Care Home: Isis Care Home

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Key inspection report Care homes for adults (18-65 years) Name: Address: Isis Care Home 16 Crompton Street Liverpool Merseyside L5 2QS one star adequate service The quality rating for this care home is: A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lorraine Farrar Date: 0 2 1 0 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. 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 mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983   Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Information about the care home Name of care home: Address: Isis Care Home 16 Crompton Street Liverpool Merseyside L5 2QS 0151 207 4196 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Julie Greene Type of registration: Number of places registered: Potensial Limited care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 7 0 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability - LD The maximum number of people who can be accommodated is: 7 Date of last inspection 2 3 0 1 2 0 0 9 A bit about Isis. It is run by a company called Potensials. They provide care services and support for people across the country. Isis supports seven adults who have a learning disability. It is in a family area of Kirkdale. Near to local shops, cafes and transport. Everyone living there has their own bedroom with a small room for a toilet and sink. People share:A private garden lounge and dining area family style kitchen. There is a separate room to smoke in for the people who live there. Isis had a bathroom and separate shower room. These are adapted to help people with their personal care and to get around more easily. Parking is available on the driveway with further parking on the street outside. Staff are available at Isis twenty four hours a day to support the people living there Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what we did when they were at Isis. Before we visited we sent the manager a form to fill in. She told us about how Isis is run and about the paperwork they have got. We looked at anything else people had told us about Isis since we last visited. This all helped us to plan what we would do when we visited Isis. We visited Isis on 30th September 2009. They did not know we were visiting. We visited again on 2nd October 2009. We were there for eight hours. We met with everyone living at Isis. We also met a relative of one of the people living there. We talked to four members of staff. This helped us to find out what it is like to live there. We looked at some of the paperwork in the office. This helped us to find out if Isis is a safe place to live and to see if people get the support they need. We looked around the house at the kitchen, bathroom, and lounges and the garden. This helped us to find out if Isis is clean and tidy and a nice place to live in. It costs between four hundred and seventy nine pounds and five hundred pounds each week to live at Isis. What Isis does well Isis is a warm, comfortable family style home for people to live in. It is adapted to support people to get around more easily and get support with their personal care. Before anyone moves into Isis they can visit and meet the people who live and work there. They are given information about how the Isis works. This helps people to make a decision as to whether Isis is the right place for them to live. The people living at Isis told us that they like living there. Staff know the people living there well and have built good relationships with them. They spend time chatting with people as well as meeting their support needs. People get support to:go out and about to spend their time at home doing the things they enjoy. Some of the things people like to do are:Shopping going to the supermarket arts and crafts baking. There is a choice of meals at Isis. Everyone chooses their favorite meal each week. People told us that they can have a drink or snack whenever they want. They always get something different if they do not like the menu. Staff get training in things like:health and safety safeguarding people new laws. This helps to give them the information they need to support people safely and well. The people living at Isis and their relatives know who to talk to if they have a complaint. They said they feel confident staff would help them. Regular house meetings are held. People can talk about the things they want to do. They can have their say about how the home is run. The bungalow and equipment in it are checked regularly to make sure they are safe. What has got better from the last inspection. Isis has a new way of writing care plans and risk assessments. Staff meet with the person to discuss their plan with them. This helps to make sure that people have their say about the support they get. The amount and times staff work during the day has been looked at. There are now two staff working at Isis in the day. This helps to make sure peoples needs can be met. What Isis could do better Before anyone moves into Isis staff should get a copy of their social worker assessment. This will help to make sure staff know as much as possible about the person and the support they need and like. Some of the information for the people living at Isis is not easy to read or understand. If the information was easier it would help people to understand as much as possible about:their rights the support they should get. When people are not well for a short time they should have a care plan to help them. This will help to make sure staff know as much as possible about the support they need. It will also help to make sure any changes can be quickly noticed and acted upon. When the people living at Isis:raise concerns ask for support from staff to go somewhere or do something a plan of how staff are going to help them should be written. This will help to make sure people get the support they need and want as soon as possible. Peoples medication needs to be checked more often. Staff should check to make sure people do not run out of their medication. This will help people to stay as healthy as possible. The garden at Isis is untidy and overgrown. Work should be done to make it a more pleasant place to sit and use. If you want to read the full report of our inspection please ask the person in charge of Isis. If you want to speak to the inspector please contact Lorraine Farrar You can ring her on:03000 616 161 You can write to us at:Care Quality Commission Northwest Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA 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 http:/www.cqc.org.uk/. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. 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 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is obtained about and given to people considering moving into Isis which helps everyone to decide if it is the right place for the person to live. However this information is not always complete or easy to understand which could lead to people not getting all of the support they need and expect. Evidence: A welcome pack giving people information about Isis and how it is run is given to people living at or thinking of moving into Isis. This gives people information about things such as the support they can expect with their health and personal care, the cost of living at Isis and the support they can expect to carry on doing the things they enjoy. It also tells people how to make a complaint if they are unhappy about something. During our visit one of the people living at Isis confirmed that they were given this pack before they moved in. This helps to ensure that people have enough information to help them to decide if Isis is the right place for them to live. However the pack is not written or put together in a way that is easy to understand. Although it uses some pictures and photographs, there is a lot of writing on the pages and it is not always easy to read. In addition the colour and size of the writing could make it more difficult for people to understand. During our second visit the manager told us that she has planned a meeting with the people living there and intends to rewrite the pack with their help and to make sure it follows good practice guidelines about easy to understand information. This will help to ensure that the people living there and anyone thinking about moving in can understand as much as possible about Isis and the support the can expect. Evidence: One of the people living at Isis told us that before they moved in the manager visited them several times to talk about Isis and about the support they needed and would like. Records confirmed that an assessment of the persons needs and choices had been carried out and that they had been invited to visit the home. The manager also told us that people can visit and stay overnight if they wish. This helps people to get to know the home, the people who live there and staff and make a decision as to whether they want to live there. In discussions with one person who recently moved into the home, they said they would advise anyone thinking of moving to Isis to visit and, find out for yourself if you like it. However a copy of the persons social services assessment was not obtained before they moved into Isis. This assessment should always be obtained prior to people moving into the home as it helps to ensure staff have as much information as possible about the person and their needs and choices and can decide whether Isis can support them successfully. 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 individual needs and choices of the people living at Isis are recognised by the staff team and generally met. However a lack of care planning and timescales could impact on the support people receive to live a lifestyle of their choice. Evidence: Individual care plans are in place for all of the people living at Isis. In discussions with the people living there they told us that they know about their plan and staff, talk about it with them when they need to do it. Plans contain information about the persons health and personal care, their lifestyle and the support they need. The plans that were in place are reviewed regularly which should ensure the information is up to date and accurate. A monthly key worker review has also been introduced. These provided a way for the person to sit down with their key worker and discuss their plan and should enable the people living at Isis to have a real say in the support they receive. A risk assessment forms the basis of everybodys care plan. If a higher level of risk is identified then a full risk assessment along with a care plan is completed for the person. Again this should help to ensure people receive all of the support they need and choose. However we found that care plans had not been put into place for all areas of the support people need. For example one person had a short term health care need and no care plan was in place. This could lead to staff not being fully aware of the support the person requires or the potential changes that could occur and require action. We also found that care plans for basic areas of care for a person that had recently moving into Isis, had not Evidence: been completed. This also applied to care plans relating to peoples lifestyle choices. For example daily records showed that one person had said that they wished to join a local library and staff documented that they informed the person they could do this the following week. However this was not recorded in their care plan and although staff were able to explain why it had not yet happened, the lack of a care plan that is regularly updated may mean that the person does not receive the support they have requested in as timely a manner as possible. On our second visit to Isis two days later these care plans had been put into place for the people concerned, which should help to ensure staff are fully aware of the support people require and how to provide it in a way that is safe and meets their choices. It should also help to ensure that people get support to live a lifestyle of their choice. In discussion with a relative of one of the people who lives at Isis they told us that Isis meets their relatives needs and supports the people living there to, make their own decisions. The people living at Isis are able to give their views about the home via key worker meetings and regular house meetings. People told us that at these meetings they talk about things such as, do we like the staff and what we like to do. Records of the meetings showed that people discuss a wide range of issues ranging from the support they receive to outings they would like to