Care Home: James Burns House

What the care home does well Over the past two years there has been a significant change in the way the home consults with people who use the service. The home has implemented systems by which people can have their say about the care they receive and know that this will be acted on. This has led to a more person-centred approach in all aspects of people`s care. There is evidence that people are involved in their admission to the home, are able to contribute as much as they want to their care plans and can set goals in relation to their aspirations. Improvements have been made in promoting social opportunities for people and the home has demonstrated a commitment to developing this further. Consultation groups have been set up to promote opportunities for people to have their say which have resulted in positive changes being made. The home works in partnership with health and social care professionals which has led to some good outcomes for individuals who live in the home being achieved. The home responds well where people`s health care needs have changed demonstrating a flexible approach, but also showing awareness of their limitations, to ensure people`s needs are met. Risks to people who use the service have been managed well, the home communicating effectively with statutory agencies to ensure people are safe. Progress has been made in improving the home environment to make it a more pleasant place to live and to ensure it is well-maintained. The home is clean and infection control procedures are in place to minimise risks in this area. Care workers employed by the service are well-trained and the home is proactive in identifying where gaps exist in training provision so that people who use the service benefit from care staff who have the necessary knowledge and skills. The home benefits from consistent and effective management with good attention paid to health and safety issues. This means that risks are identified and managed appropriately and people are safe. What has improved since the last inspection? As indicated above, the home continues to make positive progress in ensuring the service they deliver is based on what people want. This has led to a number of changes which have had a positive effect on people`s choice. lifestyle and home environment. What the care home could do better: We have made one recommendation as a result of this inspection. Recruitment procedures in the home are generally robust but we noted a shortfall in relation to obtaining full employment histories for prospective care workers. This needs to be addressed so that procedures fully protect the people who use the service. The home has identified areas for further improvement in their Annual Quality Assurance Assessment which we fully support as this will ensure that the service continues to base their development on the needs, preferences and aspirations of people who live there. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: James Burns House Greenways Avenue Bournemouth Dorset BH8 0AS     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: Heidi Banks     Date: 2 1 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: James Burns House Greenways Avenue Bournemouth Dorset BH8 0AS 01202523182 01202533058 claire.hough@lcdisability.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Leonard Cheshire Disability Name of registered manager (if applicable) Claire Hough Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: Date of last inspection Brief description of the care home James Burns House accommodates up to 21 adults with physical disabilities. It is one of a number of services in the south west region run by Leonard Cheshire Disability. The home is situated close to local facilities including a post office, library and a shopping centre. Accommodation is in single rooms with communal lounges, dining areas and shared toilet and bathroom facilities. There is level access in all parts of the building and surrounding gardens and ample car parking facilities. Based on information provided to us in November 2008, fees for residents at James Burns House ranged from 620 to 950 pounds per week. This does not include transport costs for which people are invoiced separately. Further information on fair terms of contracts and care home fees can be found on the website of the Office of Fair Trading: www.oft.gov.uk. 21 Over 65 21 care home 21 Care Homes for Adults (18-65 years) Page 4 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection of the service. The inspection took place over approximately 10 hours on 10th and 21st October 2008. Part of the inspection was carried out by two inspectors. The aim of the inspection was to evaluate the home against the key National Minimum Standards for adults and to follow up on the requirement made at the last key inspection in September 2007. At the time of the inspection there were 20 people living in the home aged between 31 and 80. Although the majority of the inspection was carried out by one inspector, throughout the report the term we is used to show that the report is the view of the Commission for Social Care Inspection. Care Homes for Adults (18-65 years) Page 5 of 31 During the inspection we were able to meet and talk with some of the people who use the service. Discussion took place with the Registered Manager of the home, Claire Hough, and some care workers on duty. A sample of records was examined including health and safety records, staff recruitment and training records, medication administration records and information about people who use the service. Surveys were sent to the home before the inspection for distribution among people who live there and those who have contact with them. We received a total of 13 completed surveys from people who use the service, 14 surveys from care workers, 6 surveys from health care professionals and 3 surveys from care managers. We received the homes Annual Quality Assurance Assessment before the inspection which gave us some written information and numerical data about the service. A total of 22 standards were assessed at this inspection. What the care home does well: What has improved since the last inspection? What they could do better: We have made one recommendation as a result of this inspection. Recruitment procedures in the home are generally robust but we noted a shortfall in relation to obtaining full employment histories for prospective care workers. This needs to be addressed so that procedures fully protect the people who use the service. The home has identified areas for further improvement in their Annual Quality Assurance Assessment which we fully support as this will ensure that the