribed "as necessary". This is to ensure people receive their medication in a safe and consistent manner. All records and checks for newly appointed staff must be obtained and maintained in line with regulatory requirements. This is to ensure staff are fully vetted before commencing work in the home. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Holgate House Mill Bridge Mill Lane Gisburn Lancashire BB7 4LP     The quality rating for this care home is:   two star good 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: Julie Playfer     Date: 1 5 0 7 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 30 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 30 Information about the care home Name of care home: Address: Holgate House Mill Bridge Mill Lane Gisburn Lancashire BB7 4LP 01200445200 01200415974 holgatehouseltd@aolco.uk 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) : Holgate House Limited care home 12 Number of places (if applicable): Under 65 Over 65 0 0 past or present alcohol dependence past or present drug dependence Additional conditions: 12 12 The registered person may provide the following categories of service only. Care home only - code PC to service users of the following gender: Either. whose primary care needs on admission to the home are within the following categories: - Past or present alcohol dependence - Code A Past or present drug dependence - Code D The maximum number of service users who can be accommodated is: 12 Date of last inspection Brief description of the care home Holgate House is a small unit offering rehabilitation for up to 12 people with a history of drug and/or alcohol dependency. The treatment approach at Holgate House is person centred cognitive therapy, based on the 12-step philosophy. The aim of the service is to provide a safe, supportive environment where people can address emotional, psychological and social issues linked to their substance misuse. The home is situated on the edge of the forest of Bowland, within walking distance of the small village of Gisburn. There are a few shops and a local bus service in the village. Care Homes for Adults (18-65 years) Page 4 of 30 Brief description of the care home The house has a mix of single and shared bedrooms. Communal rooms include a large lounge, a dining room, a group room and a kitchen. Holgate House stands in large grounds with patio areas and a covered area housing a table tennis table. A large garden across the lane provides space for badminton and football. There are ample car parking spaces. At the time of the inspection the scale of charges ranged from £408.00 to £506.00. Information about the home is given to people interested in the service in the form of a statement of purpose and information pack, which includes the house rules. Copies of the latest inspection reports can be viewed in the home or obtained free of charge from the Commissions website at www.cqc.org.uk Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: A key unannounced inspection, which included a visit to the home, was conducted at Holgate House on 15th July 2009. The inspection was carried out by one inspector, however, the report refers to we as it was written on behalf of the commission. We lasted visited this service on 17th July 2007 and an annual service review was carried out on 22nd July 2008. There have been no additional visits to the home since the last key inspection. At the time of the visit, there were nine people accommodated in the home. During the inspection we spent time with the people using the service, looked round the home, read some peoples care records and other documents and talked to the staff and the registered manager. We also consulted our records about the service and the Care Homes for Adults (18-65 years) Page 6 of 30 information we have received since the last key inspection. As part of the inspection process we used case tracking as a means of gathering information. This process allows us to focus on a small group of people staying in the home, to assess the quality of the service provided. Prior to the inspection, the registered manager completed an Annual Quality Assurance Assessment known as AQAA, which is a self assessment questionnaire covering all aspects of the management of the home. This provided us with useful information and evidence for the inspection. Satisfaction questionnaires were sent to the home for distribution to the people using the service. Ten questionnaires were returned. The responses from the questionnaires were collated and used throughout the inspection process. What the care home does well: What has improved since the last inspection? Since the last inspection, the registered manager had arranged time during a morning group discussion for people interested in using the service to discuss the home with the people currently participating in the recovery programme. This enabled people to ask about the expectations of the programme and how the home operated. A full time group facilitator had been employed to enable more group work. Care Homes for Adults (18-65 years) Page 8 of 30 Free time had been introduced on the timetable on a Friday afternoon. This enabled people who had been at the home for 12 weeks to submit a risk assessment for a suitable activity and for those people who had not lived at the home for 12 weeks to go on an afternoon walk with a member of staff. Various improvements had been made to the premises to promote the comfort of people using the service. For instance, all areas of the home had been redecorated and many rooms had been fitted with new carpets, a new kitchen had been fitted and new furniture had been purchased for the kitchen and the group lounge. Two staff had completed training in the signs and symptoms of mental health conditions. This gave them more insight into the needs of people with a dual diagnosis of substance misuse and mental health illness. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. 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 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People interested in using the service were provided with detailed information so they could make sure the service was right for them. The assessment process was thorough and ensured peoples needs were understood and met. Evidence: People were provided with written information about the service, prior to visiting the home. This ensured they were aware of the philosophy and treatment approach as well as the services and facilities available. The people who completed a questionnaire indicated that they received sufficient information to be able to decide the home was the right place for them. On visiting the home, people were given a detailed information pack and statement of purpose, both of which were explained by a member of staff. The information pack set out the ethos of the service and included details about the operation of the home and the 12 step recovery programme. This programme was based on a set of guiding principles originally proposed by Alcoholics Anonymous, which outlined a course of action to recover from addiction. It has since been adapted to address other addictions including drugs. