Care Home: Laburnum House

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What the care home does well The manager is keen to improve the service and has a person centred attitude. A service user said the manager is very nice. People have the opportunity to choose where they want to go on holiday and who they want to go with. This means holidays are more individual so people do not have to go all together if they do not want to. The garden is large, safe and enclosed and has space for people to relax and grow vegetables. There is opportunity for one to one support. Rooms are spacious so people have lots of space to relax in.The home is clean and smells fresh so is a nice place to be. The manager and staff team are stable and know service users well. What has improved since the last inspection? Improvements have been made to the environment including a new kitchen, new bathrooms, some new carpets and some parts of the home have been redecorated. The manager is now registered with us. This means people know she is a fit person to manage the service. The manager has made sure that all of the required documents for each staff member are in place as required at the last inspection. The manager has made sure that everyone has attended a fire drill as previously required and that the fire officer has a copy of the homes fire risk assessment. Some people are working with a local college to achieve a Gateway Award. The manager has organised a distance learning course for all staff on the safe administration of medication. A social club has been set up and a special Olympics organised so people get the opportunity to take part. What the care home could do better: Staff are potting up some medication in that they are taking medication out off boxes, strips and packets days before it is to be administered. This places service users at risk and was not picked up during the company audit in March 2009 and during monthly monitoring visits. After the inspection the manager put a stop to this practice. Training and support for staff in challenging behaviour is limited. There is no analysis, monitoring or in depth evaluation of incidents. This means that people are not always safe from potential harm and abuse.Not everyone has their personal goals and aspirations recorded and supported with a plan for staff to follow. This means that people may not get the support they need to achieve. Staff must have more awareness of peoples dignity and support people if they need to change their clothes. Service user plans are all written and look the same so they are not individualised to the person so may not mean much. Currently there are not many opportunities for people to be involved. For example in the cooking. The manager agrees there is potential for people to be more involved and plans to address this. Staff will need advice and training if they are to enable and empower people. The environment does not support communication. This means that people cannot find out what is for dinner, who is on duty or what the activity choices are that day unless staff tell them. The length of shift that staff work should be reviewed in case they get stressed and tired leading to bad support. There are no plans to support skill learning and development. For example learning about money, cooking or increasing skills with personal care. This means that people will not increase their skills and will have to continually rely on staff. Some windows are in need of repair as the paint is flaking off and they do not look attractive. A bedroom door on the landing has holes in and needs to be repaired. Outcomes for people may be improved if the manager has an accredited qualification relating to peoples needs like learning disability or challenging behaviour. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Laburnum House 41 Grimston Avenue Folkestone Kent CT20 2QD     The quality rating for this care home is:   one star adequate 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: Kim Rogers     Date: 1 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Laburnum House 41 Grimston Avenue Folkestone Kent CT20 2QD 01303227192 01303243416 laburnum.house@craegmoor.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Lothlorien Community Ltd care home 10 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 10 The maximum number of service users to be accommodated is 10. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Laburnum House (the Service) is registered to provide accommodation and personal care for 10 younger adults who have a learning disability. The premises are a large detached three-storey property. The main accommodation is provided on the ground and the first floors. On the second floor, there is a self-contained four bedroom flat called Treetops. This used by people who can be more independent. All of the people have their own bedroom. Each bedroom has a private wash hand basin. The property is located in a quiet residential area that is within walking distance of Folkestone town centre. There is plenty of off-street car parking. Folkestone has a mainline railway station. There is a bus service that passes near to the Service. Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home The Registered Provider is a private limited company. It runs a number of similar residential care services in the region. The range of fees charged currently for each person residence in Laburnum House runs from about 1132.97 ponds per week. The fees paid for some of the people are higher. This is because they receive special one to one assistance. The fees cover the cost of accommodation, personal care, meals at home, laundry, in-house entertainment and use of the homes two vehicles. They do not cover extras such as personal toiletries and meals out. For more information about the fees and services please contact the provider. Care Homes for Adults (18-65 years) Page 5 of 32 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 peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection of the service and included an unannounced site visit by one inspector. The site visit was carried out on 18 April 2009, a Saturday. The manager was not present for the site visit so the team leader assisted us. All of the key minimum standards were assessed at this inspection.The previous key inspection was carried out on 28 April 2008. The three requirements made at the last inspection have been met. We spoke to service users and staff, made observations and sampled some records. We had a look around the home. We found that they have made some improvements. Care Homes for Adults (18-65 years) Page 6 of 32 We spoke