Care Home: Marston Court

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Marston Court 67 Marston Road Leicester Leicestershire LE4 9FF The quality rating for this care home is: Adequate (1 star) 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: Chris Wroe Date: 0 4 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 36 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Marston Court 67 Marston Road Leicester Leicestershire LE4 9FF 01162103895 01162103895 marstoncourt@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Marston Court Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 22 Number of places (if applicable): Under 65 Over 65 22 22 0 0 learning disability physical disability Additional conditions: The Registered Person may provide the following categories of service only:- Care Home only - Code PC To service users of the following gender :- Either Within the following categories:- Learning Disability - Code LD Physical Disability - Code PD The maximum number of service users who can be accommodated is 22 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 36 A bit about the care home Marston Court is a care home, which provides care for up to twenty-two adults with learning difficulties and/or physical disabilities. The home was registered in 2002. Sixteen people live in the main house and six people live in the newer part of the home, which is the house next door. There are bedrooms on the ground floors and first floors of both parts of the home. There is a lift and stairs for access between the floors in the main house. There are lounges and dining areas for residents to use, and shared bathrooms as well as some en suite bathrooms. The home is in a residential area. There are shops, pubs and park areas within ten minutes walking distance of the home, and there are bus stops nearby. The range of fees charged by the home is £850 to £1150 per week. Care Homes for Adults (18-65 years) Page 5 of 36 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: Adequate (1 star) Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 36 How we did our inspection: This is what the inspector did when they were at the care home We visited the home We visited the home on 29th October and 4th November 2008. There were two managers who helped us during the inspection. One was David Bailey, who has been acting manager on behalf of the provider (owner) over the last nine weeks, while a new manager was employed. The second manager was Ben Morrison, who has been employed to become the registered manager. Our visit to the home lasted a total of eight and a half hours. We were also helped in this inspection by one of our experts by experience. This is someone who uses care services, who came to help us to find out about what the people who live in this home thought about the care they get. We asked people to tell us what they think of the home As part of our inspection, we sent out surveys to the home for people who live there to fill in if they wanted to, so they could tell us what they thought about the home. Five people sent us replies. They all gave us positive answers to our questions, telling us they were mainly happy with the care they received. Care Homes for Adults (18-65 years) Page 7 of 36 We also sent out surveys to staff, and we received three responses from members of staff. They gave us positive responses to our questions, and told us they felt well supported in their work. We asked for information The main way we do our inspections is using a method we call case tracking. This means looking at the care given to people in different ways. The ways this was done are: - talking to the people who live in the home - talking to staff and the manager - watching how people are given support - looking at written records. We also looked at the information that the provider sent to us. We spoke with more than six people who live in the home during our visit. People told us that they generally felt staff were good and helped them. We talked to people to find out what they liked and didn’t like about the home We spoke to four members of staff during our visit to the home, who told us about working in the home and gave us their views. They mainly felt very positive about working in the home, and said they felt well supported. We checked all the standards that the Commission for Social Care Inspection has decided are key standards during this inspection. The information in this report Care Homes for Adults (18-65 years) Page 8 of 36 just about what we checked in this inspection. We have kept details about individual people out of the report, to make sure these things are kept confidential. What the care home does well People who live in the home are assessed before they move in, to find out whether staff can meet their needs. Care plans give information about what each peoples needs are, and how staff can support people. These have some good information in them to make staff more aware about how to meet peoples needs. People enjoy different activities and have a choice about what they would like to do. There are activities within the home, and people are also able to go out into the community to do what they would like, such as shopping, going for walks, going bowling. Good meals are provided for people who live in the home. The cook understands how to cater for peoples dietary needs. Care Homes for Adults (18-65 years) Page 9 of 36 The home has good links with health services, to support people living in the home to maintain their health and wellbeing. We saw that staff treat people who live in the home with respect. There is a complaints procedure in the home, and complaints are looked into quickly. Staff have an understanding of how to keep people safe, and have had training about this. The home is generally clean and tidy, and well maintained. There are plans for more work to improve the home. The provider (owner) makes sure that checks are carried out on people who want to work at the home to ensure they are safe to work with people. Training is given to staff to help them to do their job well. The