Care Home: Monpekson Care Ltd

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What the care home does well Residents told us that they liked their new home.. They said that they choose want they want. They enjoyed going on outings and taking part in activities. They had been on a Mediterranean cruise for their holiday in 2008. Residents and members of staff got on well and residents told us that the members of staff were nice and kind. Members of staff told us that in the home it is warm and friendly. They also said that it feels relaxed and calm, the house is clean, residents are supported and residents have good holidays. What has improved since the last inspection? People moved to this home when the old home closed. It is a bungalow and so no one needs to worry if they can not climb stairs. Inside it is very comfortable and homely. What the care home could do better: If you use a wheelchair it is easy to get in at the front of the bungalow because there is a ramp. At the back there is a step down onto the patio. A wooden ramp is needed so that a wheelchair can get into the garden easily. There is water on the floor of the laundry room. The wall needs repairing to keep the room dry. A plan for training the staff so that they can give you the support that you need is nearly ready. When it is finished it needs to be in the home for everyone to look at. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Monpekson Care Ltd 2 Headstone Lane Harrow Middlesex HA2 6HG two star good service The quality rating for this care home is: 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: 1 9 0 1 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. 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 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Monpekson Care Ltd 2 Headstone Lane Harrow Middlesex HA2 6HG 02084240205 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Monpekson Care Limited Name of registered manager (if applicable) Mrs Monica Pryme Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 4 0 care home 4 learning disability Additional conditions: 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 The maximum number of service users who can be accommodated is: 4 Date of last inspection A bit about the care home This is a care home where four people can live. It opened in September 2008 and people that lived in Kenton Lodge moved here. There are 3 people living here at the moment. It is a bungalow. There are 4 bedrooms, bathroom and toilet and a kitchen. There is a dining room and from the lounge you can walk into a garden where you can sit. There is room at the front for visitors to park their cars. The manager will provide information about the home and how much it costs to live here. The cost depends on what support you need. 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 How we did our inspection: This is what the inspector did when they were at the care home We visited the home in January. We called early in the morning. We came back later in the day after residents came home from their day centres. We met everyone that was in the home that day and talked with them. Thank you. We looked at records. We looked at the home. We saw the meal when it was ready at tea time. We sent survey forms to residents, members of staff and people that visit the home. 3 residents and 3 members of staff have sent these back to us. Thank you. What the care home does well Residents told us that they liked their new home.. They said that they choose want they want. They enjoyed going on outings and taking part in activities. They had been on a Mediterranean cruise for their holiday in 2008. Residents and members of staff got on well and residents told us that the members of staff were nice and kind. Members of staff told us that in the home it is warm and friendly. They also said that it feels relaxed and calm, the house is clean, residents are supported and residents have good holidays. What has got better from the last inspection What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Julie Schofield RCT 4th floor Caledonia House 223 Pentonville Road London N1 9NG 020 7239 0330 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 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . A comprehensive assessment of the needs of the resident, prior to admission to the home for respite care, enables the home to determine whether a service tailored to the individual needs of the resident can be provided. Involvement of residents in the setting up of a new service, when they will transfer from the previous service, assures residents that their interests will be safeguarded. Evidence: This care home was newly registered in September 2008. The service had previously operated from other premises in Harrow and the residents and staff team transferred, on the closure of Kenton Lodge, to the bungalow in Headstone Lane. Since September one person has been admitted to the home for an overnight respite care placement. We looked at the records kept for this resident. Their case file included referral details and a history of the prospective resident. The local authority had supplied a copy of the FACE overview assessment and of the psychologists report. The manager had carried out a risk assessment for the provision of care. We discussed the transfer of residents from Kenton Lodge to Headstone Lane with both the manager and with one of the residents. The resident confirmed that she had visited the bungalow and chosen the room that she now had. Her choice had been based on the size of the room and what needed to be accommodated and on the outlook of the room, which was at the front of the bungalow. When we met relatives during the last key inspection of Kenton Lodge they told us that they had visited the new premises and were impressed with the property. Residents had transferred to the bungalow after a period of consultation with the funding authority. When asked on the survey form whether they had been asked if they wanted to move into this home the residents all ticked yes. They also agreed that they had enough information about the Evidence: home before they moved in so that they could decide if it was the right place for them. The manager said that residents had been able to make several visits to the bungalow before moving in and that they were able to bring some of their things with them to leave in their new rooms, prior to the moving day. 