to the manager by phone on the day of the site visit and three days after the visit to give feed back and ask some questions.The manager is now registered with us as required at the last inspection. This means that she has passed the fit person process and people know she is a fit person to manage the home. We sent out some surveys to service users and staff. We looked at the two we had back from service users. Both gave positive responses and one said they like living at Laburnum House. We looked at the Annual Quality Assurance Assessment or AQAA that the manager completed. This gives information about what the home does well and how they intend to improve. We looked at other information we have received about the home including any concerns, complaints and notifications about incidents and accidents. There have been several incidents reported to us since the last inspection. These incidents mainly involve some sort of challenging behaviour, which has resulted in some people being hurt. The manager has taken some steps to reduce incidents. There has been a safeguarding vulnerable adults alert since the last inspection. This means that the adult protection coordinator at social services was alerted about suspected harm or abuse. There has been an investigation that the manager cooperated with. The manager took steps to make sure people are safe. However a further incident has occurred when a person was hurt. This means that more support may be needed. What the care home does well: What has improved since the last inspection? What they could do better: Staff are potting up some medication in that they are taking medication out off boxes, strips and packets days before it is to be administered. This places service users at risk and was not picked up during the company audit in March 2009 and during monthly monitoring visits. After the inspection the manager put a stop to this practice. Training and support for staff in challenging behaviour is limited. There is no analysis, monitoring or in depth evaluation of incidents. This means that people are not always safe from potential harm and abuse. Care Homes for Adults (18-65 years) Page 8 of 32 Not everyone has their personal goals and aspirations recorded and supported with a plan for staff to follow. This means that people may not get the support they need to achieve. Staff must have more awareness of peoples dignity and support people if they need to change their clothes. Service user plans are all written and look the same so they are not individualised to the person so may not mean much. Currently there are not many opportunities for people to be involved. For example in the cooking. The manager agrees there is potential for people to be more involved and plans to address this. Staff will need advice and training if they are to enable and empower people. The environment does not support communication. This means that people cannot find out what is for dinner, who is on duty or what the activity choices are that day unless staff tell them. The length of shift that staff work should be reviewed in case they get stressed and tired leading to bad support. There are no plans to support skill learning and development. For example learning about money, cooking or increasing skills with personal care. This means that people will not increase their skills and will have to continually rely on staff. Some windows are in need of repair as the paint is flaking off and they do not look attractive. A bedroom door on the landing has holes in and needs to be repaired. Outcomes for people may be improved if the manager has an accredited qualification relating to peoples needs like learning disability or challenging behaviour. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 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. Assessments are carried out or obtained before a person moves in. There is some written information about the home. Evidence: We found that no one has moved in recently so the assessment process could not be fully tested. However we know about the assessment paperwork used by the company. The AQAA says the company has plans to improve the assessment tool to include peoples aspirations and personal goals. They plan to carry our yearly assessments of current service users needs. We found there is some written information about the home. This is produced in text and symbols. There is a colour brochure in the hallway that they plan to update due to some recent refurbishment. People have contracts detailing the terms and conditions of their stay. These are Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: produced in text so may not be meaningful to everyone. The AQAA says they plan to improve information about the home so that it is meaningful to more people. Care Homes for Adults (18-65 years) Page 12 of 32 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. People cannot be sure their personal goals will be identified, recorded and supported. Potential risks are assessed and managed. Choice making could be better supported. Evidence: We found that each person has a service user plan detailing their needs and what staff should do to meet those needs. One person sampled has three separate files and one book for daily reports so there is a lot of information that staff need in different places. We found that people have been involved in their plans in that they or their relatives have signed to say they agree. We found that all plans look the same and are in text and some small pictures so are not individualised to people. This means that plans may not be user friendly to everyone. We found plans to support peoples needs like personal care, sleep, social interaction. In the service user plan sampled we found no record of the persons personal goals and Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: aspirations for the future. We found no detailed support plan to support any goals. If peoples goals are not identified and recorded staff will not know how to support people to achieve. The AQAA agrees that they could be better at identifying and supporting individuals goals. One person said during the visit that they would like to buy something. Staff said that this item is very expensive and that they would have to save up. We asked the person how much they had saved up and they were not sure suggesting it has not been planned for. This goal should be recorded and planned for so it is achieved. We found no plans to support skill development and learning. For example one sheet says, in the future I would like to, during the day I would like to and other things I would like to do. This was blank. Another