provider has made sure that even though there have been changes in who manages the home, there has been ongoing management support. The service uses different ways to find out the views of people living in the home, such as having residents meetings. Staff carry out tests and checks of equipment, and work in safe ways, to make sure peoples wellbeing is looked after. Care Homes for Adults (18-65 years) Page 10 of 36 What has got better from the last inspection The manager has made improvements to care plans, to give more information about what peoples needs are. There have been a lot of improvements to the living environment in the home, including re-decoration, new furniture, new flooring and carpets, and improvements to the garden. A deputy manager has been employed for the smaller Marston Lodge, which will help staff to focus more on providing things that people who live in that part of the home need and would like. The acting manager has been organising a lot of training for staff to bring them up to date in their skills. In particular, staff have had training in safeguarding and protecting vulnerable adults, so that they know more about how to keep people safe. Care Homes for Adults (18-65 years) Page 11 of 36 What the care home could do better Members of staff need to be given training in some key areas, such as awareness about learning disabilities, and how to manage challenging behaviour - so that they have more understanding of how to meet peoples needs. All staff must be given information about peoples care needs and how to meet these, so that people who live in the home can be sure that all members of staff understand their needs. Risk assessments must be completed where staff have found something that could affect the safety of people who live in the home. It would be good if people could be given the opportunity to do paid or voluntary work, which they do not have at the moment. It would be good if staff could help each person living in the home to do more activities, so everyone does something each day. There were some mistakes in the recording of medication, so staff must make sure that systems for giving out and recording medication are tight. Care Homes for Adults (18-65 years) Page 12 of 36 Two health professionals involved with the home thought that communication between staff was not always good. This is something that could be improved so that all staff know what they should be doing when supporting each person. Staff need to make sure that toilets are kept clean at all times of the day, and including weekends. It would be better if the manager ensured that each member of staff gets individual support and supervision for their work on a regular basis. The provider must make sure that the manager of the home is registered with us, without delay. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 13 of 36 If you want to speak to the inspector please contact Chris Wroe 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 14 of 36 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 15 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living in this home cannot be fully confident that their needs will be met. Evidence: We looked at the homes Statement of Purpose and Service User Guide - these are documents, which all care services must have. They tell people, who might want to move in, about the home and what they can expect if they live there. We found they had useful information to tell people about what kind of service the home offers. The Service User Guide is written in plain English with pictures, which can help people to understand it. The information needs to be updated to show who the manager of the home is now. We saw from written records that the acting manager has carried out assessments for people who are moving into the home. These help to find out what the care needs of the person were and what support staff could give. The acting manager also got information from family members, social workers and other people who were involved, to make sure that they had all the information they needed to provide a good service. Members of staff do have ongoing training to help them to do their job well. All Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: members of care staff are studying towards National Vocational Qualifications in care. We did find, from speaking to staff and learning about how people live in the home, that there were some gaps in training. Not all staff have had training about how to deal with times where people might become very anxious or agitated. Some members of staff did not know about to help to calm things down, if someones behaviour became challenging. Not all staff have had training about learning disabilities. This has had some effect on the service given to people and how their needs have been met. But the managers have been introducing more training, because they recognise there are some areas that need improvement. Care Homes for Adults (18-65 years) Page 17 of 36 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 . Whilst there is some good care planning in the home, people who live here may be put at risk by lack of full risk assessment and insufficient communication of how to meet peoples needs. Evidence: The home keeps some written records about people who live there. The manager and staff have written care plans, which give good information about residents likes and dislikes, and about what care support they need. We found that care plans have information about peoples religious needs or wishes. The manager is planning to do person-centred care plans, which are more focussed on each individual and involve them more - but these have not been done yet. The manager and care staff keep the care plans up to date as peoples needs change. Families and other professionals, like social workers, are also involved. We also saw risk assessments, which are records to show how people are able to live their life and do things they want to do whilst being kept safe. We found that some risk assessments had not been done. When we told the managers about