Care Home: Occombe House

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Occombe House Preston Down Road Marldon Paignton Devon TQ3 1RN One star adequate 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: Michelle Finniear Date: 1 4 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Occombe House Preston Down Road Marldon Paignton Devon TQ3 1RN 01803556605 01803556605 kathy.lee2@nhs-net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Torbay Care Trust Name of registered manager (if applicable) Vacancy Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 12 0 care home 12 learning disability Additional conditions: Service Users with Learning Disability who may have additional Physical Disability or Sensory Impairment. Date of last inspection A bit about the care home Occombe House is a large old home in Paignton. Up to 12 people with a learning disability live there . Eight people live there all the time, others come and stay for a short time in a different part of the home. There is a lot of garden space for people to use and the home shares a mini bus with the day centre next door so people can go out. The home is a long walk from most shops and services, but there is a farm shop nearby. The current weekly fee at the home is over nine hundred pounds a week. 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: 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 For this inspection we sent out some questionnaires to people who live and work at the home. We went to the home three times, and had a meal with the people who live and work there; We looked round the home and garden; We talked to the staff and the people who live at the home about what they like to do; we looked at the records the home keeps; we looked at care plans and medication to see how people were being looked after; we also spent time with the people in charge of the home to see how they run it. What the care home does well Some people at Occombe house have lived there for a long time. The Staff we saw were looking after people well and understood what the people living at the home wanted and were telling them. Peoples rooms had lots of their own things in them. People could go to their rooms when they wanted to be on their own. People were helped to see their families and friends. People have a choice of what they want to eat. People at the home can do things they enjoy. What has got better from the last inspection What the care home could do better The home needs to: Make sure that peoples care plans show what support they need and why. People living at the home should help write how they want things to be done for them. New plans need to be written so that they are up to date. Plans should also show what help people need to keep well. Medication must be given to people and recorded safely. Staff need up to date training in how to look after people with Epilepsy. Some staff need training on how to stop people from being treated badly. Managers need to write down how to keep people safe in the building and jobs people do. Managers need to make sure the home is kept nicely decorated and in good condition. People using other parts of the building should not come through the home. People who come and work at the home must be checked out to make sure they are suitable. Staff should spend time with the manager to make sure they are all working in the same way to support people and have had the right training. When new staff start working at the home they must be shown and told what they need to know. The home needs to have a manager so people know who is in charge. The home needs to look at what works well and what can be improved at the home. One persons room has a high window which should be lowered so that people sitting down can look out. 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 Michelle Finniear Unit D1, Linhay Business Park Ashburton TQ13 7UP 013 6465 1800 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 . Peoples care needs are fully assessed before a decision is made as to whether the home is the right place for them. Evidence: Occombe House has a main permanent stay home and a smaller respite short stay unit also in the building but separated internally. This inspection focussed on the main permanent stay unit. The last inspection focussed on the respite unit. No new people have been admitted to the main unit for many years. Information about the home and the services provided are available in a picture supported text format, which should make it easier for people with communication difficulties to read. The home told us that they were planning to update this information and make it available in different ways so that for example people who might be better able to understand the information in a DVD format will be able to have this provided for them. It is also recommended that the information be kept in peoples rooms if they wish rather than in a file in the office, and be developed individually to meet their needs wherever possible. An assessment is undertaken whenever people are admitted to the home, and people would as a part of the homes admission policy be able to come for trial visits and meet the people already living there. For the respite unit a review is undertaken for each admission. Assessments help to make sure that the home is the right place for the person being admitted; that they can have their needs met and they will fit in with people already living at the home. Evidence: Questionnaires received from people living at the home indicated that they were asked if they wanted to move into the home, and received enough information before making a decision to move in. One person wrote yes my mum talked to me about it and explain things to me I went to visit I come house with Mum and I had two tea visits there without her before I stayed the night. A relative wrote my son uses the home for respite only. It is the nearest respite to our home and I have found it good for my son to have some social contact with other adults. Another wrote as his sister I received all the information and visited Occombe before I made a final decision Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Staff work hard to ensure they support people in the way they wish, however current staffing difficulties and a lack of completed person centred planning may