Care Home: Matthew Residential Care Home

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What the care home does well The home has encouraged residents to develop their skills and abilities and to socialise more with the other residents. We have previously met one of the residents when they were living in another care home. Although the resident has limited verbal communication skills these have greatly improved since the previous placement and the resident was asking us questions during the inspection. Another resident that was admitted to the home about a year ago spent most of her time in her room during her previous placement wearing a dressing gown. With support and encouragement from the staff team she now comes down for her meals fully dressed and has started to socialise with other residents. A health care professional in contact with the home said that the service meets the needs of the residents and respects their privacy and dignity. They commented that there is a good staff team working closely together and able to support the residents. Residents told us that they liked the accommodation and its location. They told us about the activities that they took part in and that they liked going out and enjoying themselves. They had opportunities to follow their interests. Staff told us that they were supported by the manager who was approachable and who listened to them. There were regular training opportunities. What has improved since the last inspection? Some redecoration and refurbishment has taken place. The open plan kitchen and dining area has been redecorated and the flooring has been replaced. The hallway, staff room and one of the residents` bedrooms has been redecorated. Nine statutory requirements were identified during the previous key inspection and these have now been complied with. What the care home could do better: Three statutory requirements have been identified during this inspection. They were discussed during the inspection. There is a need to repair or replace some furniture and fittings in a bedroom, where these have been damaged by a resident, and the manager said that this would be done when the room was vacant. Means of alerting staff when a resident is moving around upstairs without restricting her movement are being explored to promote her safety. Before putting measures into place they need to be risk assessed and agreed with the care manager from the funding authority. The manager is waiting for a servicing certificate for the gas appliances and supply to the home and a copy of this needs to be forwarded to the CSCI. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Matthew Residential Care Home 1 Milton Avenue Kingsbury London NW9 0EW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Schofield     Date: 2 2 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Matthew Residential Care Home 1 Milton Avenue Kingsbury London NW9 0EW 02089078435 F/P02089078435 matthewres@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Matthew Residential Care Limited Name of registered manager (if applicable) Catherine Lewis Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is :4 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Physical disability - Code PD Date of last inspection Brief description of the care home Matthews Residential Care Ltd is registered to provide accommodation and care support for up to 4 residents at 1 Milton Ave. The home is a semi-detached property located in the residential area of Kingsbury, Northwest London. It has four single bedrooms for residents, including one ensuite. It also has a communal lounge, kitchen, dining room, designated smoking area, one bathroom and toilet, one shower room and toilet, a utility and laundry room. The home has a well-maintained garden. It is close Care Homes for Adults (18-65 years) Page 4 of 31 care home 4 Over 65 0 0 4 4 Brief description of the care home to the town centres of Harrow and Wembley with a variety of local shops, public transportation services, health and social care facilities and services, plus leisure and recreational facilities. There is off street parking for 1 or 2 cars at the front of the house and there is parking available in the street outside the home. At the time of the inspection there were 4 residents living in the home. Please contact the manager of the home for information regarding the service provided and the fees charged. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspection consisted of 2 visits to the care home. The first visit took place on the 18th December 2008. It started at 8.15am and finished at 12.05pm. As the manager was not on duty we returned to the care home on the 22nd December at 1.05pm and finished at 4pm. During the inspection we spoke with the manager, members of staff on duty and with residents. We examined records, carried out a site visit and checked compliance with the statutory requirements identified during the previous key inspection. Prior to the inspection we sent out survey forms and at the time of writing the report we have received one completed form from a health care professional in contact with the care home. Care Homes for Adults (18-65 years) Page 6 of 31 Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 Care Homes for Adults (18-65 years) Page 8 of 31 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An assessment of the needs of the resident, prior to admission to the care home, enables the home to determine whether a service tailored to the individual needs of the resident can be provided. A visit to the home gives the prospective resident an opportunity to sample life in the home and to decide whether the service provided is suitable. Evidence: One person has been admitted to Milton Avenue, for a respite care placement, since the last key inspection. We examined their case file and noted that an assessment had been completed by a representative of the care home, prior to the resident being admitted to the care home. It