one risk Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: assessment that needed urgent attention, they put this right immediately. We saw that the manager and care staff in the home are sensitive to the different ways in which residents communicate. We saw that care staff supported people well, and they were able to tell us about peoples different needs and wishes. One person said to us Ive lived in many homes, some were horrible, this one is great... the staff are really good. Another person told us, All the staff are nice and look after us. People told us about different ways that they have choice and control in their daily lives. One healthcare professional who wrote to us told us they felt the home usually supports people to live the life they choose, and that all staff appear caring. They felt that sometimes there could be better communication between staff so that everyone understood what care each person needed. We found this also, in our visit - when we looked at the care of one person, written records showed us that not all staff followed the care plans fully, which had not been helpful to the individual concerned. Care Homes for Adults (18-65 years) Page 19 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live in this home mainly benefit from having a good lifestyle. Evidence: We learnt from care records about the different activities that each person is involved in. We also spoke to people to find out what they enjoy. Some of the things people enjoy include bowling, going out for dinner, going shopping in town, going for walks. Some people do more activities than others, and the managers are trying to improve the opportunities that people have. They have organised for a college co-ordinator to come to the home to talk about courses that people might like to do. One person told us they would like to learn how to use a computer. One healthcare professional who gave us comments about the home said they felt that people who live in the smaller part of the home - Marston Lodge - could benefit from more activities in the day. There is now a deputy manager working in the Lodge who has plans to make improvements in this area. Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: People who live in the home told us they have choices about what they do each day. Some people get involved in looking after their rooms. One person told us they had done the washing up that morning. We found that all residents have family who come to see them or who they meet up with. The manager and care staff are supportive in enabling residents to see relatives when they want. One person told us that there was nowhere private to meet with relatives and friends downstairs. During our visit, we saw the manager meeting in private with relatives, so it would be good if staff made sure everyone who lives in the home knows where they can meet people privately if they want to. The acting manager told us that no one in the home is in a relationship, and it might be good if the home looked at how it might support people to develop confidence and social skills, so that they might choose to develop relationships. The managers told us that none of the people who live in the home are working in a job at the moment or doing voluntary work. This could be something that the home looks at developing. We saw that the manager and staff try to enable each person to live in the home to live with dignity and choice. Staff respond well to the ways in which each person communicates their wishes and needs. We saw meal records, which showed that residents have varied nutritional meals. We spoke with the cook, who showed us that good attention is given to peoples diet. One person who lives in the home told us that they thought the cook was very good, and that they know all about healthy eating. The cook makes sure that meals meet peoples dietary needs and choices and preferences. Care staff help to make sure that each resident has a good diet and there is information in care plans, for people who need their diet to be monitored. When we visited the home there was some fresh fruit available for people to have, although this was kept in a locked kitchen, and was not a very large amount. Care Homes for Adults (18-65 years) Page 21 of 36 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 . Some good attention is paid to personal care and healthcare of people who live in this home, but there are some gaps which could put people at risk. Evidence: People are supported to look after their personal care, in the way that they need and wish it. One persons care plan said that they prefer male care staff - although when we spoke to them they said they were happy with either male or female. One person did say they felt there are not enough male carers in the home to support the men who live there. We found that care plans have detailed information about peoples physical and mental health needs. Everyone who lives in the home can see a GP when they are unwell. People also receive other health care, such as eye tests - although some people told us that they have not seen a dentist for a while. Care staff show good understanding of how health problems and pain might affect the wellbeing of people who live in the home. The managers make sure that they get the right professional help where it might be needed to help people. This was confirmed by a healthcare professional who gave us feedback about the service. They told us they felt that generally good health care support was given to people in the home - although they said communication Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: could sometimes be improved. They did say that the home does have particular strengths: I feel that Marston Court provides very good palliative/end of life care for individuals if required. They have a good relationship with generic services to provide a holistic level of care. People told us they felt able to tell staff if they had any health problems. One occupational therapist, who works with people who live in the home, said that staff are always welcoming and