sheet says the skills I want to learn. This was also blank. Without identifying the skills people would like to learn and then having a plan of support in place, people will not increase existing skills and learn new ones. We found that potential risks to people are identified, recorded and assessed. Action that staff should take to minimise risks is also recorded. This protects people. We found that people have regular reviews with their care managers. Family and friends are invited if the person wishes. We found that how people prefer to communicate is recorded in only basic terms. For example in one plan sampled the words, uses Makaton, was ticked. But staff said they do not use Makaton and have not used it for ages. The way one person communicates was described as speaks and points. From observations we found this person has a communication need. This means that staff may not know what people are trying to say so cannot support choice and decision making. We found that choice making could be better supported. We observed one person making a choice to go out only to be told by staff that they did not know where the person was going as staff had not arranged anything yet. Staff did say that they try to get people out everyday but without having things planned and offered things may not happen and people will not know what the choices are. Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: The environment does not support communication in that there is no way that service users can go and find out things for themselves rather than have to rely on staff telling them. For example one person asked staff what was for dinner that night. Staff said the menu is displayed but it is written and so not meaningful to everyone. People have no way of knowing who will be on duty and supporting them unless staff tell them. People do not know what activities are on offer that day, or that week unless staff tell them. The manager and team leader said that they plan to improve communication by having boards showing pictures and photographs of who is on duty and the meal choices of the day. Care Homes for Adults (18-65 years) Page 15 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity to take part in a range of activities. There is potential for people to be more involved in planning and preparing meals and to be involved in the running of the home. Relationships are supported. Evidence: We found that people have the opportunity to take part in a range of activities in the community. People attend activities like sports including swimming and horse riding. One person said they have support to go to church. People go to local clubs, shops and discos so feel part of the community. Some people were out shopping and one person went out during the visit.Other people stayed in and watched a DVD together. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: We found that hobbies are supported. We found that people have the support they need to keep in touch with family and friends. Service users have the opportunity to invite family and friends to their review meetings. At the last inspection we found that there is a lack of opportunities for life long learning and employment. The manager said she has been looking into employment opportunities with the company. The manager said that some people have enrolled on a Gateway Award scheme with a local college. We found that people do not take part much in preparing meals. People get together each month to plan the menu but staff said that they do the cooking. We observed this, with staff on their own in the kitchen making lunch for everyone at home.The manager agreed that there is potential for people to be more involved. We found that the menu is displayed but is written so does not mean much to most people. We heard one person having to ask staff what is for dinner even though they could see the menu. This means that people do not know what the choices are and have to rely on staff to tell them rather than find out for themselves. The manager said she plans to have the menu choices displayed in photographs and pictures soon. We found that people have free access to the kitchen during the day so can get to drinks and snacks when they need to. We found that there are no plans in place to support people to develop and increase their skills. In one plan sampled was a page of information asking what skills the person wants to increase. The sheet says the skills I want to learn. This was blank.Without identifying skills people would like to learn and then having a plan of support in place, people will not increase existing skills and learn new ones. The AQAA shows the manager has identified this and has plans to address it giving people more opportunities. Care Homes for Adults (18-65 years) Page 17 of 32 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. Peoples personal and health care needs are met. Medication practice must improve and be regularly checked to ensure that practice is safe and service users are protected. Evidence: We found that peoples personal care needs are recorded in their individual plans. This means that staff know how people prefer to be supported. There are enough bathrooms for people to use and these have recently been updated. We found that staff need to be more aware of peoples dignity. For example we observed a person had tea or coffee stains down the front of their clothes and no one gave support to get the person clean clothes. So throughout the morning of the visit the person sat with stained clothes on. We found that health needs are recorded in individual plans. There is information about peoples medication so staff can look out for possible side effects. We found records of appointments and outcomes with health care professionals. We found that Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: people have the support they need to attend health appointments. We found that staff have worked with the local community team and other health care professionals to support peoples health needs. We looked at the storage of medication and sampled some administration records. Currently people have to come to the medication cupboard for their medication. We found that staff control medication so no one has any control over their own medication at present. We found that assessments are carried out to see if people can have some control although these are unrealistic, as they require people to be able to do things like open containers and know about side effects. In reality people can have some control with the right support to keep them safe without knowing about side effects and being able to open