go on. At the end of the minutes any actions are listed. However the list of actions from the August 2009 meeting had not all been met. A simple action plan with dates and review dates would help to ensure that the things people have asked for are provided in a timely manner. Information about advocacy services that help people speak up for themselves are clearly displayed within the home. One of the people living there told us that they have an advocate and staff help them to contact their advocate if they wish to do so. This is good practice as it helps to ensure people are getting support outside of the staff team to speak up for themselves and the things that are important to them. However we read records for one person that showed they had requested to ring a relative. Staff had recorded that they explained to the person they needed to ask the manager or their social worker and there was no record of any further support being provided to the person for this request. There were no recorded reasons why the person should not receive this support. The law states that people have the ability to make their own decisions unless assessed as lacking that ability for a particular decision. Therefore not providing this support or taking steps to provide it could impact on the persons legal rights and the support they receive to live a lifestyle of their choice. Whilst we were at Isis we observed people making everyday decisions for themselves. This included things such as when they wanted support with their personal care, how to spend their time and what they wanted to eat or drink. Staff responded positively to requests for this support and spent time talking with people and listening to their requests. 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. The people living at Isis are generally supported to live a lifestyle of their choice. Evidence: During our visit to Isis the people living there were spending their time in different ways, choosing whether to spend their time with others chatting and watching TV or in their bedrooms as they preferred. Some of the people living there attend local resource centres and one person explained that staff had helped them sign up for a course at a local college that they wished to attend. In discussions with some of the people living at Isis they told us that they had enjoyed a recent holiday to Blackpool and that they get to go out and about with staff. Where people are able to go out and about on their own clear care plans and risk assessments are in place to support this. One person explained that they regularly went food shopping with staff and another that they had been asked if they wanted to go out but choose not to. Records showed that other people had been out and about shopping and for lunch several times. When at home people can choose to spend time in their room listening to music or TV or in the shared lounges with others. There are a number of activities available at Isis that people enjoy. These include in-house games such as bingo as well as arts and crafts and baking. Throughout our visits we observed that staff spent time socialising with the people living at Isis as well as meeting their support needs. In discussions with the staff team they had a good understanding of the different things people like to do and the support they need with these. This all helps to ensure people are supported to live a lifestyle of their choice. Evidence: People told us that they can have visitors whenever they want. This was confirmed in discussions with a visitor who told us that they are always made welcome and kept informed about how their relative is. People get opportunities to meet others via their use of community facilities and various colleges and resource centres that they attend. As identified elsewhere within this report better care planning and record keeping would help to ensure people get timely support when they wish to try new activities or community facilities. Routines in the home are flexible with people deciding for themselves things such as when they want to go to bed, have help with their personal care or have a drink. Currently a menu is planned weekly with the people living at Isis. This showed that everyone living there has the opportunity to choose their favorite meal for the week. Records of meals showed that people are offered a varied diet with plenty of fruit and vegetables. The people living there told us that they can have what we like at meal times, explaining that if they do not like the planned meal staff always offer an alternative. Care plans record if people are well enough to be involved in household tasks or making a drink or snack and one of the people living there confirmed that they are able to do this when they want. We also observed people going in and out of the kitchen throughout the day. The fact that meals are planned by the people living there and that they are able to go food shopping helps to ensure people are as involved in the daily running of their home as possible. 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 people living at Isis get the support they need with their personal care. However systems are not robust enough to ensure they always get their medication as prescribed, which could impact upon their health. Evidence: In meeting the people living at Isis it was clear that they had received support with their personal care and appearance. People were dressed appropriately for their age and the weather, with care taken by staff to ensure people were warm enough if sitting for long periods of time. We observed staff respond positively to requests from the people living at Isis to have support to use the shower and to take their time in providing that support. The people living at Isis told us that they get support when they need it and that they can get up or go to bed when they chose. This was recorded in daily records, which also showed that if someone is having difficulty sleeping, staff make then a drink and spend time with them helping them to settle. Records showed that staff provide support for people to make and attend regular health appointments, such as the Chiropodist or Dentist as well as following advice given by Continence Nurses, District Nurses and Occupational Therapists. This helps to ensure that people get the advice and support they need