support him to be able to do his work. He said that senior staff are very willing to work with him to find out the best way to support people, but he had a concern that sometimes information does not seem to pass to all staff. The manager agreed this was an issue they wanted to improve. During the inspection they made changes to systems to try and make things better. Another health professional who sent us comments in a survey gave us positive answers about how well the home works with them. They commented only that staff sometimes appear disorganised. We checked how staff look after and give out medication. All members of staff who give out medication have had training about how to give it out safely. Medicines are kept securely locked away. We saw some good systems in place in the main home. Two members of staff worked together to give out medicines and to make sure everything was checked properly. In the smaller Lodge next door, we found there were some problems with medication. Some of the recording of medication was not being done in a way which was safe. It was also unclear what had been prescribed to be taken, and when it should be taken. When we spoke to the managers about this, they immediately contacted the doctor to get clear information. But there are some systems that need improving, to make sure that people are kept safe. Care Homes for Adults (18-65 years) Page 23 of 36 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 . People who live in this home are partly protected from harm by policies and staff awareness. Evidence: We saw that there is a complaints procedure in the home, which is written in plain language, with pictures to help people understand it. The home has received two complaints since we last inspected. One of these was also sent to us, and we asked the provider (home owner) to look into it. There were some issues about how care had been given, which had been found to be not up to a good enough standard. The home has learnt from this, and changes have been made so that these issues do not come up again. People who live in the home tell us they feel safe and well cared for. Since the last inspection, we were also told about a serious incident that had happened in the home, which could have affected the welfare of people living there. We did a smaller random inspection last year - and we found that the manager had learnt from what had happened, and had put in place training for staff to make sure everyone was aware of how to protect people and keep them safe. Care staff have had training to help them to understand how to safeguard people who live in the home and protect them from harm. One member of staff was able to tell us about action they would take if they ever had any worries about the safety of people Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: living in the home. We had a concern during our visit that there was not enough attention given to looking at risks, following an incident which had happened in the home. The managers made sure this was dealt with during the inspection, and risk assessments were prepared. There was also a concern that a situation was made worse because staff did not follow processes properly, and managers must make sure all staff are aware of how to deal with incidents, as laid down in care plans. Not all staff have had training about how to manage difficult situations or behaviour which is challenging, and this should be provided. (We have made requirements for action about these areas in other parts of the report). Care Homes for Adults (18-65 years) Page 25 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live in this home benefit from being in a good, homely and mainly clean and safe environment. Evidence: We looked around the home and found that all the rooms we saw were tidy and well maintained. People who live in the home have their own personal things in their bedrooms, and they told us they are able to choose what colour they would like their rooms to be decorated. The acting manager told us about many improvements that have been made in the home since we last inspected. There is new furniture in the dining room and sofas have been ordered for the lounge areas. The garden has been improved, with new fencing and lawns. There has been new flooring put in the home downstairs and in some bedrooms, and new carpets on upstairs landings. While we visited, we saw that one person was having new flooring put in their bedroom. The managers have plans for continuing refurbishment of the home. There is a laundry area in the home, which we saw was clean and hygienic. Care staff in the home do laundry, and will support people to do their own laundry if they choose. We saw from written records that there is ongoing maintenance in the home, and that Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: equipment is checked regularly, There has been an environmental health inspection recently, and the home must carry out some identified actions, including putting in proper ramps to the back gardens to enable access. There are plans in place to make sure improvements are made within the timescales set by the environmental health department. One person told us that the toilets are not cleaned during the weekends, as there is no cleaner to do the job during this time. During our visit, we found that there were two toilets, which were too dirty to use (when we brought this to the managers attention, staff cleaned them). This may be an issue that staff need to keep a closer check on, so that people have clean toilets to use at all times. Care Homes for Adults (18-65 years) Page 27 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live in this home benefit from having a caring, supportive staff team. Evidence: All staff who are working in the home are studying towards National Vocational Qualifications (NVQ) in care, level 2 or above. Care staff have also done other training courses, such as first aid, health and safety, and moving and handling training (to help make sure that they assist people to move safely). The managers are making sure