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 care plans on a regular basis ensures that changes in the needs of residents are identified and can be addressed. Residents have the opportunity to exercise choice in their daily lives. Responsible risk taking contributes towards the resident leading an independent lifestyle. Evidence: We looked at the case file for each of the 3 residents. Files contained a care plan, which was reviewed and updated on a regular basis. Relatives had been invited to attend the review meetings. The review format was user friendly and included photographs of the resident. The preferences of the resident and their routines were described. A person centred approach meeting took place on a regular basis and relatives were invited to attend. Each of the 3 files contained behaviour guidance. The files contained a health action plan and guidelines for members of staff when they were supporting the resident. One file contained a copy of the local authoritys FACS Eligibility and Care Plan which had been sent to the home following the review meeting. Each of the residents has a review meeting convened by the local authority planned for January 2009 and one of the residents told us that their meeting was taking place on the day after the inspection. When asked on the survey form members of staff said that they were always given up to date information about the needs of the people they supported. We discussed opportunities for residents to make decisions in their lives with the manager. She gave examples of decisions being made in respect of meals, activities, socialising and what to wear each day. When asked on the survey form whether they made decisions about what to do each day 2 residents ticked always and 1 resident Evidence: ticked sometimes. They all agreed that they could do what they wanted during the day, during the evening and at the weekend. Each of the residents needs support in managing their finances and records were examined. The manager is the appointee for 2 of the residents. Records were complete and up to date, with receipts for items of expenditure. Records of savings demonstrated that residents financial interests were respected. The case files included a recent risk assessment action plan, tailored to the individual needs of the resident. Identified risks included vulnerability, using the kitchen, choking, mobilising around the home and financial management. Each risk assessment included risk management strategies. One of the residents has epilepsy and there was a risk assessment in the event of a seizure included in the case file. 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 . Residents attending day care services are provided with an opportunity to develop their social skills. Taking part in activities and using community resources gives residents the opportunity to enjoy an interesting and stimulating lifestyle. With staff support, residents are encouraged to maintain contact with their families and to enjoy fulfilling relationships. Residents are encouraged to make decisions and their wishes are respected. A varied and wholesome diet is offered to residents so that their nutritional needs are met. Evidence: We discussed the day care programmes of the residents. One of the residents attends a day centre on 2 days per week and attends a different centre on another 2 days per week. A second resident also attends a day centre on 4 days per week. Each of these residents has a day at home during the week but a different day to the other resident. The third resident does not wish to attend a day centre and a list of activities has been drawn up for her, taking place both inside and outside the home. She told us that she works in a charity shop for 2 days a week and that she enjoyed this. During the inspection we heard 1 of the residents singing hymns. The manager said that the residents attend church. Residents make use of resources and facilities in the community including shopping centres, restaurants, cinemas, church, parks, museums and pubs etc. They use public transport facilities and taxis to go to a variety of community facilities. A resident said that they had enjoyed going to the shops and to the cinema at the weekend. They told Evidence: us that they had been to see a film that had recently been released and was in the news. Rotas are arranged so that staff are available to escort residents. Each of the 3 residents currently living in the home had a holiday last autumn. They enjoyed a Mediterranean cruise. One of the residents told us that the cruise was very good and that they took plenty of clothes with them to wear. We saw that 2 of the residents were enjoying sitting and watching a music channel on the television. The manager said that residents attend discos and clubs and this was confirmed by one of the residents. Outings have included a day trip to Southend and a weekend in Weymouth. Residents went to see a pantomime recently and go out to a restaurant on a monthly basis. A resident confirmed that family and friend relationships are supported and encouraged and we have met relatives visiting the home on the previous key inspection. The parents of one of the residents confirmed that the resident goes to stay with them for several days at a time. We noted from the case files that relatives are invited to care plan reviews and attend when they are able. In between visits the home keeps in touch with relatives by telephone. We discussed the opportunities for residents to exercise choice in day to day living and the manager gave the example of moving into the bungalow. Residents and their relatives came to see the property and residents chose their bedrooms, helped choose colour schemes and new furniture for the home. At Christmas time residents chose the menu for Christmas day from leaflets provided by the large shops and supermarkets. We saw during the inspection that residents are encouraged to take part in the daily routines in the home and with the chores. With support they are encouraged to keep their room tidy and to help with their laundry. One of the residents told us that she enjoys helping with the chores and during the inspection she helped prepare the vegetables for the evening meal. One of the residents said that she did not have any particular food preferences although she liked having a takeaway and said that she could choose from the take away menu. She said that the meals served in the care home were good and that the food was tasty. We saw the serving of the evening meal and residents were having either cottage pie or stewed meat with roasted sweet potatoes, carrots, cauliflower and spinach, garnished with garlic and onions. One of the residents has a soft diet and 2 of the residents are following a healthy eating plan to reduce their weight. One resident has IBS and there is information about what foods the resident should eat or avoid on the residents case file. A resident confirmed that if they do not like or do not want the meal being prepared an alternative will be offered. During the inspection we heard the member of staff about to prepare the evening meal check with residents whether they wanted cottage pie or stewed meat or something else. The home has a 4 week rolling menu cycle and there is a user friendly menu for residents to check. Menus were varied and wholesome. Food records are kept. 