to remain as healthy as possible. However our last inspection at Isis in January 2009 noted that staff did not always follow up in a timely manner on health issues identified within daily records. During this inspection records showed that one person had asked to see their GP, however it was several days before staff made an appointment for them. This delay could have a negative impact on peoples health. Another person had developed a short term health issue. As detailed elsewhere within this report the care planning for providing support with this was not in place. Although at the time of our visit the person was getting the support they needed a lack of detailed planning and records could lead to changes to their health not being Evidence: quickly noted and acted upon. There are some aids and adaptations at Isis to support people with their mobility and personal care. These includes call bells, adapted showers and toilet chairs and rails. We observed that call buzzers were within reach of people sitting in their rooms and records showed that staff respond quickly to these when used. Advice about peoples mobility and aids and adaptations had been obtained for one person through an Occupational Therapist. As detailed within the environment section of this report, the equipment and advice given is not proving a practical solution for the person and staff. The manager advised us during our second visit that she planned to discuss this with staff the following week and then obtain further advice. This will help to ensure that as peoples needs change they can be supported in a way that is safe for themselves and the staff team. The people living at Isis told us that they get their tablets on time and that if they are in any pain staff given them their pain relief medication quickly. During our visits we looked at samples of medication storage, records and checks for some of the people living at Isis. We found that medication was stored correctly and that when medication, including creams are given these are signed for. However as well as the Medication Administration Sheet (MAR) used by staff to sign for medications given, there is also a separate sheet that is completed when people have medication prescribed as required. This is used to record the amount of medication given and the total that should be left. However it did not tally with the record on the MAR sheet which did tally with the amount of medication in the home. The as required sheet includes a running total but does not include a count of the actual medication. On this occasion it was easy to audit as the lack of recording had occurred within the past month. However having two recording sheets, one without a count of medication could lead to confusion regarding the amount of medication people have remaining. Monthly audits of medication are carried out and we looked at an audit from September 09 that covered record keeping, counting medications received in boxes and staff training. However one medication had been out of stock and therefore not given for four days before being ordered. On another occasion one person had been given a once a week tablet twice in one week. This had not been noted until medication was audited a week later. Advice was sought from the GP to ensure that the person would not suffer any ill effects of taking the medication twice. However a prescription was not obtained for that week, therefore on the second week the person did not receive this medication. A lack of a clear audit system which quickly notes any issues with medication along with a system for ensuring people do not run out of their prescribed medication could impact on their health. Most of the staff have had training in dealing with medication, however the audit noted that one member of staff had not. The manager assured us that staff will not deal with medication unsupervised until this training has been delivered and their competency assessed. This will help to lessen the risk of errors occurring. 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 people living at Isis are confident that any complaints they have will be listened to and acted upon. However smaller concerns that people raise are not always dealt with as swiftly as they should be. This could lead to people not getting the service they need or choose. Evidence: The people living at Isis told us that they know who to talk to if they have any concerns or complaints and are confident staff would help them. We also spoke to one persons visitor who confirmed that they had been given information about the companies complaints procedure. The welcome pack given to people about Isis contains information about how to raise a concern or complaint and this information is also displayed in the hallway. However as detailed earlier in this report, this information is not provided in as easy to read a manner as it could be. During our visit records of a recent house meeting showed that one person had raised concerns about their personal care. Although this had been documented there was no evidence that an investigation into their concerns had started. However at our second visit the manager had taken steps to gain more information from the person and advised us that she intended to then investigate the matter further. A system for documenting all concerns raised and investigating them as soon as possible would help to ensure people are getting the service they need and choose. It would also help to monitor the quality of the service Isis provides and quickly note and deal with any potential issues. Records showed that staff have had training in safeguarding adults and staff we spoke with were clear about the signs that could indicate people living at the home may be being abused. They knew what action they should take to make sure that people who live at the home are protected. The people living at Isis told us that they can have their money whenever they want. Potensials acts as appointee for the benefit money of most of the people who live there. We checked samples of records and amounts held in the home for people and found that Evidence: these tallied with clear records kept of monies spent. Since our last inspection clear records of how peoples money is managed for them are available. In addition a finance care plan and risk assessment is in place for the people living there. This open approach to supporting people with their money helps to ensure a clear audit trail is in place and that peoples money is managed in their best interests. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Isis provides a clean, comfortable and welcoming home for people to live in. However as their support needs change, action needs to be taken to make sure they can continue to be supported safely and appropriately. Evidence: Isis is a bungalow that was specially built to meet the needs of people who have physical disabilities. Outside it looks like an ordinary family home and fits in well with other houses in the area. It is in the Kirkdale area of Liverpool and is well located for reaching local facilities including shops and public transport. Everyone living at Isis has their own bedroom with an en suite toilet and basin. People told us that they can choose the decoration and furniture in their bedrooms and we noted that they were personalised with the things people like. During our visit the bungalow was clean warm and cosy. However at out last inspection we noted that one of the bedrooms felt cool and recommended that as people like to spend time in their rooms the temperatures were monitored to make sure it was warm enough. At our first visit this time no record of temperatures had been made. However at our second visit the manager told us that the temperatures would now be monitored and action taken if the rooms were found to be too cool. There are two lounges at Isis, one of which is used as a smoking lounge for the people who live there. At the front of the house an L shaped room provides a homely lounge and dining area for people to share. In the hallway a large notice board contains leaflets and information that detract from the more homely atmosphere of the rest of the house and which may not be needed in such a small, domestic home. The bungalow also has a family style kitchen and a separate laundry room. Staff are provided with disposable gloves and aprons and had a good knowledge of infection control. This all helps to prevent or deal with a possible outbreak of infection. Evidence: There is a bathroom and separate shower room within the bungalow that everyone can use. The shower is narrow but accessible for people who use a wheelchair and a shower chair is available along with grab rails and call buzzers. There are a number of aids and adaptations at Isis to support people with their mobility and personal care. This includes call buzzers, ramps, shower and toilet chairs. At our last inspection we noted that as one persons mobility was decreasing staff were finding it difficult to safely support them. Following this the manager arranged for an assessment by a qualified Occupational Therapist and additional aids and adaptations were provided. However most of these are no longer in use and staff expressed concerns that the support they provided may not be sufficient to safely support the person with their personal care and mobility. The manager agreed to discuss this with the staff team and seek further advice from health professionals about how to safely support this person. Parking is available on the drive and the street outside. At the back of the bungalow there is an enclosed back garden with patio. However the bushes and grass were overgrown and the patio needed weeding. Although a ramp provides access to the garden it does not appear an inviting place to spend time. Throughout our visit we observed the people at Isis using all areas of their home as they choose. People were clearly comfortable moving around the bungalow spending time alone in their rooms, or in the kitchen and lounges as they chose. 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. The people who live at Isis have confidence in the staff team who know then well. However staff do not always respond quickly to documented issues that are raised by the people living there. This could impact on the quality of support people receive. Evidence: The people living at Isis told us that they like the staff who work there and that they get the help they need from staff. During our visit we noted that staff spend time chatting and socialising with the people living at Isis as well as supporting them with their personal care and daily living needs. This contributed to a welcoming atmosphere in the home with a lot of humour and chatting throughout the day. It was clear from discussions with the people who live there and watching interactions throughout the day that the people living at Isis like and trust the staff who work there. In discussions with staff they displayed a good knowledge of the support needs and choices of the people living at Isis. Staff were able to explain peoples support needs with their health, personal care, behaviour and lifestyles. Staff do record information in peoples records, however as detailed elsewhere in this report they do not always act quickly in response to concerns or issues that the people living there raise. Since our last inspection at Isis in May 2009 staffing levels have been reviewed. There are now two staff in the house from nine am to nine pm and a waking staff throughout the night. However the staff rota shows that some staff are working long hours and for long periods of time without a day off. For example one member of staff had worked for eighteen days without a day off and had worked seventy two hours in one week. The hours and length of time staff work should be monitored to ensure they are not working excessive hours which could impact upon the support they provide. Staff told us that they have regular training to help them support people successfully. Records showed that staff have undertaken a variety of training in different aspects of Evidence: supporting people. These range from areas of health and safety such as fire and moving and handling people to more specialist areas such as diabetes and the new Deprivation of Liberty laws and Mental Capacity Act. The training staff have had and that is planned helps to ensure staff are as up to date as possible in how to support people safely and well. We looked at a sample of staff files relating to recruitment of staff to work at Isis. Before anyone starts work in the home two written references, a Criminal Records Bureau (CRB) check and check of the safeguarding adults list are made. However we noted that references obtained for one member of staff were brief and did not contain a lot of information. In order to gain as much information as possible the home should ensure that additional information or references are obtained in these circumstances. This would help to ensure staff are suitable to work with people who may be vulnerable. 