that people get all the up to date training they need. We have talked about some of the gaps in training earlier in this report. We found that proper records were in place for staff. The manager has carried out checks on staff to make sure they are safe to work with people living in the home, such as checking with the Criminal Records Bureau (CRB). One healthcare professional gave us feedback about the home. The told us that senior staff are knowledgeable. They also said All staff appear to be very caring towards residents. Staff told us they received induction training when they first started working in the home, and that they worked alongside another member of staff. They told us that the staff team is good, and supportive to each other. The managers told us that while they Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: support people as they work, they have not given them formal one to one supervision, and want to bring this in. Staff told us that they found the managers approachable and were able to talk to them about their work. Care Homes for Adults (18-65 years) Page 29 of 36 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 . Due to continuing changes in management, the service cannot guarantee that the home is well managed for people who live there. Evidence: There have been a number of changes of manager since we last inspected the home. Most recently, a senior manager from the organisation has stepped in to act as manager. Now a new manager has been employed who will be registered to manage the home. Whilst changes like this can make things unstable, people who live in the home seem to be satisfied. But they would benefit from good ongoing management, to make sure that staff all work in the same way to meet peoples needs. The acting manager told us that there has been a drop in standards because of lack of good management, but that work was being done to improve things. The provider must make sure that there is a registered manager in the home without more delay. The managers and the provider use different ways to make sure the service continues to run well. The provider visits the home every month and carries out checks to make sure everything is running smoothly. Staff meetings are held, and members of staff told us that they feel able to give their ideas about how the home runs. Resident Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: meetings are also held, involving people who live in the home. We did find when we looked at records of resident meetings, that each month residents were asked where they would like to go on holiday - but that no holidays have been provided. The managers agreed that it would be better to only ask about things that they are able to provide. There are rules about how care staff should do certain jobs, to make sure that residents are kept safe. To help this, staff have had training in areas such as infection control and first aid. Staff told us that they have ready access to protective clothing and gloves to help them when they are carrying out cleaning and care tasks. We saw records, which showed us that tests are carried out to make sure that equipment in the home is safe to use. Care Homes for Adults (18-65 years) Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 36 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 2 18 Training must be provided for staff in key areas linked to the registration category of learning disability, particularly relating to managing challenging behaviour. 31/03/2009 This is to ensure that staff are properly and safely able to meet the needs of people who live in the home. 2 6 12 19/12/2008 All staff must be informed about each persons care needs and given clear guidance about how to meet their needs. This is to ensure that people can be confident their care needs will be understood and met by staff. 3 9 13 Risk assessments must be completed, where a risk to 19/12/2008 Care Homes for Adults (18-65 years) Page 33 of 36 someones health or welfare has been identified. This is to ensure that people are enabled to live their daily lives as they choose, and be kept safe. 4 20 13 The provider must ensure 19/12/2008 that each persons medication is administered and recorded in a way which is safe and complies with how it has been prescribed. This is to ensure that everyone who lives in the home receives the medication they need at the correct frequency and dosage. 5 37 9 The provider must ensure that a manager is registered as fit to manage the home. 31/03/2009 This is to ensure that people can feel more sure of being kept safe by the management of the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 12 It is recommended that the provider looks at whether there would be opportunities to support people who live in the home to take part in paid employment or voluntary work. It is recommended that the provider pays attention to making sure that everyone who lives in the home has the opportunity to be involved in daily activities of their choice, both within and outside the home. Page 34 of 36 2 14 Care Homes for Adults (18-65 years) 3 15 It is recommended that the provider looks at how to support people to develop confidence and social skills, so that they might choose to develop a relationship with someone if they would wish to. Given the feedback from healthcare professionals, it is recommended that the provider looks at communication systems within the home, to make sure that staff are aware of the need to pass on information to other professionals, and aware of how they have been asked to support someone. It is recommended that the provider ensures that good attention is paid to cleanliness and hygiene of toilets throughout the day and on each day of the week. It is recommended that supervision is provided to staff, so that the provider can make sure they understand how to work well in their role. 4 19 5 30 6 36 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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. Care Homes for Adults (18-65 years) Page 36 of 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!