service continues to base their development on the needs, preferences and aspirations of people who live there. Care Homes for Adults (18-65 years) Page 7 of 31 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home liaises effectively with prospective residents and placing authorities to ensure that individuals needs can be met by the service and to facilitate a smooth transition. Evidence: The manager of the home told us that they have reviewed the services assessment procedures four times over the past twelve months to ensure the system in place is robust and so that they can demonstrate how they will meet peoples needs. We spoke with two people who have moved to the home since the last inspection. Both described how they and their family had been involved in choosing to move to the home and had opportunities to visit and talk to staff before making a decision. Both individuals told us that they felt the home was the right place for them. We received three surveys from care managers who have placed people in the home. Two indicated that the assessment arrangements in place always ensured accurate Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: information was gathered and the right service was planned and given to individuals, one indicating that this was usually the case. One care manager told us; I have one service user who is a resident at James Burns House. Thorough assessments and information gathering were planned before the service user placement began. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being proactive in supporting people with identifying and fulfilling their individual needs and making decisions about their lives. Evidence: We looked at the care plans for two people who use the service. These contained substantial information about their needs and preferences and had been drawn up in consultation with the person concerned. We spoke with some people who use the service who confirmed they had input into their plans, one person indicating that their input had been substantial, this clearly being important to them. Plans indicated what people could do for themselves and the areas in which they required support. We noted that there was a considerable amount of paperwork for each person. Four out of fourteen care workers responding to the survey remarked on this telling us that the paperwork they were expected to do felt cumbersome and interfered with time they are able to spend with residents. We discussed this issue with the manager and Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: senior team leaders who informed us that the documentation in place was under ongoing review and it is hoped that it will be streamlined over time so that it is more user-friendly. The manager told us that various strategies had been put in place to support care workers with completing the documentation as this was an area where some people lacked confidence. A system has been established in the home to help people who use the service identify and achieve their goals. People we spoke with told us about the things they wanted to do and how this was part of their goal plans. This included swimming, attending social clubs, accessing public transport, a trip on an aeroplane and holidays. We saw documentation supporting this on peoples files. The homes efforts to support people with their personal goals were noted by some care managers who have contact with the home. One commented on the way the service work closely with the service user in meeting their identified needs. Support the service user in achievable goals when care planning. From our conversations with people who live in the home it was apparent that the key worker role is central to supporting goal-setting. Surveys we received from care workers indicated differing responses to this, some clearly grasping this as part of their role, a minority indicating some confusion about this. Discussion with the manager demonstrated her awareness that shifting the balance of control towards being a more user-led service had entailed some changes for staff. The manager has put strategies in place to support staff with gaining confidence in this aspect of their work. We looked at a sample of risk assessments in place for two people. These showed consideration of peoples desire to maintain independence while being mindful of their safety and welfare. People we spoke to at the inspection gave examples of how they had made decisions to participate in activities where potential risks had been managed. People told us that on an everyday basis they were enabled to do tasks for themselves including their own laundry and preparation of snacks and drinks. We saw risk assessment documentation in place to support this. Care Homes for Adults (18-65 years) Page 13 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Significant progress is being made to ensure that individuals are able to live the life they choose and are consulted about lifestyle issues that are important to them. Evidence: Out of thirteen completed surveys received from people who use the service , eight told us that they always made decisions about what they did each day, four told us that this was usually the case and one said this sometimes happened. We looked at strategies that the home has in place to promote peoples engagement in activities of their choice and minimise barriers to this. The manager told us that they have now secured funding to appoint an activities co-ordinator who will be responsible for developing peoples access to activities, particularly those based in the community. The home has also reviewed the staff rota to increase the opportunities available to Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: people for spontaneous trips out. A Social Inclusion Group has also been developed within the home to promote peoples partcipation in making decisions about social opportunities and ensure their views are heard. Both staff and people who use the service gave us examples of how care planning processes have helped them identify their goals and ensure they are fulfilled. The home has also been proactive in asking for feedback from people about activities they have engaged in with a view to encouraging others who may wish to participate. A relative we spoke to during the inspection reported that they were always pleased to see their family member engaged in an activity when they visited. They were happy that arrangements had been made for them to attend a church group on a regular basis as this is something their family member is known to enjoy. A care manager who responded to the survey told us; James Burns House have done some really good work with service users around