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 assistance with personal care in a manner, which respects their privacy. Arrangements are in place to ensure that residents healthcare needs are met. The general well being of residents is promoted by assistance or support from staff in taking medication, as prescribed. Evidence: We saw that each of the residents was clean and tidy and smartly dressed and discussed the provision of personal care with the manager. Residents are supported with their personal care at a level that meets their individual needs. The manger said that while 1 resident only needs reminding to carry out certain tasks the other 2 residents need prompting and some direct assistance. The staff team includes male and female members. Female residents are always assisted with personal care by a female member of staff. We saw during the inspection that assistance with personal care is offered discreetly. When residents were leaving to go to a day centre a member of staff was giving helpful advice about being appropriately dressed for the weather. At the weekend when residents do not have to be ready at a specific time for the transport to take them to a day centre the routines are more relaxed and residents can have a lie in. Case files contained evidence of access to health care services in the community and there was a record of appointments with the chiropodist, optician and dentist. Appointments at the cardiovascular clinic and the neurology clinic had also taken place and there was confirmation on file that residents are supported by either the manager or by a member of staff when they attend appointments. Residents have been offered the opportunity to have a flu jab but their decision whether or not to accept one of these is respected. One of the residents is epileptic and epilepsy training was included in the training matrix for April 2008 to 2009. When the residents epilepsy was Evidence: monitored at the hospital the psychiatrist recorded that the home has put strategies in place to minimise any risks associated with seizures and that the risk management plan had been discussed. When necessary, referrals are made to a health care specialist and there was a record on file of a referral made to the dietician, on behalf of a resident. Each residents file contained a health action plan. We discussed first aid training for carers and recommended that the training includes instructions to members of staff in the event of a resident choking. The home has a medication policy and procedure. One resident self administers their medication and has a lockable storage facility in their room. There is a risk assessment for self administering medication on the residents case file. A weekly dosette system for administering medication to the other residents is in use in the home and the pharmacist fills these. We have been told previously that the dosette boxes are checked before using. We looked at the storage of medication and saw that medication was stored in a locked cabinet. We noted that the compartments had been emptied from the dosette box according to the day of the week and the time of day that the inspection took place. Within the cabinet storage was orderly. We looked at the records and saw that residents had an agreement with the home for members of staff to assist them with medication. Nomad sheets were correctly initialed and were complete and up to date. A record was kept of medication administered on a PRN basis, with a balance of tablets remaining. The manager confirmed that the pharmacist carries out regular medication audits in the home and copies of the reports were available. The most recent audit had taken place in November 2008 and the report confirmed that there were no concerns about the administration of medication in the home. Medication training was included in the training matrix for April 2008 to 2009. 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 rights of the residents. An adult protection procedure and training in protection of vulnerable adults procedures help to promote and protect the welfare and safety of residents. Evidence: There is a complaints policy and procedure in place, which includes details of the stages involved and the timescales allocated to each stage. This is recorded in pictorial and written format and is displayed in the home. We discussed how residents might complain or make their feelings known. One of the residents that is able to use the telephone has the telephone numbers of the joint proprietors and will speak to one of them, if the resident has any concerns. When asked on the survey form whether they knew what to do if a resident, relative, advocate or friend had concerns about the home the members of staff ticked yes and 2 members of staff commented that they would inform the manager. When residents were asked on the survey form whether they knew how to make a complaint they ticked yes. During the inspection a resident named the people that they would speak to if they had concerns about anything. The manager said that since the last key inspection no complaints have been recorded. The CSCI has not received any complaints about the service. The manager told us that since the last inspection no allegations or incidents of abuse have been recorded. A procedure is in place in the home and this includes the action to be taken in response to an allegation or suspicion of abuse. The policy documents that the local authority must be informed of all allegations of abuse and that the Commission for