was recorded that the prospective resident had contributed information towards the assessment and when we spoke with the resident they were able to express their opinions and views on a range of subjects. The manager said that the resident had been supported by their family during the period prior to the residents admission to the care home. There was also evidence that the placing authority had supplied information to the home about the prospective resident Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: when the referral was made. The manager has drawn up a respite care management plan in which objectives and needs are identified and an action plan to meet the needs is included. The management plan has then been developed into a plan of care. The respite care placement has continued for longer than had been initially expected although at the time of writing this report the resident has left Milton Avenue. There was evidence that the resident had visited the care home, with relatives, prior to their admission for a respite care placement. A copy of a letter sent to the placing authority was on the residents case file. It confirmed that the outcome of the pre admission visit was positive. The manager said that during this visit the resident had been able to view the room that was available, to see the communal areas in the care home, to become familiar with the location of the care home and the facilities in the immediate neighbourhood, to meet the staff team and to meet the residents currently living in the care home. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Reviewing the care plan and the placement on a regular basis ensures that changes in the needs of residents are identified and can be addressed. The residents right to exercise choice in their daily lives is respected. Staff support residents to take responsible risks so that residents can enjoy an independent lifestyle. Keeping risk assessments under review assures residents that changes in needs are identified and met. Evidence: We examined 2 case files and each file contained an assessment of need, which has formed the basis for the development of the care plan. Each element of the care plan is reviewed on a monthly basis and a brief statement is recorded. In addition, there was evidence that a meeting had taken place in 2008, attended by a representative of the funding authority, to review the care plan and placement. The care home also carries out 6 month placement reviews. Relatives are invited to attend review meetings. A risk assessment is in place to support a resident likely to be aggressive, Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: where needed. A system of key working is in place in the care home and some residents were able to name their key worker. Members of staff were able to describe the duties that accompanied the role. While talking with residents and while observing interactions between residents and members of staff on duty we noted that residents are encouraged to exercise their right of choice in day to day living. One resident described their daily routine and it was clear that this included what the resident wished to do. The weekly programme of activities had been been drawn up with the involvement of the resident and was based upon the residents likes and interests. Another resident also described their life style and commented that they did things that they enjoyed. All of the residents need help in managing money and while the resident having respite care is supported by their family the care home supports the remaining 3 residents. Records were available and were up to date and complete with a record of the balance after each transaction. Receipts are obtained when money is spent and these are numbered, for easy reference. Passbooks demonstrated that savings accounts were in place, where appropriate. Case files contained risk assessments. There was a general risk assessment and then risk assessments tailored to the individual needs of the resident e.g. mobility within the care home or using the stair lift. Risk assessments included risk management strategies. Some risk assessments were recent and there was evidence that risk assessments in place for some time had been reviewed on a regular basis. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Taking part in activities, developing new skills and using community resources gives residents the opportunity to enjoy an interesting and stimulating lifestyle. By maintaining contact with their family and friends the residents need for company and fellowship is met. Residents are encouraged to become more independent by making decisions and by having their wishes respected. Menus respect the religious, cultural and dietary needs of residents. Evidence: We discussed day care provision for each of the residents. The resident on a respite care placement has a weekly activities programme, which includes opportunities for exercise and outings. One of the other residents does not wish to attend a day centre and does not really enjoy going out although she is encouraged to do so for exercise purposes. A third resident attends college on 2 days per week and has other activities Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: arranged, both inside and outside the home, on other days. The fourth resident no longer attends a day centre although she likes to go out, with a member of staff to accompany her. The manager and residents gave examples of the facilities and services in the community that residents used. These included the shops, the church, the gym, the cinema, parks, restaurants, hairdressers and pubs. Residents use taxis; dial a ride or public transport to travel. One of the residents said that he liked travelling on a bus and that the manager had driven him in her car to his appointment at the hospital. A discussion took place with the manager regarding an annual holiday for residents. Two of the residents had gone on a holiday to