Care Home: Mrs Linda Nicholls

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What the care home does well Each person has their own bedroom. They have their personal things that are important to them in their bedrooms. The people living there go to day centres, lunch clubs and colleges during the day if they want to so they can do the things they want to. The ex by ex said, ` It was really good to see that all the policies that were up on the wall were easy to understand.` The people living there are supported to go on holiday each year if they want to and said they enjoyed this. Staff support the people living there to use healthcare services to help them keep well and meet their health needs. The ex by ex said, `Staff are welcoming and friendly. Staff spoke to me and not my supporter. This is good.` Each person has a care plan that includes pictures making it easier to understand. The person helps write their care plan so that staff know how to support them to meet their needs. Staff have the training they need so they know how to support people to meet their needs and to be safe. What has improved since the last inspection? The Service User Guide has pictures in it so it is easier to understand. Each person who lives there has a copy of it so they know what the home provides. Staff have more information about people`s health needs so they know how to help people to keep well. The people who live there help to write their risk assessments. These were more detailed so that it is clear what the risks are and how staff help people to be as safe as possible. People are helped to be more independent and do some more things for themselves. The complaints procedure includes pictures so making it easier to understand. The ex by ex said that they understood this and would know how to make a complaint about the home. People`s money was looked after better. Records about these were clear so that people know their money is kept safe and they can use it to buy what they want. Questionnaires that ask the people who live there what they think about the home include pictures and symbols so they are easier to understand. What the care home could do better: Staff should continue to help people to be more independent and do more things for themselves. Where the doctor has said that people need to take medication `as required` it should be written down when and why the person should take it. This will make sure the medication is not misused and people`s health needs are met. The Vulnerable Adults policy should state that if staff think that a person is being abused they must tell Social Services so that things can be done to keep people safe. Staff should make sure that the conservatory is not too hot or too cold so that people are comfortable when sitting in there. There should be at least six staff meetings a year to help staff to know about any changes to the needs of the people living there. Staff should have at least six formal, recorded supervision sessions each year so they are supported to know how to help the people living there. The fire alarm should be tested weekly to make sure it is working and people would know if there was a fire. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Mrs Linda Nicholls 573 Chester Road Castle Bromwich Birmingham West Midlands B36 0JU     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: Sarah Bennett     Date: 2 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Mrs Linda Nicholls 573 Chester Road Castle Bromwich Birmingham West Midlands B36 0JU 01212407786 01212407786 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Linda Nicholls care home 5 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 5 573 Chester Road is registered as a Care Home for Younger Adults, providing care and support for no more than five people with Learning Disabilities. Mrs Nicholls is the owner of the service and is also registered as the Manager. The home is a detached 5 bedroom family house on a main road on the border of the Castle Bromwich and Smiths Wood areas of Birmingham and Solihull. Each person has their own bedroom. People receive care and support within a domestic living environment. Local shops and amenities are a short distance away, and a local day centre is within walking distance. The main shopping area of Chelmsley Wood is a short drive away. Fees vary and are dependent on the needs of individuals. The statement of purpose stated that the fees range from 360 to 869 pounds per week Items not covered by the fees include activities, chiropody, clothing, daytrips, hair care, holidays and transport (other than in the case of medical appointments). For up to date fee information the public are advised to contact the home. Care Homes for Adults (18-65 years) Page 4 of 32 Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 quality rating for this home is two stars. This means that the people living there experience good quality outcomes. This was the homes key inspection for the year 2008 to 2009. They did not know we were going to visit. The focus of our inspections is on the outcomes for people who live in the home and their views of the service provided. We look at how the home meets the Regulations, the minimum standards of practice and what they need to do to make the service better. The manager completed the Annual Quality Assurance Assessment (AQAA) about the home and how they think the home is running. They sent this to us before our visit. Care Homes for Adults (18-65 years) Page 6 of 32 We looked at some parts of the building. We looked at records about two of the people living there and three staff. We looked at health and safety records. We talked to the people living there, the staff on duty and the manager. Some people were unable to communicate their views verbally so we also observed what was going on during the day. An expert by experience visited as part of the inspection with their supporter. This is a person who has experience of using services. They talked to the people living there and gave their views about the home. Their views are included in this report where they are referred to as the ex by ex. Two people who live there were case tracked. This means we look at their experiences of living in the care home by meeting or observing them, talking about their care with staff and looking at their records. Tracking peoples care helps us understand the experience of people who use the service. What the care home does well: What has improved since the last inspection? The Service User Guide