Social Care Inspection must be informed without delay. There is a copy of the inter agency guidelines in the event of abuse that staff can refer to and use, if necessary. We saw from the training records that refresher training in respect of protection of vulnerable adults procedures took place in May 2008. Members of staff confirmed that they had received training in the protection of vulnerable adults procedures during the last key inspection in July 2008 and were clear about their role and duties in the event of a disclosure being made. They were able to link the procedure in the home with whistle blowing. The home also has a policy on physical Evidence: intervention and the staff team has had training from HLDT in respect of calming strategies or breakaway techniques. During the inspection a resident named the people that they would talk to if they were unhappy about something. When asked on the survey form whether they knew what to do if a resident, relative, advocate or friend had concerns about the home the members of staff ticked yes and one member of staff linked this to the whistle blowing procedure. 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 . Residents live in a home, which is comfortably furnished and provides a pleasing environment in which they can relax and enjoy themselves. Good standards of cleanliness provide residents with hygienic surroundings. Evidence: We carried out a site visit during the inspection. The residential care home is a bungalow with 4 bedrooms. It was redecorated and refurbished to a high standard, prior to registration in September 2008. Communal areas are bright and airy and the decor is homely. A good sized lounge and a large dining room, which is a conservatory, gives residents a choice of areas in which to relax. Bedrooms reflect the personality of the individual resident and 2 of the bedrooms have en suite facilities. One of the residents said that her room was large and very nice. She said that she thought that the bungalow was a better property than the previous premises and that she liked the fact that there were shops nearby. Within the property there is level access for residents, with the office and staff bathroom in the loft space. At the front of the house there is a ramp to the doorway providing level access. Access to the garden is via patio doors from the lounge with a step over the threshold and down onto the patio. There is a large patio area and a well managed garden that is safely enclosed. All the areas that we saw were clean and tidy and the home was free of any offensive odours. When asked on the survey form whether the home was always fresh and clean the residents ticked yes. We saw from the training records that training in respect of infection control procedures had taken place in September 2008 and the home has an infection control procedure in place. Laundry facilities are contained in a building in the garden and consist of a washing machine and a separate tumble drier. These are for domestic use and the manager confirmed that the home does not service soiled or wet linen. We noted that water was seeping under one of the walls of the laundry building. The inspection took place after a period of heavy rain. The manager said that this had been seen and repairs would be carried out. Evidence: 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 . A programme of NVQ training for members of staff assures residents that care practices are based on an understanding of the residents needs. Staffing levels in the home assure residents that there are sufficient members of staff on duty each day to support the residents and to meet their needs. Recruitment practices promote the welfare of residents. Residents benefit from support given by members of staff that are skilled and trained. Evidence: We reviewed the support given to NVQ training with the manager and with members of staff. Of the 5 carers on duty in the care home, 1 person is a qualified RGN, one member of staff is currently undertaking NVQ level 3 training and 3 members of staff have completed their NVQ level 2 training. Therefore the target of a minimum of 50 of carers achieving an NVQ level 2 or 3 qualification, or its equivalent, has been exceeded. One of the carers on duty told us that the manager was encouraging her to undertake NVQ level 4 training. When asked on the survey form whether staff treated them well and whether the carers listened and acted on what the residents said the residents ticked yes. We discussed staffing levels with the manager. She informed us that at present, as there are 3 residents, there is one member of staff on duty during the day. The early shift is from 8am to 4pm and the late shift is from 4pm until 10pm. At night a member of staff sleeps in on the premises but is on call in the event of a resident needing assistance. The manager said that the member of staff sleeping in is always a female carer. In addition the manager is on duty during the day from Monday to Friday. At other times there is a manager from the company that is on call. The manager gave an example of when she recently was contacted at the weekend and came to the home to give support. A member of staff on duty during the inspection confirmed that the on call management rota was known to staff and that support was given, as required. In the evening or at weekends, if residents need support with activities outside the home Evidence: an additional member of staff may be on duty. When asked on the survey form whether there are enough staff to meet the individual needs of all the people that use the service 1 member of staff ticked always and 2 members of staff ticked usually. We looked at the personnel files for 3 members of staff. They each contained an application form. The form included a section where any convictions or cautions had to be declared. The file also contained a declaration of health. There was a statement of terms and conditions of employment. Each file contained 2 satisfactory references, proof of identity in the form of passport details and an enhanced CRB disclosure and pova first check. We saw the training records and noted that they contained individual training profiles. Attendance certificates were kept, where possible. There was a training matrix for April 2008 to 2009, where courses were listed with the date on which they had been held. It is recommended that for each course a list of participants is kept. It is also recommended that for certain mandatory training, which needs to be refreshed at recognised intervals, a table is drawn up to easily identify when a member of staff requires this training. Training courses on the matrix included training in safe working practice topics, health and safety, medication, epilepsy, challenging behaviour and the Mental Capacity Act. A manager in the company is in the process of drawing up a training plan for the home. When asked on the survey form whether their induction covered everything that they needed to know to do the job when they started 2 members of staff ticked very well and 1 member of staff ticked mostly. They agreed that since then the training given is relevant to their role, helps them to understand and meet the individual needs of residents and keeps them up to date with new ways of working. One member of staff commented that they have supervision with their manager. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The manager demonstrates her competence and commitment to a quality service by continuing to develop her understanding, skills and knowledge through further training. Systems are in place to gather feedback on the quality of the service provided to enable the service to develop in ways that meet the changing needs of the residents. Training in safe working practice topics enables members of staff to safeguard the health, safety and welfare of the residents. Regular servicing and checking of equipment used in the home ensures that items are in working order and safe to use. Evidence: The registered manager has many years experience of working with residents who have a learning disability. She completed an NVQ level 4 training course in management in 2005 and also has nursing qualifications. She has managed the home for several years, and is a joint provider for several care homes. Recent training has included training in respect of Health and Safety and the Mental Capacity Act. We noted when observing residents interacting with the manager that they found her approachable and supportive, and that she knew the people living in the home very well. When asked on the survey form whether their manager meets with them to give them support and to discuss how they are working the members of staff ticked regularly. The care home has a quality assurance policy and procedure, which includes philosophy of care monitoring and a record of standard targets for the service, including staff training. We spoke with the manager about quality assurance systems that are in place in the home. Feedback is sought from residents during 1 to 1 meetings with their key workers and during residents meetings, which are held on a Evidence: monthly basis. The minutes of these were available for inspection. Informally, and on a day to day basis, the reactions of residents are observed and monitored to gauge satisfaction with the service provided. Review meetings give relatives and representatives of the funding authority the opportunity to provide feedback and to request changes. We have seen previously that when family members were present in the home there was a good relationship between the family members and the members of staff on duty and that opinions and suggestions were discussed in a helpful manner. The home also sends out an annual quality assurance questionnaire to family members and to stakeholders. The manager said, I am open. The home has Investors in People accreditation and evidence of this was on display. We discussed health and safety within the care home. As part of the registration process the Fire Officer was invited to comment on standards in the home and a letter dated the 21/8/08 confirmed that measures in place were deemed to comply with the regulations. We also saw a number of valid documents including a Landlords Gas Safety Record, an electrical installation certificate and a certificate for the testing of the portable electrical appliances. There was a general risk assessment of the property and a detailed fire risk assessment, which had been completed in 2008. There was evidence that that smoke detectors and emergency lighting were checked on a monthly basis and that fire drills were held on a monthly basis. There was a current employers liability insurance cover certificate. The Environmental Health Officer visited the home on the 26th January and awarded the home 4 stars on the doors. Training records demonstrated refresher training sessions in fire safety awareness, first aid, infection control, food hygiene and manual handling taking place in September 2008 and January 2009. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 24 23 When drawing up a maintenance plan for the building the need for level access to the home through the patio doors is included. 01/03/2009 This will enable easy access into the garden if a person has problems with mobility. 2 30 23 When drawing up a maintenance plan for the home the need to make the laundry building waterproof is included. 01/03/2009 This will enable the floor of the building to remain dry and to alleviate the risk of cupboards being damaged by standing water. 3 35 18 That when the training plan for the home is completed a copy of this is kept on site. 01/04/2009 To enable the plan to be used for reference by the manager and by members of staff and for it to be used when planning developments in the service. 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 6 That as the care home has recently relocated to new premises a review of all documents on the case files takes place and the address of the care home is changed, where appropriate. That the content of the first aid training course for carers is reviewed to ensure that it contains guidelines for carers in the event of a resident choking. That the need for ceiling blinds in the conservatory is assessed during the summer and is implemented if the temperature in the conservatory on a sunny day is uncomfortable. That a wooden, portable ramp is considered for use with enabling access through the patio doors into the garden as the current residents have good mobility. That when a training course takes place a list of all participants is kept. That there is a system in place for readily identifying when a member of staff requires refresher training in respect of mandatory topics. 2 19 3 24 4 24 5 6 35 35 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. 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