Care Home: Overbrook

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What the care home does well Although the four people who live at Overbrook do not have the cognitive ability to give a view about life at the home they all appeared relaxed and happy and well cared for. The home has a consistent staff team who are experienced and committed to the people who live at the home. Care staff have undertaken NVQ`s and other training relevant to their role. Staff have a good understanding of the individual needs of the people who live at the home including dietary needs and likes and dislikes. The home provides an environment that is domestic in character with a homely, friendly atmosphere. The home has an ongoing programme of maintenance and redecoration as required. The home provides a range of in-house and community activities. These provide leisure and social opportunities that people enjoy. People are provided with choice about most aspects of their lives. What has improved since the last inspection? The home has met the four requirements made following the previous inspection undertaken in January 2007. Copies of contracts, terms and conditions of registration were seen in peoples care plans. Staff are now receiving formal supervision. At the time of the previous inspection there were concerns about the use of agency staff who were being left in charge of the home at night and did not know the people who live at the home. The home now rarely uses agency staff instead if additional staff are required the providers own domiciliary care service provides staff and these staff do not work in the home unsupervised unless they are well known to the people who live at the home. The home has secured funding for additional one to one time for some of the people who live at the home. This is provided by the providers domiciliary care service by consistent staff who have got to know the person they are supporting. The home has more staff who are able to drive the house car and therefore people are now able to attend planned activities on a regular basis. At the time of the previous inspection the homes registered manager was also responsible for another similar service. The home has a new registered manager who is only responsible for Overbrook. All care staff have completed person centred care training and new care plans are now in place following a person centred format. Care plans are individual and provide a high level of detail as to how people`s specific needs should be met. What the care home could do better: Two requirements are made following this inspection with other areas where the home could improve being included in the appropriate outcome group evidence section. Some people at the home are receiving vitamin and mineral supplements. These are not supplied by the pharmacist and therefore the home does not have a prescription for them. The persons GP has verbally recommended these supplements and a record of this has been recorded on the person`s health information in their care plan. These are written onto the medication administration records by the homes care staff, but the person writing them on does not sign the additions to the medication sheet. Two staff must sign additions to the medication administration records. The home has guidelines for as required medication however the people who live at Overbrook do not have the capacity to say when they require additional medication (such as pain killers) and therefore the home should add details to the guidelines as to how staff would decide that an individual person is in pain or requires other as needed medication. Some cleaning products were noted not to be stored securely. These were identified to the staff and secured during the inspection. All substances hazardous to health (COSHH) must be stored securely at all times. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Overbrook 92 High Street Wootton Isle Of Wight PO33 4PR     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: Janet Ktomi     Date: 1 5 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect 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 33 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 33 Information about the care home Name of care home: Address: Overbrook 92 High Street Wootton Isle Of Wight PO33 4PR 01983883390 01983883390 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Tina Merrett Type of registration: Number of places registered: Islecare Ltd care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 4. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Overbrook is a small group home providing care for four adults with learning disabilities. The home is a domestic residence situated in Wootton High Street and is close to local shops and amenities. The property is a two-storey building with a staircase to the first floor. There is no lift. There is level access to the front and rear of the property and a handrail around the garden to assist residents who have a visual impairment. There is off road parking to the front. The home is owned by Islecare Ltd and managed by registered manager Ms Tina Merritt. Information about fees is 4 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 33 Brief description of the care home available from the manager and there are additional charges for transport, chiropody, hairdressing, alternative therapies, outings and day trips. Care Homes for Adults (18-65 years) Page 5 of 33 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: This report details the results of an evaluation of the quality of the service provided at Overbrook and brings together accumulated evidence of activity since the last key inspection on the 22nd January 2007. All core standards and some additional standards were assessed. Compliance with the four requirements made following the previous inspection was also assessed. The home was previously inspected on the 22nd January 2007 and had an annual service review in February 2008. The visit to the home was undertaken by one inspector on the 15th January 