individual choice and lifestyle. Care workers we spoke with during the inspection demonstrated an awareness of peoples rights and were able to give examples of situations that may infringe on peoples rights and how they aim to overcome these. Staff also told us in surveys that they receive training in disability and equality as part of their core training in the home. The manager has told us in the homes Annual Quality Assurance Assessment that they are already using some forms of advocacy in the home but are also looking at mentoring schemes to raise peoples awareness of their rights. People we spoke with during the inspection told us that they have contact with friends and family and there was evidence of individuals being able to form close personal relationships of their choice. A relative we spoke to told us they always felt welcomed in the home, this also supported by comment cards we read which referred to the homes friendly and welcoming atmosphere. The manager told us that the rota in the home has been reviewed to make sure that senior staff are available to visitors at times when they are more likely to visit, for example, evenings and weekends. We saw evidence that the home has implemented regular group meetings for friends and families of people who use the service as a means of updating them on events and enabling them to contribute ideas to the development of the service. The manager has also established regular contact with the relative of a service user who lives some distance from the home so that they too feel involved and to ensure that there is open communication. We observed on our tour of the premises that the home has installed a computer suite for use by residents with internet, e-mail and skype facilities to enable them to communicate with friends and family and be part of social networks. We talked to a member of staff with responsibility for catering in the home who told us that they have a sufficient budget to ensure that they can provide a good variety and Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: quality of food to people who live there. A Food Focus Group is held within the home which gives residents an opportunity to contribute ideas about meal-time arrangements including food choices, special diets and design and layout of the dining area. The chef in the home told us that they receive lots of feedback from residents and use this to tailor the menu accordingly. The chef demonstrated awareness of the special dietary requirements of some individuals in the home and how these are met. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home works hard to meet the individual personal and health care needs of people who use the service demonstrating the ability to work effectively with specialist health care professionals in order to achieve some positive outcomes for those they support. Evidence: We looked at the care plans for two people in relation to their personal care. These contained some useful information about individuals needs and choices, for example, X requires a member of staff to stay with (them) to wash their hair. X then likes to be left alone for 5 minutes to wash. There were some detailed instructions on file regarding how to support individuals with transfers where there were moving and handling requirements. We observed some interaction between care workers and people who use the service, in particular noting a member of staff who took the time to understand what one person was trying to communicate and not making assumptions about what they wanted. This was echoed by a relative who told us that on their visits they had heard nothing but kindness from care workers towards their family member even when staff Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: were not aware of their presence. All thirteen people responding to the survey indicated that staff always treated them well; They are kind and understanding. Some individuals I dont get on with but they all treat me well. A care manager responsible for placing one person in the home told us in a survey; The service user regularly e-mails me saying how pleased they are with staff support. Out of nine health and social care professionals, seven indicated that in their experience staff at the home always respected peoples privacy and dignity, two indicating that this was usually the case. At the last inspection of the service we made a requirement about staffing levels in the home impacting on the delivery of prompt personal care to individuals, in particular the response times to peoples call bells. The manager told us in the homes Annual Quality Assurance Assessment that staffing levels had been reviewed in relation to this and implementation of a new call bell system means that she can monitor response times. We noted from records that in recent months there had been a significant reduction in people waiting more than five minutes to be attended to and it is anticipated that this will decrease further. People we spoke to at this inspection did not raise concerns about waiting times and reported that they received care when they needed it. The majority of care workers responding to the survey told us that there were usually enough staff to meet the needs of people who use the service although it was identified that there were still periods of the day, for example around tea-time, when they felt under pressure. It is suggested that the home continues to keep staffing levels under review, particularly as the needs of people who use the service fluctuate and new people are admitted. Notifications we have received from the service in the last twelve months have demonstrated ways in which the home have worked hard to manage individuals complex health care needs including palliative care needs and enteral feeding. The manager told us that this has involved close liaison with specialist care teams. The home also ensured that options were explored in relation to an individuals epilepsy medication to promote their dignity and has sought advice as necessary with regards to sourcing specialist training for care workers. The majority of health care professionals responding to the survey indicated that the home always seeks advice and acts upon it to manage and improve peoples health care needs. A care manager noted that something the home does particularly well is to work in a multi-disciplinary way, enabling people with deteriorating conditions to remain in their home with support. We noted in the records of people who use the service that health care appointments had been documented including those with general practitioners, district nurses, Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: occupational therapists and the dentist. In one record we looked at we noted that the service user had expressed a wish to manage their own appointments without intervention from staff and this had been respected. The manager told us that regular meetings between staff at the home and community nurses had been set up to promote positive joint working, this also being noted by a health care professional who reported significant improvements in communication since the meetings had been initiated. The majority of health professionals responding to surveys said that the home usually met the health care needs of people they support with two saying this was always the case. One question in the survey asked health care professionals what they thought the service did well. Responses we received were; Putting clients first, treating them as individuals; Really care about the individual; Cares for all its residents on an individual and personal level; As a surgery we have been very impressed with the level of care our patients have received. Medication is supplied by a local pharmacy and stored in peoples bedrooms in metal cabinets with medication administration record charts which are also produced by the pharmacy for use in the home. We saw that information about the way in which individuals prefer to have their medication administered is detailed in their care plans including whether they wish to self-medicate. We noted in one persons record that they had expressed a wish to self-medicate and we saw a plan in place to support them in working towards this goal. We looked at the medication for one person who lives in the home, observing that their allergies had been documented on the medication administration record and there was information about the medication prescribed for them and its side effects. We saw evidence of an audit trail in place, a senior team leader confirming that audits are done on a regular basis to ensure that people are receiving the medication they require. Discussion with the senior team leader who takes responsibility for medication in the home indicated that training for care workers is continuously being reviewed and some small group sessions are being planned to refresh peoples knowledge and understanding of good practice. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home demonstrates good practice in relation to responding to concerns and safeguarding issues thus promoting the safety and welfare of people who live in the home. Evidence: The manager has told us in the homes Annual Quality Assurance Assessment that a complaints procedure is in place in the home. All thirteen people who responded to the survey told us that they knew who to speak to if they were not happy. Comments we received included; Management or keyworker; A carer or the manager; I tell the staff. They listen to me. The majority of people who use the service indicated that they knew how to make a complaint if they needed to. Two said they did not know although there was evidence on record of the manager sending out a letter to people to remind them of the procedure. All care workers responding to the survey told us that they knew what to do if a service user or relative had concerns about the service. The majority of health Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: and social care professionals indicated in surveys that the care service had always responded appropriately if they, or people who use the service, had raised concerns about their care. The Commission has not received any complaints about the service in the last twelve months. The home communicates well with the Commission about safeguarding incidents in the home which require referral to statutory agencies for investigation. They have also ensured that relevant agencies are notified when there are safeguarding concerns. A care manager who has contact with the service commented; James Burns House are very proactive specifically in regard to PoVA (Protection of Vulnerable Adult) issues and work well to resolve situations with ourselves. All care workers employed in the home receive training in relation to safeguarding as part of their induction programme. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service continues to make improvements to the premises to ensure it is wellmaintained and provides suitable accommodation for people who live there. The home is clean and there are infection control procedures in place to ensure people who use the service are safe. Evidence: James Burns House was built more than thirty years ago. The home accommodates up to twenty-one people in single rooms on the ground floor. Bedrooms do not have ensuite facilities. A care manager commented that the homes layout is slightly instututional but that without a complete rebuild of the premises this cannot be addressed. However, the service has shown a positive commitment to improving the premises in the past twelve months. Our tour of the home showed evidence of redecoration, installation of new bathing facilities, new widescreen televisions and new furnishings in communal areas. The manager told us that peoples rooms are to be redecorated in the next twelve months. We noted that comments received via the homes suggestion box were highly complimentary about the work that has been undertaken to improve the homes environment. X likes the changes that have been done in the home. She especially likes the table Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: cloths on the dining room tables. X likes the new TV in Sunnymead lounge; (written on behalf of a service user) I have been pleased to receive all the updates on works done at James Burns House, the bathrooms and washing of clothes facilities. Then, whilst I visited the volunteers made a start on the garden. It all makes for pleasing surroundings to live in (Relative). X has been telling me with great pleasure all about Xs redecorated room and how nice it has been made. Thank you.; (Relative) It is gorgeous. Well done (Visitor) Positive remarks from people who use the service and staff about improvements to the home environment were also received during the inspection; Its great!; (Service user) I never thought it could look this good; (Care worker) The majority of people who use the service told us in surveys that the home is always fresh and clean, the remaining two people indicating this was usually the case. A relative told us in a survey; We always find it fresh, clean and inviting. The home presented as clean and tidy at the time of the inspection. Senior staff undertake monthly audits on the home environment including infection control procedures. We looked at the most recent checklist that had been completed which covered clinical waste facilities, protective equipment and staff training. The manager has confirmed in the homes Annual Quality Assurance Assessment that all staff working in the home have received training in infection control and are undertaking training on the action to be taken in the event of a pandemic. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems for recruiting staff are generally robust and care workers receive the training they need to meet the needs of people who use the service. Evidence: We looked at three staff records for evidence that the home has robust recruitment procedures. In each case there was evidence of proof of identity and confirmation that necessary checks with the Criminal Recods Bureau had been undertaken prior to them starting their employment. Two written references had also been obtained for each person. Although there was evidence on two records of a full employment history or evidence that gaps in employment had been explored at interview, one applicant had only given an employment history since 2001. The home has told us in their Annual Quality Assurance Assessment that they have an induction training programme in place that meets the National Minimum Standards. All three care worker records showed evidence that they had undertaken the organisations induction training. Correspondence on their files indicated that this is classroom-based for three days and includes core training such as moving and handling, first aid and health and safety. Correspondence also indicated that new staff undertake a period of shadowing experienced care workers during which time they are Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: supernumerary. This is intended to offer them the opportunity to get to know people who use the service and familiarise themselves with their needs. Out of fourteen care workers who responded to the survey, eight indicated that their induction training covered what they needed to know very well while six said this was mostly the case. The home has told us in their Annual Quality Assurance Assessment that, out of twenty-six permanent care workers, thirteen have a National Vocational Qualification (NVQ) at Level 2 or above and five are working towards this qualification. We observed care workers in the home coming in to meet with their NVQ assessor during the inspection process. The service has a dedicated training and development officer who maintains records of training undertaken by care workers and ensures people are booked onto update training as required. Discussion with a senior member of staff indicated that the home continues to look at increasing the uptake of specialist training to respond to the needs of people who use the service, for example, training in epilepsy, Multiple Sclerosis, Cerebral Palsy and strokes. We looked at two staff training records which showed evidence that they had received training in enteral feeding, Multiple Sclerosis and basic stoma care. The homes Annual Quality Assurance Assessment tells us that all care workers are to receive training in individual service planning and key working. Discussion with the manager and care workers during the inspection indicated that this training is underway. All staff responding to survey said they were being given training which is relevant to their role and that keeps them up to date with new ways of working. We received some positive comments from staff about the training they receive: I ask for training if I need it and my employer always makes sure they can get me on a training course; I have not experienced any training anywhere else like I have at James Burns House. The mandatory training is very thorough and covers every aspect of what I am required to do within my job role but also the scope for additional training is massive which creates the opportunity for...additional responsibility. The majority of health and social care professionals indicated in surveys that staff usually have the right skills and experience to support peoples social and health care needs, one noting that the home has been proactive in sourcing training to respond to individuals changing needs. Care Homes for Adults (18-65 years) Page 25 of 31 Care Homes for Adults (18-65 years) Page 26 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has systems in place to ensure it is safe and protects the welfare of people who live there. The home has made commendable efforts to become more service user-led, ensuring that consultation with people who use the service is fundamental to its development. Evidence: The registered manager of the home, Claire Hough, has been in post for nine years. She has a range of qualifications relevant to her role and ensures her knowlege is updated through continuing professional development. There is a management structure in place comprising two senior team leaders and three team leaders who have delegated management and supervisory responsibilities. The home communicates well with the Commission, notifying us of incidents occurring in the home as appropriate, this being echoed by the local authority. The service has various quality assurance processes in place including formal audits and consultation groups which have been set up by the home to involve people who Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: live there in its development. Suggestions boxes have been put in place which enable people to put forward ideas and comments, feedback from which has been collated in a book with information about outcomes. Meetings for relatives of people who use the service have also been implemented to promote communication and feedback. The homes Annual Quality Assurance Assessment submitted by the manager is very comprehensive indicating not only where the home is making good progress but also identifying areas for further development and how these are to be met. Health and safety audits are in place. We saw evidence of checklists being completed on a monthly basis by senior staff in the home covering gas and electrical safety, water temperatures, fire safety, hazardous substances, risk assessment, accident reporting, first aid procedures, food safety, security, maintenance and infection control. We saw records to evidence that water temperatures are checked before people have their baths, these being within a safe range. Care Homes for Adults (18-65 years) Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 34 The service should review systems in place to obtain full employment histories from prospective care workers to ensure practice is consistent. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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