mean that peoples needs may not always be being met consistently. Evidence: Care plans for three people were seen in detail and other plans and records were looked at on the site visit. Time was also spent talking to people living at the home and observing the interactions with staff. Care plans outline the support needed by each person and how that support is to be given. Some evidence was seen of people being involved in the drawing up of the plans and of involvement in their reviews. This helps to ensure that people have a say in the way their care is delivered. Plans were not however particularly goal focussed or based on peoples strengths. The homes staff could show some developmental work being undertaken in person centred plans for each person which will better reflect peoples views on their chosen lifestyles and preferences. These files will need to be developed in a variety of formats , not just pictures and text, and should be kept by the person themselves wherever possible. It is understood that staff are to recieve further training in person centred planning in the near future to enable them to carry out this process. Discussion was also held on using external advocates and support. Daily recording is undertaken in several documents so that a record is kept of all the activities each person does in the day both in the home and at the day services attached to the home. These diaries showed that people had opportunities to take part in a variety of activities during the day, and also recorded choices made. Evidence: Peoples care plans are being reviewed every six months in general. Some of the information in the plans seen was no longer accurate however or could not be seen being followed through during the day. For example one persons care plan indicated that when speaking to the person the communication should always start with their name and this was not always the case in the interactions seen. One person had clear guidelines for managing behaviour that was challenging or risky for other people at the home and evidence was seen during the visit of this being used well in a positive fashion to support the person whiclt at the same time protecting others from any injury. People were also seen to be using the space at the home as they wished, for example some people chose to eat their evening meal in the homes hallway rather than joining everyone else in the dining room. Questionnaires completed by relatives/service users indicated they were happy with the care given. None however mentioned they were involved with care plans or reviews, and one person wrote that staff make all the decisions for their relatives care. Staff who completed questionnaires indicated that people were very well looked after, but also raised concerns over the high use of bank or agency staff who did not know the people they were looking after therefore placing additional burden on the permanent staff. The home have taken steps to manage this by having short pen pictures of peoples needs and how they are to be met available. People with severe communication difficulties may find it hard to make people who do not know them well understand their wishes or needs. Information on communication in some files was limited and discussions with staff indicated that sometimes with people at the home who did not communicate verbally the communication they did have would be very subtle and difficult to interpret other than by people who knew them very well. Staff were seen managing one person who was distressed during the evening and this was handled very well, with great concern for their wellbeing and privacy. This is to be commended. Personal risk assessments were available in peoples files, but it is understood that these are being revised with a new more comprehensive format. Risk assessments help judgements to be made about how risks can be minimised whilst still offering opportunities for new experiences and opportunities to develop new skills. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People have opportunities for work and leaiure experiences and these will be enhanced with person centred planning and more comprehensive communication assessments and plans. Evidence: During two of the three visits made for this inspection time was spent with people living at the home, and a meal was shared with them. People were seen first thing in the morning before they went off to day centres, and on their return. Time was also spent looking at their care plans, and individual diaries which detail activities followed through the day in both day-care centres and in the home. This communication helps staff at the home to understand what people have done during the day, and to tailor the evening activity accordingly. For example on this visit one person had been swimming and had a health-care appointment during the day, which meant they were tired during the evening and did not wish to participate in other activities. On their return to the unit people chose to use the space of the home in a variety of ways. Some people went to their rooms, others chose to spend time in the homes hallway, dining room or lounge watching television. Some sought out staff for contact. One person was quite distressed and spent time having one-to-one contact with a member of staff in the homes garden. This contact was sensitively managed and enabled the person to calm down in a supportive atmosphere. Everybody at the home is out during the day unless they are unwell during the week. Evidence: People attend the adjoining day centre, or other specialist work place centres or day centres locally. Evidence could also be seen of participation within the local community, with people using local services such as hairdressers. The day prior to the inspection people living at the home had all been taken to the beach to take advantage of fine weather. The home have told us that they share a vehicle with the day centre, but public transport is used by those who can access it. They have also said that people living at the home access local festivals such as a recent cultural diversity festival, and a number of people living at the home also attended a conference for people with profound and multiple disabilities. Questionnaires completed by people living at the home or their relatives indicated they follow a variety of activities, some chosen and supported by staff. Staff questionnaires indicated there is a high use of agency staff at the home, and this may mean that on occasions people do not achieve their first choice activity or staff would not have the communication skills to understand each individual. The development of improved communication plans and person centred planning should better be able to support people leading full lives in the way that they choose. Meals for the day centre as well as the home are prepared daily. Discussions with the cook indicated a good variety of meals were served and people had a choice of home cooked ham with kacket potatoes or vegetable lasagne on the day of the first visit. The evening meal was sausages and hash browns with beans and yogurt for dessert. People were seen being offerred a choice of meals and these were eaten communally with staff. Support with eating was given discreetly. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Care plans do not fully record the healthcare needs of people and staff need updated training in the management of certain healthcare needs to ensure thay can care for people in safety. Medication practices need to ensure that all prescribed medication is signed for and given in accordance with the prescribers instructions. Evidence: People living at Occombe House need support to maintain and promote their health. This includes the administration of medication, support with moving and handling and for the management of medical conditions. During the site visits it was clear that this was offered sensitively and with respect for peoples privacy and wishes. As an example one person who became distressed was offered individual support in a way that appeared to be a shared social experience rather than a way of managing challenging behaviour. This was commendable. Some evidence was heard of people using the home having written information available with them to detail how they wished to be moved and handled, and equipment is available to support peoples moving and handling needs, although some areas of the home have narrow corridors which make it difficult to manoeuvre equipment. Equipment is also available for pressure relief and specialist seating to ensure people can be made comfortable. Discussion with staff indicated they are clear about peoples individual communication, however this is not documented fully in communication plans in peoples files. Staff training has not been maintained for all staff in certain aspects of managing medical conditions, in particular epilepsy and artificial feeding systems. The care plans available included some information on medical conditions or mental health issues that Evidence: people may have been diagnosed with, but not enough information on how that condition directly impacted on the individual and affected their day to day life. The medication systems in use were seen, and found to be generally satisfactory, and the home is due a pharmacy inspection in the near future. Staff could be seen to be signing for medication administered to people, but do not sign for creams or prescribed shampoos, which means that there is no audit trail to show if they have been used or not. Also some prescriptions where there was a variable dosage (i.e. one or two tablets ) were not recording the amount actually given. In one instance the prescription on the administration chart did not reflect the medication being given. The chart stated the medication should be given If absolutely necessary however the medication was being given every night without a protocol being seen. Other evidence in the persons file showed that this was known to medical staff, so the prescription needed to be updated to reflect the way the medication was being used to avoid any risk or errors. The care plans and files seen did not contain full assessments of peoples health in accessible formats, but it is understood that these are being implemented as a part of the care plan review being undertaken. These Health Action plans should help support people to be more involved in their healthcare and ensure full accessto NHS healthcare facilities. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Arrangements are in place to protect people from abuse, however additional training is required for staff in this area. The home has a complaints policy which may benefit from being made available in additional formats. Evidence: Occombe house has a complaints procedure which is available in a picture format. This is on display on a noticeboard in the home, and copies are kept in peoples individual care plans. However it is acknowledged that for most of the people at the home this would not be of much support in helping them make a complaint. Staff spoken to indicated that complaints procedures have been discussed with individuals living at the home, and Staff spoken to were clear about how they would know if somebody was unhappy, or how they would show distress. However this is not fully recorded in peoples care plans. Staff spoken to were clear about the actions they would take to support someone expressing dissatisfaction. Some relatives who completed questionnaires indicated that their relatives living at the home would not be able to make a formal complaint. Not all staff have received training in adult protection, however it is understood that this is planned, as is training on the Mental Capacity Act. Adult protection training would include training on what constituted abuse and abusive practice and what to do if it is suspected. This helps to ensure that people living at the home are protected. No complaints had been received regarding the home since the last inspection. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The accommodation and grounds are spacious, but some areas are tired and in need of refurbishment. Other uses of the building should not compromise the privacy of the people who live there. Risk assessments for the premises need to be updated to ensure the building and gounds are safe for the peope living there. Evidence: Occombe House is a large period property, set in attractive grounds with rural views. Attached to the main building is the Fairwinds day centre, which several people from Occombe House attend during the day. Accommodation on the lower ground floor is set aside for a short term respite unit, with four bedrooms, a lounge and kitchen /diner. The building is large and now some parts are no longer used for residential accommodation, in particular the first floor which is now used for meetings, office accommodation and is proposed for some storage. This must not be allowed to intrude on the accommodation used by people living at the home, to protect their privacy and the feel of the home. Each person living at the home has a single bedroom, none of which have ensuite facilities but all of which were personalised and individual. Rooms showed evidence of peoples interests, activities and personal belongings. One room contained an unsecured electiric fire which was removed during the inspection pending discussions with the Fire Authority. People were seen using the space flexibly during the visits, with one person choosing to spend most of their time in the entrance hallway, others in the garden, lounge, dining room or in their rooms. Some of the accommodation is looking tired and in need of refurbishment. Development work being undertaken on health and care plans may identify further work that may need to be undertaken in relation to sensory impairments. There should be a plan for the ongoing maintenance and refurbishment of the home to make sure that the condition of the home does not deteriorate further. It is understood there is Evidence: an environmental audit undertaken yearly. Risk assessments need to be undertaken and updated regularly for the premises as those seen on the inspection were outdated. One room has a window that is too high to enable the person to look out from a seated postition. Discussions with staff indicated that appropriate arrangements are in place for controlling risks from infection and all areas seen were clean. Laundry is completed on site and commercial machines are available for this in an external laundry. There are attractive grounds which allowed people a choice of space outside with seating areas, and mature fruit trees. The home is close to a local farm shop but other facilities would need transportation to access. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Recruitment, supervision and training require attention to make sure people at the home are supported by well trained staff who understand their needs. Evidence: On the visits to the home time was spent talking to staff about their role, and observing the way they interacted with people living at the home. Time was also spent looking at staffing practices such as recruitment, training, staffing levels and appraisals. Questionnaires completed before the inspection site visits indicated that there were some concerns over the number of bank and agency staff being needed to cover the staffing at the home. On arrival on the first visit three out of five staff on duty were bank staff. The home have attempted recruiting extensively and are hopeful that they will have been able to appoint new staff in the week folowing the inspection. Having permanent staff is especially important when people have complex needs or communication difficulties which mean they make take time to develop relationships or make themselves understood. Time was spent looking at the recruitment practices for new staff. People living at the home are involved in the interviewing process which is commendable. Records for some recently recruited staff were seen, and these showed that a full recruitment process was completed,. This includes obtaining references and a criminal records bureau check, which helps to ensure people are protected from being cared for by people who may be unsuitable to work with vulnerable adults. However the records seen did not include a full employment history, only the last five years. The acting service manager agreed to check that these records are seen elsewhere as a part of the recruitment process. This is important as it helps to identify any gaps in employment history or any concerns in relation to peoples past employment. The numbers of staff were also discussed, as at times it appearred that the level of staff on duty mean that people may not be able to follow activities of their choice. The Evidence: service manager confirmed that the service is looking at the current aloocation of 1:1 funding for one person and how that time can best be used. Discussion was held on staff training. It was identified in questionnaires and discussion that staff urgently require training in Epilepsy management and the use of Enteral feeding systems. Other areas of induction and core training have been identified as being needed. One staff member spoken to had completed their NVQ 2 and is hoping to start their NVQ 3 in the near future, however the homes supplied information indicated that only five out of twenty one care staff have achieved their NVQ2 or above, with another three working towards this. The NVQ qualification is a National award recognising the competency of the workforce in their job role. National Minimum standards recommend at leatst 50 of staff have this level of achievement. Staff recieve an annual apprasial and senior staff are seen regularly for supervision but this is not in a formal system for all staff and is not formally recorded. Supervision is a system which combines personal development with performance management and should help ensure staff are working consistentkly to support people and to the best of their ability. There are bi monthly staff meetings. The staff seen working with people living at the home had a clear understanding of their needs and clearly had good working relationships with people they were caring for an working with. They included people living at the home in their interactions and were aware of subtle changes in their behaviour and acted on them accordingly. Some communciation seen was discussed as it did not reflect good practice. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home has sufferred from a lack of permanent management in post. Health and safety arrangements need review to ensure people can live and work at the home in safety - A lack of current risk assessments could leave people at risk. Evidence: Discussions were held with the homes acting management and senior staff on duty during the visits to the home. Time was also spent looking at records and management systems. The home has not had a permanent registered manager in post for over a year and although acting manager cover has been provided during this period the home has sufferred from a lack of continuity and security. It is understood that recruitment has been undertaken and within a month following the inspection interviews are being held for a permanent registered manager. This should help to bring some consistency and leadership to the home. Time was spent looking at the homes health and safety policies . Those seen were piecemeal and needed reviewing or developing to ensure people can live and work in safety. Staff have reciebed basic training in health and safety practices. Routine fire tests and drills were being completed regularly, and the home has a Fire Risk assessment. Information on chemicals and cleaning materials in use has been obtained since the last inspection. The home has a quality assurance report which was completed in the last year. Another cycle is to begin shortly, which will include questionnaires to stakeholders and people living at the home about the service and their views. A full quality assurance Evidence: process would also involve information from other areas, such as internal and external review and audit, planned developments and challenges to the service over the year, such as a review of complaints and incidents. A review was also held on the system for the management of personal money owned by people living at the service. The current system involves the use of several systems including individual accounts and appearred overly involved. The manager agreed to raise this for review. Money held was however fully accountable and individual amounts could be identified for each person along with reciepts for any purchases made on their behalf. 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 1 33 18 (a) The management must 23/12/2007 review the staffing levels at the home to ensure that there are sufficient staff on duty at all times to provide the necessary care for the people who live at the home at the home. This refers specifically to ensuring the peoples? social needs can be met at weekends. This will ensure that the people who live at the home can be provided with the level of care they need to pursue outside interests. 2 43 24 (1) (a)(b) and 2 and 3 A representative from the 23/12/2007 Care Trust must recommence monthly required visits to the home. This is to ensure that the management of the home is monitored and ensures that the service being provided is in the best interests of the people who live at the home. 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 19 12 Care plans must include full 21/01/2009 assessments of peoples healthcare needs, how these impact on the individual and how these needs are to be addressed. This is to ensure peoples needs are met in a way that reflects their indicidual needs and aspirations. 2 20 13 Medication records must 21/11/2008 record the administration of all medication prescribed and given to people at the home. Medication must be given in accordance with the prescribers instructions. This is to ensure medication is used safely. 3 22 13 The registered person must 21/01/2009 make arrangegemtns for the training of all staff in prevention of abuse and what to do if abuse is suspected. This is to ensure people living at the home are protected from abuse and abusive practice. 4 24 13 Risk assessments must be undertaken and regularly reviewed for the premises. 21/12/2008 This is to ensure people living and working at the home are not subject to undue risks. 5 24 12 The use of unused 21/11/2008 accommodation at the home must not intrude on the privacy of the people living at the home. This is to ensure people living at the home have their privacy maintained. 6 35 18 Training must be provided for staff in Epilepsy management and Enteral feeding (for those people who deal with this area). 21/11/2008 This is so that peope can be cared for safely by staff who have knowledge about their condition. 7 35 18 A staff training and 21/01/2009 develoment programme must be provided which details the training that staff have undertaken and training requird to meet the needs of people living at the home. This is so that the home can ensure staff can met the needs of people living at the home and identify priotties for training. 8 36 18 A full programme of supervision must be implemented for all staff. 21/01/2009 This is to ensure staff are working consistently and to their full potential. 9 37 8 A registered manager must be appointed 01/01/2009 This is to ensure consistency and leadership for the home. 10 42 13 Risk assessments must be undertaken for all areas of health and safety management at the home. Policies and procedures for Health and safety management need to be reviewd regularly and made available within the home. 21/01/2009 This is to ensure people can live and work in safety at the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Person centred plans should be produced in a format that meets the persons needs and available to them wherever they wish to have them kept. Care plans should contain communication assessments 2 6 which are followed through in all interactions to ensure consistency. 3 19 Health action plans should be provided for each person to support their access to and wherever possible control over healthcare facilities. The home should consider making the complaints procedure available in formats that may be more suitable and accessible for people living at the home A refurbishment programme should be constrated so that the ongoing maintenance and refurbishment needs of the home are identified and addressed. This should include any relevant sensory equipment or alterations needed as peoples individual health needs may deteriorate. Each persons individual accommodation should have a window through which the person can have a view from a seated position. A review should be undertaken to look at the staffing levels and ensure that peoples needs can be met with the level of staff on duty. The home should take action to reduce the dependency on bank or agency staff. A full employment history must be obtained for each person recruited to work at the home. 4 22 5 24 6 26 7 33 8 34 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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