Brighton in 2008. One of the two residents told us that they had enjoyed staying in the hotel and going out in the evenings. Another resident was hoping to go on holiday with their family in 2009. Residents confirmed that outings had taken place and the pantomime was given as an example. One of the residents said that she enjoyed watching the soaps and usually watched television in the lounge rather than on the portable television in her room. Two residents said that they enjoyed listening to music in their rooms. One of the residents told us that they had attended a Christmas party on the day before the inspection and the manager said that residents are able to attend the Zoom club, Apple disco and dinner and dances, if they wished. When residents are at home there are puzzles and card games available or they can sit and chat. Although visitors to the home are made welcome most residents do not have many visits from family members. When visits do take place the resident can entertain their relatives in their room, if the resident wishes. Relatives are invited to attend review meetings, birthday celebrations etc. Distance can be a reason for irregular visits and the manager said that she was hoping to take one resident to Devon for a holiday so that the resident could visit a family member while there. One resident does have regular visits from family members and also visits the family, including staying overnight. During the inspection residents moved around the house as they wished and we spoke with one of the residents in her room. The resident said that she was able to use her room when she wanted to and that she liked to spend time there. She had chosen the colour scheme in her room, as had the resident admitted to the home prior to the previous key inspection. We heard one resident decide where they would like to go after choosing to go out shopping. Residents confirmed that they were able to choose when they got in the morning and when they went to bed. They are able to choose what clothes to wear and they have the choice of using the bath or a shower. Residents are encouraged to take part in the daily household tasks and a resident told Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: us that he sometimes made his own breakfast, makes a cup of tea in the morning and sometimes helps to keep his room clean and to do the laundry. One of the residents also enjoys helping with cooking. Residents confirmed that they had choice in what they ate and that meals were taken outside the home, from time to time, The home has a menu and a varied and wholesome diet is offered to residents. Residents confirmed that an alternative is given if they do not like or want the main meal being prepared. Residents said that they liked the food served in the home and gave examples of their favourite meals. The manager said that as 3 of the residents do not have any teeth food preparation is designed to meet their needs. There is a large dining table in the open plan dining and kitchen area and a small dining table in the open plan dining and lounge area giving residents a choice of where they dine. Meal times are flexible and residents were observed coming down for breakfast when they were ready. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive prompting with personal care in a manner, which respects their privacy and dignity. Residents health care needs are met through access to health care services in the community. Residents general health and well being is promoted by staff that assist the resident to take prescribed medication in accordance with the instructions of the residents GP. Evidence: Residents receive assistance with personal care tasks although they are encouraged to do as much as they can for themselves. Female residents receive assistance with personal care tasks from a female member of staff. Routines are based on the residents needs and wishes and vary from day to day e.g. residents being able to have a lie in at the weekends. Residents are encouraged to choose what clothes to wear each day and although one of the residents is unable to speak she is able to make her choice of clothing known by pushing away clothes that she does not wish to wear. At the last inspection the manager gave an example of how the home is supporting a resident to maintain their personal dignity by being appropriately dressed in communal areas. We noted during this inspection that the particular resident was Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: fully dressed when coming down to breakfast and that the support and encouragement from the staff team had enabled the resident to achieve this goal. When examining residents case files we saw that when necessary specialist support and advice is obtained e.g. an assessment by the physiotherapist. Information on the health care needs and how these are met are contained on the residents case files. Residents confirmed access to routine health screening and support for out patient appointments at hospitals. There was evidence of regular health checks e.g. by the optician, the dentist and the chiropodist. Residents were able to have a flu jab, if they wished. One of the residents had been referred to the physiotherapist and a copy of the report of the assessment was kept on the case file. Case files contained a health action plan. The home has a medication policy in place and has a written protocol for the use of PRN medication. None of the residents self medicate. The home has a contract with their pharmacist that includes regular audits by the pharmacist and there was a record of one taking place in December 2008. Records were inspected and were up to date and complete. The home uses blister packs and these had been appropriately opened prior to the inspection, according to the time of day and the day of the week on which the inspection took place. The storage of medication was safe and secure and staff have received refresher medication training from the pharmacist in November 2008. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A complaints procedure is in place to protect the interests of residents. Knowledge of the adult protection policy and provision of protection of vulnerable adults training for staff contribute towards the safety of residents. Evidence: A complaints procedure is in place in the home and a copy of this is pinned on the notice board in the office. It includes each stage of the process, with timescales attached. There is a user friendly complaints procedure for residents to use. The manager said that no complaints have been recorded since the last inspection. No complaints have been made directly to the Commission for Social Care Inspection about the home. Residents said that they would tell some one if there was something that they were unhappy with and we noted that there was a good rapport between residents and members of staff. A protection of vulnerable adults (pova) procedure is in place in the home. A copy of the multi agency protection of vulnerable adults guidelines was present on one of the residents case files examined and a copy of the guidelines leaflet was pinned on the notice board in the office. The manager said that all members of staff have undertaken protection of vulnerable adults training and training in supporting residents with challenging behaviour. Members of staff on duty during the inspection confirmed this and they were able to demonstrate an understanding of their duties and Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: responsibilities, in the event of an incident occurring or a disclosure being made. The manager has kept her pova training up to date by attending a refresher session. No allegations or incidents of abuse have been recorded since the last key inspection. A resident said that they preferred living in this care home compared to a previous placement because they had not felt safe during the previous placement. The policies and procedures manual contains procedures in respect of handling residents monies and supporting residents that display aggressive behaviour. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers pleasant communal and private facilities, providing residents a comfortable and homely environment in which to relax. Residents benefit from living in a home where standards of cleanliness are good. Evidence: During the inspection a tour of the building took place. Although it was December the level of heating in the care home was sufficient to provide a comfortable environment for the residents. The building is in a good state of repair and is comfortably furnished and decorated and provides residents with a homely environment. A Christmas tree and decorations were in the lounge and residents said that they enjoyed looking at these. Each resident has their own single bedroom with a wash hand basin and one of the bedrooms has an ensuite bath and toilet. Residents said that they were happy with their rooms. We saw that one bedroom had sustained damage, caused by its occupant, and we discussed this with the manager. Items have been replaced and these have then been damaged. The resident is leaving the care home soon and the manager plans to carry out a refurbishment when the room is empty. The manager is concerned about the safety of a resident occupying a bedroom on the first floor when the resident chooses to spend time upstairs and is exploring options for being alerted to the resident moving around upstairs without restricting the residents freedom of Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: movement. One bedroom is lacking any personal items reflecting the residents personality but the resident occupying this room has a history of throwing things out of the window. There is level access to the front of the home but at the back of the house there is a step down from the dining area through doors to the patio. There is also a step down from the kitchen door to the patio. A resident said that the garden is in use in the summer and that there is patio furniture so that they are able to sit out on the patio. There is stair lift in the home to help residents that may have difficulty climbing up or down the stairs but the space left between the banister and the tracking for the stair lift, for people using the stairs independently, is restricted. During the tour of the building it was noted that all areas were clean and tidy and there were no offensive odours. The utility room leads off the kitchen but although laundry is carried through the kitchen the manager said that the home does not service incontinent laundry. Laundry facilities are sufficient for the number of residents and include a washing machine, without a sluicing cycle, and a tumble drier. There is a wash hand basin in the utility room. The home has an infection control procedure and the 3 members of staff that gave their comments during the inspection said that they have undertaken infection control training. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. NVQ training enhances the general skills and knowledge of carers and contributes towards the quality of service that the residents receive. The rota demonstrated that there were sufficient members of staff on duty to support the residents and to meet their needs. Recruitment practices protect the welfare and safety of residents. Training records demonstrate opportunities for staff development that ensure residents benefit from a service based on current best practice and guidance. Evidence: There are 8 names of carers on the rota and the manager confirmed that 7 of the carers have completed their NVQ level 2 or level 3 training and that the remaining member of staff is a student nurse who is half way through her nursing training. The 3 members of staff that gave comments during the inspection confirmed that 2 of them had completed their level 3 training and the third person was currently undertaking level 3 training. Residents described members of staff as helpful and one resident referred to a member of staff that was on duty as a lovely lady. It was noted that all members of staff on duty interacted well with residents and were good listeners and communicators. When we spoke with members of staff they were knowledgeable about the individual needs and preferences of the residents. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: A discussion took place with the manager regarding staffing levels. During the early and the late shifts there are either 2 or 3 people on duty and this depends on what the residents are doing that day and what support is needed. At night there is one member of staff on waking night duties and 1 member of staff sleeping on the premises, but on call in the event of an emergency. These were the staffing levels seen on the day of the inspection and are sufficient to meet the needs of the current residents. Three staff files were examined. We noted that they contained evidence that an enhanced CRB disclosure had been obtained. They also contained proof of identity i.e. passport details and 2 satisfactory references. The right to reside and to work in the UK had been established. The application forms contained a health declaration and a declaration regarding cautions and convictions, which had been completed and signed by the applicant. Staff files also contained a copy of the terms of employment. A training programme was available for inspection. Staff files contained a training profile and record and one file contained a personal learning plan for the period November 2007 to October 2008. Members of staff on duty during the inspection gave us details of the training that they had undertaken. Each person had completed training in epilepsy, protection of vulnerable adults, medication, health and safety and in safe working practice topics. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Undertaking periodic training to update her skills and knowledge helps the manager to organise a service that is based on an understanding of the needs of the residents. The level of quality assurance monitoring reflects the size of the home and residents are assured that their views are listened to and taken into account. Regular servicing and checking of equipment used in the home ensures that items are in working order and safe to use. Evidence: A copy of the managers NVQ level 4 for Registered Managers (Adult services) certificate has been seen during a previous key inspection. She informed us that she is currently studying for an NVQ level 4 in Care. The manager has previously said that she qualified as a mental health nurse. Since the last key inspection the manager has attended refresher training in safe working practice topics. Both residents and staff have a good rapport with the manager and both have said that she is approachable and that if they had a problem they would talk with her. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: This is a small residential care home that is registered to accommodate up to 4 residents. One of the 4 residents is unable to give any verbal feedback. Members of staff study the facial expressions and body language of residents in the absence of verbal feedback or when the resident has limited verbal communication skills to understand the wishes of the resident. Two residents can readily give verbal feedback and appear to be comfortable in giving their opinions. Another resident can give limited feedback and we have noted that this residents communication skills have increased over time, while living in this care home. Although the manager has developed a quality assurance survey form (with illustrations and pictures to assist completion) for residents to use she prefers to spend time with residents, on an individual basis, to monitor their wellbeing and one resident likes to sit in the office when the manager is working there. The manager said that when the home has sent quality assurance survey forms to funding authorities these have not been returned. We asked the manager whether any ideas or suggestions made by residents have been implemented and the manager said that a resident had suggested changing the curtains in the lounge to match the ones in the ground floor bedroom so that curtains at the front of the house were the same. This was done. Certificates for servicing, checking or inspecting equipment and systems in the home were shown. These included valid certificates for the portable electrical appliances, fire extinguishers, fire precautionary system and the electrical installation. The manager said that although the Landlords Gas Safety inspection had been carried out in December, prior to the inspection, she was still waiting to receive the certificate. This was forwarded to the CSCI after the inspection. Records for the weekly testing of the fire alarm system were up to date. The fire risk assessment had been reviewed in May 2008. Staff received training in safe working practice topics i.e. fire safety, infection control, first aid, manual handling and food hygiene. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 16 When the bedroom that has been damaged by the occupant is vacant the room is refurbished. This will enable the next occupant to enjoy pleasant surroundings. 12/02/2009 2 24 13 Means of being alerted to the resident moving around upstairs without restricting the residents freedom of movement need to be in place but subject to a risk assessment and with the agreement of the residents care manager. This will enable the resident to move safely throughout the care home. 12/02/2009 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 Care Homes for Adults (18-65 years) Page 29 of 31 1 35 That a personal learning plan is drawn up for each member of staff and is updated on an annual basis. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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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