has pictures in it so it is easier to understand. Each person who lives there has a copy of it so they know what the home provides. Staff have more information about peoples health needs so they know how to help people to keep well. The people who live there help to write their risk assessments. These were more detailed so that it is clear what the risks are and how staff help people to be as safe as possible. People are helped to be more independent and do some more things for themselves. The complaints procedure includes pictures so making it easier to understand. The ex by ex said that they understood this and would know how to make a complaint about the home. Peoples money was looked after better. Records about these were clear so that people know their money is kept safe and they can use it to buy what they want. Questionnaires that ask the people who live there what they think about the home include pictures and symbols so they are easier to understand. Care Homes for Adults (18-65 years) Page 8 of 32 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 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users have the information they need so they can make a choice as to whether or not they want to live there. Evidence: The service users guide was produced using pictures making it easier to understand. It included the information that people would need about the home so they can make a choice as to whether or not they want to live there. Each person who lives at the home has a copy of the service users guide so they are aware of the terms and conditions of their stay. They had signed this to show that they had these explained to them and agreed with them. The ex by ex said, There was lots of easy to understand information around the home. This was really good. People who make an enquiry about living at the home are also given a brochure. This provides the information people would need in picture and easy read format making it Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: easier to understand. The statement of purpose of the home was updated in December 2008. This included the information that people need about the home and had pictures so making it easier to understand. The people living there have all lived there for a few years. There were no vacancies and no people had been admitted since our last visit. Therefore, the standard relating to the assessment of peoples needs before they are admitted was not assessed at this visit. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have the information they need so they know how to support the people living there to meet their needs, make choices about their lives and ensure their safety and well being. Evidence: The records of two of the people living there were looked at. These included an individual care plan. These showed staff how to support the individual to meet their needs and achieve their goals. Care plans included pictures and symbols so making them easier to understand. Records showed that people had been involved in their care plans. They were written in a way that centred on the individual and how they want to be supported not what staff think. Care plans showed how staff are to support individuals to make choices and decisions about their lives. Because of peoples needs this was often limited to two choices of things so as not to confuse them, which would mean that they were unable to make Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: the choice. Care plans about this included how the individual communicates and how they understand what is said to them to ensure that they are enabled to make choices. People told the ex by ex that staff buy their clothes for them. Staff said that the people living there go out with staff to buy their clothes. Records sampled showed that people go out to do their personal shopping with staff. People also told the ex by ex that staff had chosen the colour of their bedrooms but they had chosen their personal things in their bedrooms. It was not clear from records who had chosen the decoration of the home. The ex by ex said, I think that the things that need to improve were more choices about how the home is run. It is clear that since our last visit a lot of work has been done to involve people in making choices and this could be developed further as people develop their skills in making choices and decisions about their lives. One person has an advocate who visits him when he asks him to or when there is something he needs help in making a decision about. Regular meetings are held with the people living there. Minutes of these meetings sampled showed that people are encouraged to make choices about the menus, the activities they do, where they go on holiday and what they do to celebrate festivals such as Christmas. Each morning people are given a choice as to what they want to eat for their evening meal. Since our last visit individual risk assessments had improved. These were now produced using symbols making them easier to understand. They showed staff how to support the individual to take risks whilst ensuring the risk to their safety and well being were minimised as much as possible. They stated who is going to help the person to minimise the risk and why they are taking it. For example one persons risk assessment was about shaving. Although there are risks to this it is important to the persons well being that they are supported to shave each day. Another was about using transport, although there were risks to this it was important to the person to increase their independence and do the activities they like doing. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living there are generally supported to experience a meaningful lifestyle so ensuring their well being. People have a healthy diet and choose their meals. Evidence: Each person has an activity board with pictures so they know what they are doing each day. People go to day centres or clubs during the day if they want to. Records showed that from day centres some people attend college courses. In the evenings people attend clubs if they want to. One person had decided that they do not want to attend clubs in the evenings as they are out at clubs or centres every day so they prefer to relax. People use Ring and Ride transport to go to clubs and social activities. Staff said that Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: a vehicle is available that people can use but it helps people to be more independent if they use other transport. Staff said that all the people living there have a bus pass so they can use public transport if they want to. People who want to go to church. They do not all go to the same church but attend different ones depending on their individual beliefs and cultural background. Care plans stated what hobbies and interests the person has and how staff are to support them to follow these. Records showed that people are supported to do the things they enjoy. One person has a season ticket for a local football club and attends all home matches with a member of staff from the day centre he goes to. Records sampled showed that when his team are playing on TV he is able to watch it as Sky TV is provided in the home. The ex by ex said, One man was going to the football match that weekend, this was good as this man was really excited. People told the ex by ex that they do not do many in house activities apart from watching TV or DVDs. The manager said that they had recently bought some games and were looking for other things for people to do in the home. There was an exercise bike in the conservatory. Records sampled showed that people used this sometimes. Staff said and minutes of meetings showed that if people want to they can go on holiday with staff either for a week or two short breaks. One person has decided that he would prefer to go on holiday with his family and this is respected. When other people go on holiday staff support him to do the things he wants to do at home. Four people went away with staff for a long weekend in November to Weston for a Turkey and Tinsel weekend. People said they enjoyed this. Records showed and people said that they are able to keep in contact with their family and friends. A cordless phone is provided so that people can make phone calls in their bedroom if they want to so they can have privacy. Staff said that each year they arrange a big Christmas party, hiring a local hall and people invite their friends from the day centres and clubs that they go to as well as their relatives if they want to. Since our last visit people have been more supported to develop their skills in independence and some of this is being recorded, although recently few records had been made about this. It was observed and people said that they can help to do things. Staff were observed to do the cooking and make drinks for people. People told the ex by ex that staff do the shopping and cook the meals. The ex by ex said, People need to be supported to do more things for themselves. The manager said that shopping is done on the Internet and delivered to the home as it would be difficult for people to do the supermarket shopping. People have a choice of what is bought as Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: they are shown pictures of foods that are available. Supporting individuals to do things for themselves should continue so that people can be more independent. The ex by ex said There was a picture menu on the wall in the kitchen that is changed every day. This is good especially for the people that have limited communication. One man said that he gets to choose between two different meals, staff confirmed this. Records sampled showed and it was observed that people do have a choice of what they eat. Culturally appropriate meals are cooked if this is what people want so to meet their cultural needs. Food records sampled showed that people ate the foods they liked. They showed that people were encouraged to eat healthy meals that included fruit and vegetables. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that individuals personal care and health needs are met so ensuring their well being. Evidence: Care plans sampled showed how staff are to support the person to meet their personal care and health needs. Care plans showed how peoples personal care needs were to be met to meet their cultural needs including creams and oils to be used for their skin and hair care. The people living there were dressed in individual styles and attention had been given to their personal care so ensuring their well being. Staff said that a mobile barber visits the home about every six weeks. People had individual hair styles. Records sampled included an individual Health Action Plan. This is a personal plan about what health care services the individual needs to use and what support they need to meet their health needs. Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: Records sampled showed that health professionals are involved in peoples care where this is needed. Records showed that staff followed the advice of health professionals to help peoples health needs to be met. People have regular check ups with the dentist and optician to help to keep them well. Staff had worked with the Speech and Language Therapist to help people to communicate their needs. Health action plans sampled stated how the person communicates if they are unwell or in pain. It stated what staff are to do if the person communicates this so to ensure their well being. Records showed that as individuals are being helped to communicate and staff understand what this means people are less frustrated and do not behave in a way that may challenge. Records showed that where people had been unwell staff had supported them to go to the GP so that referrals could be made to specialists to help them get any treatment they need. Staff support people to attend healthcare appointments. Records showed that this support involved reassuring the individual to ensure their well being and minimise their distress. Records included what medication the person takes. Staff have training in how to administer medication. Only staff who have received this training are able to give medication to the people living there. Since our last visit there is a medication trolley that is secured to the wall. This ensures that medication is stored safely and people are not at risk of taking medication they are not prescribed. Each person has information about the medication they take and any allergies they may have in a small plastic bottle. This is called Message in a bottle and is used so that if a person needs to go to hospital in an emergency this can go with them so this information can be communicated to the hospital staff. This helps to ensure that people get the treatment they need. Medication records sampled indicated that medication had been given as prescribed. The medication looked at was stored appropriately ensuring that people get the medication they need. The pharmacist that supplies the medication visits the home every three months to audit the medication. At their last visit earlier in the month they stated that the medication systems in the home were excellent. They had made some recommendations that staff had ensured were met. Some people are prescribed as required (PRN) medication. It was written on their Medication Administration Record how much of the medication could be given in one Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: day. It did not state when the medication should be given to the individual. This could result in staff making decisions based on little information about when they should give it to the person. There should be a protocol in place for each PRN medication prescribed to a person. This will ensure that it is not misused and peoples health needs are met. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that the views of the people living there can be listened to so helping to ensure they are safeguarded from abuse and harm. Evidence: The complaints procedure was produced using symbols so making it easier to understand. The ex by ex said that they understood the procedure and would know how to make a complaint about the home. We have not received any complaints about this home since our last visit and no complaints had been received by the home. Training records sampled showed and staff said that they had received training in how to safeguard the people living there from abuse. The Vulnerable Adults policy stated how staff are to safeguard people from abuse. It stated that if they suspected abuse they should contact us but it did not state that they should contact Social Services. This is very important as Social Services take the lead in any instances of abuse being reported to ensure that vulnerable adults are safeguarded. The manager said that as the people who live there do not have an allocated social worker this was difficult. It is important to ensure that staff know they can contact the duty social worker if abuse was suspected. Training records sampled showed that some staff had received training in the Mental Capacity Act. This Act came into force in April 2007. It requires an assessment to be Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: completed if there is any doubt that a person lacks the mental capacity to make a decision about their welfare. If it is assessed that they lack the capacity an Independent Mental Capacity Advocate (IMCA) can be appointed to help them with this. The manager said that they have DVDs about this that they are going to discuss with staff in their supervision. This should help to ensure that all staff know about this and how this legislation may affect the people living there. The manager and senior had attended a conference that morning on the Deprivation of Liberty Safeguards. This legislation is linked to the Mental Capacity Act. It requires that staff ensure that people who lack capacity are not being cared for in a way that deprives them of their liberty and the care given is in their best interests. The manager said that all staff will receive this training so they know how this could affect the people living there. The finance records of the people case tracked were looked at. The City Council is the appointee for both of these people. Each person had their own bank account that their personal allowance is paid into. The manager supports the individual to withdraw money from their bank account when they need it. Records showed that people are given money when they want it and sign to say they have received it. Each person has a lockable space in their bedroom to store their valuables in. There is also a safe in the home to keep peoples money safe. Bank statements showed that people are also supported to save their money so they have the money to buy the things they want. Receipts are kept of all expenditure and these cross referenced with the records indicating that their money is spent appropriately. Records showed that people spend their money on personal items not on things that should be provided by the home as part of the fees they pay. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely, comfortable and clean home that meets their individual needs. Evidence: The home was well decorated and maintained. Staff said that new flooring was fitted in the kitchen last year. There was a lot of space in the kitchen. The cupboards and worktops were well looked after. This helps to keep a good standard of hygiene in there. Each person has their own bedroom. The ex by ex saw one persons bedroom. They said, This was a big room with a shower and sink in it. He had lots of personal items that he had chosen in there. Three of the people that live there have a shower in the en suite in their bedroom. The other two people share a bathroom that has a bath with a shower in it. Staff said that another person uses the bath as he prefers this to a shower. There were signs around the home that had symbols on them so that people found these easier to understand. For example there was one on the door that led to the garden that stated in icy or wet weather the decking may be slippery. This helped people to keep safe. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: There is a large conservatory that is used as a dining room and one end of it is used as an office. There were two radiators and a heater in there. At the beginning of the day it was cool in there but it warmed up during the day. Staff said that sometimes during the winter they move the table into the kitchen so that people do not have to sit in a cold room to eat. The ex by ex said, I did see a heater in the conservatory, which was on. Two people said it is really cold in there. People ate their tea in the conservatory and did not complain that it was cold. There were blinds on the windows and ceiling to keep the room cooler in the summer months. Staff said that in the summer the conservatory can get very hot so an air conditioning unit has been provided so that people can sit in there comfortably. The home was clean and there were no offensive odours making it pleasant for people to live in. The AQAA stated that since our last visit they now use laundry bags as it is not possible to move the washing machine from the kitchen. This helps to reduce the risk of cross infection. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staffing, their recruitment and development ensure that the people living there are supported to meet their needs and are protected from harm. Evidence: The AQAA stated that all staff complete National Vocational Qualification(NVQ) in Care at Level 2 ensuring that they have the skills and knowledge to meet the needs of the people living there. The senior staff have achieved NVQ level 3 and the manager and deputy manager have achieved NVQ level 4. Since our last visit more staff have been recruited to work there so there are more staff on duty to support the people living there. The manager said and rotas showed that when staff are off sick or there are vacancies permanent staff work extra hours. They do not use agency staff to cover so that the people living there are supported by staff who know them well. Minutes of staff meetings showed that these were held monthly until December 2008. There had not been any meetings since. The manager said that they did not have one in January as they had staffing difficulties and staff were covering extra shifts to ensure continuity to the people living there. Records showed that another meeting was Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: booked at the beginning of March. There should be at least six staff meetings a year to ensure that staff know about any changes to the needs of the people living there and are kept updated with best practice. The ex by ex said, The staff were welcoming and friendly. They spoke to me and not my supporter. This was good. Staff interact with the people that live there well. The records of three staff employed to work there were looked at. One of these staff had been recruited but had not yet started working there. This was because the manager had not yet received a satisfactory Criminal Records Bureau (CRB) check to ensure that the person was suitable to work with the people living there. The other records included evidence of a CRB check and satisfactory references about the person. The manager had ensured that any gaps in the persons employment had been explored to ensure they are suitable to work there. Staff said that they enjoy working at the home and are supported to do the training they need so they know how to support the people living there. Training records showed that staff have received or are booked to do the training they need so they can support the people living there and keep them safe from harm. Records showed that when staff started working at the home they received an induction so they know how to support people to meet their needs. The manager said that staff have formal supervsion sessions every six weeks so they are supported in their role. Records sampled did not show that staff had these so frequently. Staff should have at least six formal, recorded supervision sessions each year so they are supported to know how to support the people living there. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements ensure that the people living there benefit from a well run home so ensuring their safety and well being. Evidence: The manager is also the registered owner and has been running the home for 8 years. She has the experience and knowledge to run the home to benefit the people living there. There is also a deptuy manager and senior who have the skills, knowledge and experience to assist in running the home. The manager said that a local service user organisation visits the home every three months to do an audit. This gives their views on how they think the home is run and how things could be improved for the people who live there. Staff ask the people living there for their views about the home. They use a sheet that is produced using pictures that says How do I feel. People can comment about their bedroom, the other people living there and the things they do by ticking either a sad Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: or smiley face. People can use these everyday if they want to so that staff know their views on the home and what can be done to improve it. There is also a service user questionnaire that asks for their views. This is produced using pictures so making it easier to understand. Staff said that they ask for peoples views at their monthly meetings using this questionnaire. Records sampled included an individual fire risk assessment so that staff would know what the risks are for that person if there was a fire and how they can keep them as safe as possible. The fire procedure is produced using symbols and pictures so making it easier to understand, helping all people know what to do if there is a fire. Fire records showed that staff test the fire alarm and emergency lighting evey month to make sure it is working. It is recommended that the fire alarm is tested weekly. Fire drills used to be held weekly but this was now monthly as one person found this to be disruptive. There should be a fire drill at least every six months so this could be less frequent. The fire alarm could be tested when people are out so to avoid disruption. Records showed that all equipment in the home is serviced and tested regularly to ensure that it is safe to use. Staff test the fridge and freezer temperatures every day to make sure that food is stored safely so to reduce risks of food poisoning. Records showed that the temperatures are within the recommended limits for safe food storage. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 16 Staff should continue to encourage people to develop their skills in independence and record this to ensure individuals self esteem and well being. There should be a protocol in place for each PRN (as required) medication prescribed to a person. This will ensure that it is not misused and peoples health needs are met. The Vulnerable Adults policy should state that if staff suspect that a person is being abused they must contact Social Services to safeguard people from abuse. Staff should ensure that the conservatory is at the right temperature so that people do not eat their meals in a room that is too hot or too cold, which may affect their well being. There should be at least six staff meetings a year to ensure that staff know about any changes to the needs of the people living there and are kept updated with best practice. Staff should have at least six formal, recorded supervision sessions each year so they are supported to know how to support the people living there. Page 30 of 32 2 20 3 23 4 24 5 33 6 36 Care Homes for Adults (18-65 years) 7 42 The fire alarm should be tested weekly to make sure it is working and would alert people if there was a fire. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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