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: The registered manager had access to peoples health and social care histories before deciding to accept a referral. In most cases the person considering the service was invited to the home for an introductory visit and assessment to ensure the programme was suited to their needs. People spoken to said they had found the visit to the home very useful and had found the environment to be welcoming and friendly. The personal files of two residents were looked at in detail as part of the case tracking process. From this we could see that the assessment was detailed and covered a wide range of needs, including the persons personal, social, cultural and healthcare needs. The assessment also sought details about peoples family relationships, areas of risk and history of addiction. All aspects were discussed with the person to make sure the service could accommodate their needs. The assessment information was made available to the staff team, so they were aware of the residents needs. The registered manager confirmed that a person would not be admitted if their needs could not be met, or they were not compatible with the existing group. During the assessment visit, people were shown round the home, so they could meet staff and other people using the service. Since the last inspection, the registered manager had arranged time during a morning group discussion for prospective residents to discuss the home with the people currently using the service. This enabled people to ask about the expectations of the programme, how the home operated and the support provided. On admission, each person signed the house rules, which clearly set out the restrictions to choice and freedom whilst they were undertaking the treatment programme. The rules were designed to keep people safe and minimise risk of contact with previous social networks, which could affect their recovery. People spoken to felt the rules were an important support and provided structure for their daily lives. They confirmed all the rules had been thoroughly explained so they knew what to expect from the service. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples individual needs were addressed and they were fully involved in setting their own goals. The lack of freedom to make decisions and take risks was understood and agreed with people using the service. Evidence: Individual needs were discussed on admission, to ensure people received the correct treatment. The information gathered during the assessment process was used to form an overall support plan. People using the service were involved in setting their own goals, which were discussed and monitored at weekly personal development groups. Records were made at the personal development groups and future goals were agreed to help the person focus their work for the following week. Since the last inspection, a full time group facilitator had been employed to enable more group work. Each person was also allocated a keyworker on admission, to enable them to discuss any personal issues they felt they could not share in a group situation. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: People using the service were responsible for writing their own diaries and notes, which they were able to discuss as part of the group and on an individual basis. People spoken to found this useful, as it gave them the opportunity to explore their feelings and past experiences in a safe and supportive environment. In addition to the ongoing reviews, a three monthly review was carried out with each persons funding authority. As part of this, the registered manager compiled a report, which outlined the persons progress with their 12 step work. The people using the service found the 12 step treatment programme to be very beneficial to their recovery, one person who completed a questionnaire wrote, The 12 steps have opened my eyes to my addiction. They give you the tools to cope with everyday life and another person commented, The staff help us to learn how to live a normal life with the 12 step programme and cope differently with our feelings. Risk assessments were carried out on admission to ensure general risks were identified and strategies were put in place to reduce any potential hazards. For the first 12 weeks people were not permitted to go into the community unaccompanied, however, after this time people were encouraged to draw up their own risk assessments and discuss them with the group. Following discussion, the group and made suggestions as to how any risks could be minimised. This approach ensured people were able to carefully consider individual risks and devise personal strategies to cope and manage stressful situations, which may have the potential to affect their recovery. Whilst peoples choices were restricted due to the house rules, they were able to make decisions about what they ate and what activity they wanted to take part in. Peoples views about life in the home were fully discussed as part of the group discussions. There was more flexibility and decision making towards the end of peoples stay to prepare them for more independent living during the next stage of the programme. Policies and procedures were in place to support people with their financial affairs. Records were made of all financial transactions. A random check of money deposited in the home for safe keeping corresponded accurately with the records. This meant that peoples finances were fully accounted for and safeguarded. Care Homes for Adults (18-65 years) Page 14 of 30 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 were provided with a structured programme of therapeutic support and complimentary activities, which gave them the support they needed to assist their recovery. Evidence: The focus and emphasis of the treatment approach was about promoting the personal development of the individual. As such there was a set programme to promote routine and self discipline. All people participating in the programme had a daily timetable, which set out where they were expected to be and what activities they were involved in. This provided people with structure and the opportunity to discuss, with support, emotional and psychological issues, which may have contributed to their past difficulties with addictive substances. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: The timetable included activities for daily living, such as cleaning and cooking. These tasks were mainly completed after 5.30 pm, when the planned therapeutic work for the day had ended. People spoken to said they had gained new skills with the support of the staff, by participating in the household duties, particularly in cooking meals. People said they had gained renewed confidence in their abilities and realised they were able to achieve complex tasks. As people progressed through the 12 step programme, staff assisted them to look at new areas of activity and occupation to suit their new lifestyle. Staff also assisted with housing, budgeting and other areas of daily living. During the first 12 weeks of the programme, leisure activities were arranged in groups. There were sometimes difficulties with this due to peoples financial constraints and the group reaching an agreement about what to do and where to go. To improve this situation, free time had been introduced on a Friday afternoon. This enabled people who had been at the home for 12 weeks to submit a risk assessment for a suitable activity and those people who had not lived at the home for 12 weeks to go for an afternoon walk with a member of staff. People attended weekly AA (Alcoholics Anonymous) and NA (Narcotics Anonymous) meetings. This gave them the chance to meet other people in the community and discuss similar experiences. With staff support, people also went shopping to a nearby supermarket and village shops. There were restrictions placed on visiting arrangements, which were fully explained and agreed at the time of admission as part of the house rules. If people wished to have a visitor, this was arranged by the use of a risk assessment, to ensure that the person and other people living in the home were not placed at risk. Specific arrangements were made for people who had children, bearing in mind any existing court orders. People using the service were responsible for planning meals, shopping and cooking on a rota basis. The meals were agreed in a group meal planner, which was checked by staff to ensure people received a varied healthy diet. Two people made and prepared meals by themselves with the help and support of staff where necessary. Alternatives were available if anyone didnt like the meal on the main menu. People spoken with were satisfied with the arrangements made for meals and said the food was plentiful and of good quality. Care Homes for Adults (18-65 years) Page 16 of 30 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 healthcare needs were well supported and there were appropriate records in place to manage medication. Evidence: There were set times for personal care routines within the daily timetable. The house rules stipulated there was an expectation that people would be appropriately dressed and groomed at all times. Staff support was available if necessary. Peoples physical and mental health needs were identified during the assessment process and documented within a separate care plan. Everyone was registered with a local Doctor, who had an understanding of the treatment undertaken by the home. People also accessed other primary health facilities such as Dentists, Chiropodists, Opticians and NHS services and were supported to attend appointments by the staff in the home. People were able to discuss any worries or concerns about their treatment or other personal issues with their keyworker. People spoken with said the one to one sessions were helpful and the staff valued their thoughts and opinions. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: A set of policies and procedures were in place for the safe handling and administration of medication. There were complete records of medication received and disposed of and the medication administration record (MAR) charts demonstrated that medicines were given as prescribed. However, we noted that not all the instructions on the prescription labels had been transferred to the MAR charts. Some people administered some of their own medicines. They had signed a declaration to indicate they were able to self medicate, however, there were no assessments seen to show that they were able to do so safely. We also noted that procedures had not been drawn up to set out the circumstances for the administration of medication prescribed as necessary. This is important so staff administer this type of medication in a safe and consistent manner. The registered manager gave assurances that improvements would be made to medication systems as soon as possible. The medication was stored in a locked cupboard in a room used for one to one discussion. One person who returned a survey identified this as an issue as they felt the medication was not readily accessible if the room was being used over lunch time. Further to this, we were informed that plans were being considered to move the medication to a more suitable location. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems were in place to ensure any complaints or concerns were listened to and acted upon and there was an established procedure to protect people from harm. Evidence: A complaints procedure was included in the statement of purpose and information pack and was displayed on the notice board in the hallway. This was explained by a member of staff to all people during the admission process. The procedure was presented in an easy read format and included relevant information should a person wish to raise a concern. People who returned a questionnaire indicated they were aware of how to make a complaint and people spoken with during the visit said they would be able to speak to any of the staff if they were unhappy about something. People said the staff and manager were very approachable and they felt confident any issues would be dealt with fairly. The registered manager had not received any complaints over the last twelve months. Appropriate arrangements were in place should a complaint or concern be received. Policies and procedures were available in respect of the protection of vulnerable adults. The procedures included information about the types and indicators of abuse or Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: neglect and set out a response in the event of an alert. Staff received training on these issues and had access to a whistle blowing procedure. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were provided with a clean, pleasant and well-maintained environment, which suited their needs. Evidence: Holgate House is a detached grade II listed building set in its own grounds on the edge of the Forest of Bowland. The small village of Gisburn is within walking distance. There are a few shops and bus service in the village. A minibus is owned by the home, which is used for outings and appointments. Accommodation is provided in four single rooms and four shared rooms of which two rooms have an ensuite facility comprising of a shower, wash hand basin and toilet. There are also two other shower rooms. People using the service were able to personalise their bedrooms during their stay at the home, with photographs and other small items of personal value. People spoken to were happy with their rooms, which they described as comfortable. They also said they enjoyed sharing rooms. Since the last inspection, various improvements had been made to the premises to promote the comfort of people using the service. For instance, all areas of the home had been redecorated and many rooms had been fitted with new carpets, a new Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: kitchen had been fitted and new furniture had been purchased for the kitchen and the group lounge. Appropriate arrangements and records were in place for general maintenance and repairs. This meant that routine problems with the building were promptly rectified. The home had a good standard of cleanliness in all areas seen. Arrangements were in place for people to do their own laundry. This meant they could maintain and build on their independence skills. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service benefited from competent well trained staff. Evidence: Staff had been issued with an appropriate job description during the recruitment process, which clearly set out their roles and responsibilities. During conversations with the staff, it was evident they were aware of the limitations of their role and had a good understanding of the needs of the people using the service. Staff referred to people in respectful terms and were observed to interact with them in a pleasant way. A staff duty roster was drawn up in advance and provided a record of the number of hours worked by the staff in the home. The roster indicated that a sufficient number of staff were on duty throughout the waking day. One member of staff carried out a sleeping in duty during the night with an additional person available on call. All staff left in charge of the building were aged over 21. Many of the staff had worked at the home for some time, which meant they had a good knowledge of peoples needs. A recruitment and selection procedure was available; however, this did not reflect all current legal requirements. The files of two members of staff were looked at in detail. From this we could see that one member of staff had not completed an application Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: form and only one written reference had been obtained prior to the staff member commencing work in the home. Whilst, the other member of staff had completed an application form, they had not provided a full history of employment, with a satisfactory explanation of gaps. We also noted that both references were received after the person started work in the home. There were no health questionnaires seen on either file. CRB (Criminal Records Bureau) and POVA (Protection of Vulnerable Adults) checks had been obtained. The registered manager gave assurances that the recruitment procedure would be updated to ensure appropriate records and checks would be obtained in line with regulatory requirements. Arrangements were in place for all new employees to undertake induction training, which incorporated the Skills for Care standards. The latter provided underpinning knowledge for NVQ level 2. According to information supplied during the inspection, three out of the five staff had completed NVQ level 2 equivalent or higher. This meant 60 of the staff team had achieved an appropriate qualification to enable them to carry out their role effectively. Staff attended both internal and external training courses and had at least three paid days training a year. Staff discussed their individual training needs during their supervision sessions and staff meetings. This meant the registered manager could plan future training for staff in line with the people using the service. Since the last inspection, two staff had completed training in the signs and symptoms of mental health conditions. This gave them more insight into the needs of people with a mental health illness. People spoken with said the main strength of the home was the staff, who they described as wonderful and very supportive. The people who completed a questionnaire were also complimentary about the staff. Comments included, I think the staff are brilliant, theyve saved my life and The staff make me feel safe and secure and they support me in every way. Care Homes for Adults (18-65 years) Page 24 of 30 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. Management and administration practices were effective in ensuring the home was run in the best interests of the people using the service. Evidence: The registered manager had managed the home for nine years and had completed a Diploma in Management, the Registered Managers Award and NVQ level 4 in Care. The manager had also undertaken periodic training to refresh her skills and knowledge. The management approach was consultative and there were established ways of working to consult the staff and people using the service on an ongoing basis. Relationships within the home were positive and staff spoke to and about the people using the service and other staff in respectful terms. People were able to make their views known and were thus able to contribute to how the service was run. Staff meetings were also held on a regular basis. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: The service had preferred provider status with the Local Authority and there were some quality assurances systems in place. These included regular audits of the environment and weekly checks of the medication. People using the service were given the opportunity to complete a satisfaction questionnaire on leaving the home and at approximately three month intervals. However, the responses from the completed questionnaires had not been collated. The registered manager said that any comments or suggestions would be followed up. However, there was no overall development plan seen to show the future plans for the service based on the overall outcomes of the quality assurance processes. There was a set of health and safety policies and procedures, which included the safe storage of hazardous substances, food safety and infection control. Staff received mandatory health and safety training, which included food hygiene, moving and handling, first aid and fire safety. Documentation seen during the inspection and information supplied in the AQAA indicated that the electrical installations and fire systems were serviced at regular intervals. The fire log demonstrated that the staff had received instructions about the fire procedures during their induction and had participated in regular fire drills. Arrangements were in place to record accidents and incidents in the home. Care Homes for Adults (18-65 years) Page 26 of 30 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 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Risk assessments must be 14/08/2009 carried out for all people who choose to self administer their medication. All information from the prescriptions labels must be transferred to the medication administration records. Procedures must be drawn up for the administration of medication prescribed as necessary. This is to ensure all medication is administered in line with the prescribers instructions and is given in a safe and consistent manner. All records and checks for newly appointed staff must be obtained and maintained in line with regulatory requirements. 12/08/2009 2 34 19 Care Homes for Adults (18-65 years) Page 28 of 30 This is to ensure staff are fully vetted before commencing work in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 39 A plan should be drawn up to show how the service is to be developed. Views of people using the service and the outcomes of the quality assurance processes should underpin the planned improvements. Care Homes for Adults (18-65 years) Page 29 of 30 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. 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