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. A number of systems and procedures are in place at Isis to monitor and improve the quality of the service offered. However these are not always sufficient to identify and act upon improvements for the people living there. Evidence: The registered manager at Isis is experienced in managing care services for adults who have a learning disability and holds qualifications in care and management. She undertakes regular training to ensure she is up to date with new laws, and practice in supporting people safely and well. Staff told us that they find her approachable and in discussions she was clear about her plans to improve the service offered at Isis. As the registered manager is also registered to manage another care home nearby, she spends a minimum of two days a week at Isis. A full time deputy manager also works there. This helps to ensure there are clear lines of accountability and management support. There are several systems in place at Isis for checking and improving the service that they offer. This includes regular reviewing of care plans with the people living there. In addition the manager has put together a development plan. This lists improvements and tasks that will be carried out each month. For example the plan for July covered risk assessments, meetings and repairs. In addition daily, weekly and monthly checks and audits of the service are carried out. These covers all aspects of the service provided, including, health and safety, money, medication, support with activities and care plans. A senior manager from Potens visits Isis regularly and audits the service. This includes talking with the people who live and work there and examining records and the Evidence: environment. Once the audits is completed a clear action plan for improvements is put together and checked at the next visit. These audits and plans should help to ensure that any issues can be quickly identified and action taken to further improve the service. However a number of the areas for improvement noted within this report had not been picked up by the auditing process within the home, which could impact negatively on the service people receive. The people living at Isis told us that they have regular meetings in the house where they can, talk about what we want to do. This helps to provide them with a way to influence future improvements to the service. Regular checks are carried out on the building and equipment at Isis, this includes checking portable electrical appliances, fire systems and electrics. In addition risk assessments are completed and reviewed for areas of the building and tasks such as cooking and gardening. These checks help to ensure that Isis is a safe place to live, work and visit. 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 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 15 A system must be set up to 13/11/2009 ensure care plans are in place for all areas of support people require. This should include support for short term needs and lifestyle choices. This will help to ensure people get all of the support they need to remain as healthy as possible and live a lifestyle of their choice. 2 20 13 A system must be put into place to ensure that people do not run out of their prescribed medications. 30/10/2009 This will help to ensure that people remain as healthy as possible. 3 22 12 A system must be set up for swiftly dealing with and documenting any concerns that people raise. 13/11/2009 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 This will help to ensure that people get the service they need and choose. 4 29 23 A review of mobility aids and 20/11/2009 adaptations must be carried out for the person identified during the site visit. This will help to ensure the home can support the person safely and successfully. 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 1 The welcome pack for people living at or considering moving into Isis should be reviewed. This review should ensure the pack is presented and written in an easy to understand way. This will help to ensure people can understand as much as possible about the service and the support they can expect. Prior to anyone moving into Isis a copy of their social services or health assessment should be obtained. This will help to ensure that as much information as possible is available about the persons need and choices and the support they need. Further discussions and trainings should take place with the staff team around recording and supporting people with their decisions in a timely manner and the impact the Mental Capacity Act and Deprivation of Liberty laws has on this. This will help to ensure people receive timely support with the decisions they make and clear explanations are given as to why support for a particular decisions is not 2 2 3 6 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 provided or takes time to provide. 4 7 Clear timescales and action plans should be put into place following house meetings. These should be reviewed regularly. This will help to ensure people are getting the support they require in all areas of their daily life. Bedroom temperatures should be monitored and recorded to ensure they are at a comfortable heat to meet peoples needs and choices. The amount of hours and days staff work should be monitored to ensure they are not excessive and could have an impact on the support staff provide. Where staff references are brief or do not contain sufficient information this should be followed up by further verbal or written reference requests. This will help to ensure staff are suitable to work with adults who may be vulnerable. The way in which audits are carried out at Isis should be reviewed. This will help to ensure that any issues that impact upon the people living at Isis are quickly noted and acted upon. 5 24 6 33 7 34 8 39 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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