containers. We found that staff are potting up medication which places service users at risk. This means staff take tablets out of packets, bottles and strips and put them into another container days before they are to be taken.There is no information on the secondary containers so staff will not know what the medication is, what the dose is and how it is to be taken etc.We found that they are not following the guidelines outlined in the Minimum Standard from the Royal Pharmaceutical Society and this places service uses at risk. We found that this was not picked up by the companys own audits and checks. The manager said she stopped this practice following the inspection. We found that staff have training before they administer medication to people. Staff then have their competency assessed regularly by the manager to ensure they are still safe to give out medication. The manager said she has enrolled the whole staff team on a distance learning safe handling of medication course, which will start soon. There has been a medication error at the home since the last inspection. They told us that a person was given the right medication at the wrong time. They said they sought medical advice and retested the staff members competency. The AQAA has little information about what could be better saying continue to meet standards. There is little information about how they intend to improve, the AQAA says to remain consistent. Without plans to improve outcomes for people may not improve. Care Homes for Adults (18-65 years) Page 19 of 32 Care Homes for Adults (18-65 years) Page 20 of 32 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. Not everyone can use the complaints procedure as it is. People have been placed at risk of harm and abuse. Evidence: We found that there is a complaints procedure. This is produced in large text with symbols and is displayed in the home. We showed a service user and asked what it is about and they did not know. This version may not be meaningful to everyone and so not everyone can use it. Staff talked about ways this could be improved to make it more meaningful to everyone. This means that more people could use it. We have received a complaint since the last key inspection, on 14/07/08 about the home being short staffed and not having enough support for people at night in the form of a waking night staff, the home has a sleep in staff at night.We passed this to the Provider to investigate which they did. They said that the home is adequately staffed. For more information please contact the manager. We found that there is a policy and procedures in place to safeguard people from harm and abuse.Staff told us what abuse is, how they would recognise it and who they would report to. The manager has reported several incidents of injuries to people since the last inspection. Most of the injuries are a result of challenging behaviour. Most of the incidents were not witnessed by staff even though some people involved are Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: funded on a one to one basis for up to fourteen hours a day. Incident reports show that staff have been reactive to incidents and people have been hurt. We found that staff training in supporting people with challenging behaviours is limited.We found that the manager has made a referral for support from the local community team. In the meantime we found that no functional assessment or functional analysis has been carried out to see if a pattern emerges. The manager keeps a monthly tally of incidents but has not looked into where and when and in what circumstances incidents are most likely to occur. This means that staff cannot be more proactive and prevent incidents from happening. After the inspection the operations manager told us that there have been no incidents for ten weeks. The operations manager also told us that there is a reporting procedure which analyses critical events including aggressive incidents. This is then compiled for the manager and area manager. There has been a safeguarding alert since the last inspection. This means that the safeguarding vulnerable adults team at social services were alerted about possible abuse and have investigated this. The manager and staff cooperated with this investigation and took steps to make sure people are safe. For more information please contact the manager. The AQAA has no information about how they intend to improve in this area, safeguarding people. Care Homes for Adults (18-65 years) Page 22 of 32 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 home is clean and safe. Improvements to some parts will enhance peoples lives and make the home a more attractive place to live. Evidence: We found that the home is safe and generally well maintained. Some parts of the home need attention including some windows need repair as there is flaking paint. We found that one door on the first floor landing has some holes in it that need repairing. People said they are happy with their rooms which are personalised so are individual. All bedrooms are single room and none have en suite facilities but all have a wash hand basin. Bathrooms and toilets are near to bedrooms and have been updated recently. Some rooms have been decorated and there are some new carpets.The kitchen is new and spacious. There is no restriction on the kitchen during the day so people have free access and get drinks and snacks when they want to. This is also the case for the garden so people can get out and get fresh air when they want to. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: The garden at the rear is large and safe with patio area and a vegetable plot. The garden is well kept so is a nice place to spend time. There are two lounges so people have space to relax in. Staff said that they do most of the cleaning. The manager agreed that there is potential for service users to be more involved in the housework and other chores. She plans to asses people using a new form to see what support people need to be more involved. Care Homes for Adults (18-65 years) Page 24 of 32 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. There are enough trained staff to meet peoples needs. Recruitment checks are robust protecting service users. Training in active support techniques will give service users more opportunities to be involved and empowered. Evidence: We found that there is usually six staff on duty during the day including a team leader. There is a sleep in staff at night. We found that there are enough staff on duty to meet peoples needs. Some people are funded on a one to one basis. We found that staff keep records of this extra support. We found that support is not always planned in that staff said they do not really have a plan for the day and there have been incidents not witnessed by staff. This means that the staff deployment may not be effective and they may want to consider more effective shift planning. We found that staff work early and late shifts but some staff work long days. This means that staff could work up to fourteen and a half hours and could become tired and stressed. Because this affects outcomes for people who use the service we made a recommendation that this be reviewed. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: The home has a full staff team and do not use agency staff. This means that people know who will be supporting them and get continuity in their support. Staff have access to regular training and some have attended training in person centred thinking. The manager said that all staff have completed the required mandatory training like first aid and food safety. The AQAA shows that most of the staff have a National Vocational Qualification. A new staff said they are working through their induction folder with support from other staff and the manager. They said they have enjoyed attending the induction training. We found that the induction is in line with the Minimum Standard. Staff said they have the opportunity to attend regular staff meetings and have one to one meetings with the manager. This gives them support, coaching and mentoring and an opportunity to talk about any issues they might have. The AQAA sys they plan to have a supervision timetable so it happens more often. We found that service users are involved in recruiting staff. They meet prospective staff when they have a look around and the manager said she has involved service users in interviewing prospective staff. This means that people get to have a say about who may potentially support them. We found that people fill out an application form and have an interview with the manager. We found that recruitment checks are carried out before a person starts work at the home like references and a Criminal Records Bureau check. This protects service users. We found that staff do things for service users rather than with them. For example one staff was making lunch for everyone on their own in the kitchen without service users helping. Staff say they do the cooking and cleaning. The manager agreed that there is potential for service users to be more involved but feels the staff culture needs to change for this to happen. To ensure opportunities for people are increased we recommended that staff have the training they need in active support techniques to enable and empower people. The AQAA shows that staff are trained in issues relating to equality and diversity. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is adequately managed and managed in peoples best interests. There are quality monitoring systems in place to ensure good practice. People know their health and safety will be protected. Evidence: The management of the home is stable with the same manager in post since the last inspection. The manager is now registered with us, which means she has passed the fit person process and is a fit person to manage the service.The manager has a National Vocational Qualification in care at level 2 and 3 and is working towards a Registered Managers Award. The manager has no qualification relating to peoples specific needs, that is learning disabilities or challenging behaviours. This means that she is not up to date with the latest research and best practice.The manager said she is keen to gain a qualification in learning disabilities and service users specific needs. We made a recommendation for this to happen, as outcomes for service users will then be improved. Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: Staff said the manager is approachable and supportive. A service user said the manager is very nice. The manager completed the Annual Quality Assurance Assessment. This was generally well completed and gives information about what the service does well, what could be better and how they intend to improve. The AQAA does not identify what could be better in this management area. The AQAA shows that only one barrier to improvement has been identified, that is available places at staff training. If barriers are not identified then there will be no plans in place to overcome them and the service may not improve for people. We found that there are systems in place to get the views of people who use the service. There are monthly service user meetings and people have reviews when family and friends may be invited to attend. However due to the need for better communication support we found that some peoples views may not be heard. The AQAA tells us about limited changes that have been made based on service users views. The company carries out audits of the service. The manager said they have recently had two audits, one in December 2008 and another in March 2009. An area manager visits the home and carries out monitoring checks. However these systems did not pick up issues with medication found at this key inspection. We wrote to the Provider with concerns about this. The AQAA shows that the required health and safety checks of premises and equipment are carried out.Staff have training in areas related to health and safety like food safety and first aid. Care Homes for Adults (18-65 years) Page 28 of 32 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 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 Peoples personal goals and aspirations must be identified, recorded and supported. To ensure that people have the support they need to achieve their goals and aspirations. 30/06/2009 2 20 13 Staff must not pot up medication. There must be robust audit and monitoring systems in place to check medication practice to protect service users. To ensure service users are protected and safe. 31/05/2009 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 33 To ensure that staff are not tired and or stressed, staff working up to fourteen and a half hour shifts should be Page 30 of 32 Care Homes for Adults (18-65 years) reviewed. 2 35 To ensure that staff have the skills they need to empower and enable people they should have training in person centred active support and training related to service users needs. To ensure the manager is up to date with latest research and best practice and can improve outcomes for people we recommend she gain an accredited qualification in learning disabilities. 3 37 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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