2009 and lasted approximately five hours commencing at 12.30pm and being completed at 5.30 Care Homes for Adults (18-65 years) Page 6 of 33 p.m. The inspector was able to spend time with the people in charge of the home and staff on duty and was provided with free access to all communal areas of the home, documentation requested and people who live at the home. Information from the Annual Quality Assurance Assessment (AQAA) completed by the registered manager is also considered. During the visit to the home the inspector was able to meet all the people who live at the home. The inspector spoke with one person who lives at the home and observed interactions between staff and the other people who live at the home. The inspector was not able to discuss the service with the other people who live at the home due to the level of their cognitive disability. The inspector telephoned social and health care professionals following the inspection visit. What the care home does well: What has improved since the last inspection? The home has met the four requirements made following the previous inspection undertaken in January 2007. Copies of contracts, terms and conditions of registration were seen in peoples care plans. Staff are now receiving formal supervision. At the time of the previous inspection there were concerns about the use of agency staff who were being left in charge of the home at night and did not know the people who live at the home. The home now rarely uses agency staff instead if additional staff are required the providers own domiciliary care service provides staff and these staff do not work in the home unsupervised unless they are well known to the people who live at the home. The home has secured funding for additional one to one time for some of the people who live at the home. This is provided by the providers domiciliary care service by consistent staff who have got to know the person they are supporting. The home has more staff who are able to drive the house car and therefore people are now able to attend planned activities on a regular basis. At the time of the previous inspection the homes registered manager was also responsible for another similar service. The home has a new registered manager who is only responsible for Overbrook. All care staff have completed person centred care training and new care plans are now in place following a person centred format. Care plans are individual and provide a high level of detail as to how peoples specific needs should be met. Care Homes for Adults (18-65 years) Page 8 of 33 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 33 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 33 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. The home would only admit new people whose needs could be met at the home and who were compatible with people already living there. Information about the terms and conditions of residency are now available in care plans. Evidence: The inspector discussed the homes admission process with the deputy manager and viewed information about contracts held in peoples care plans. The home has not admitted any new people for over four years, with the other people living at the home having done so for in excess of sixteen years. The home does not currently have a vacancy. The deputy manager identified the procedure that they would undertake should they be in the position of admitting a new person. This would include a thorough assessment, information from professionals involved with the person and their relatives, meeting the person and if they felt the home could meet the persons needs Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: they would invite them to visit the home on a number of occasions. The opinions of the people already living at the home would be sought following the visits and a final decision would be based on their views. During discussions it was clear that they were aware of the homes registration categories and the level of needs the home could meet. With no new people admitted to the home recently or by the people currently managing the service it is difficult to ascertain how effective the home would manage an admission and meet the needs of a new person. However, based on the records available and observations of the current people who live at the home it is possible to say that people appear happy living at Overbrook and that their lives seem full and to be meeting their needs. Following the previous inspection a requirement was made that each service user or their representative must have a contract or details of the terms of the services and facilities provided at the home. This had been a repeat requirement from the inspection undertaken prior to the previous inspection. Within care plans viewed were copies of the terms and conditions of residency providing written information about the services that the home provides and those that are not provided or would incur an additional charge. Whilst these did not include the fees payable, nobody living at the home is self funding and the fees payable would be known by the authorities funding the placements. Care Homes for Adults (18-65 years) Page 12 of 33 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. The home now uses a person centred care planning system. Staff are committed to supporting people to lead purposeful and fulfilling lives as independently as possible. People are supported to make decisions about their lives and are encouraged to be as independent as possible and to take sensible risks, which enhance their enjoyment of life. Evidence: Two care plans were viewed. Risk assessments and the ways in which risks should be managed were seen in care plans. The inspector spoke with staff about care plans and the person centred training they have undertaken since the previous inspection. The inspector also discussed how decisions are made and observed how people who live at the home are encouraged and supported to be active and independent. The deputy manager stated that all care staff have undertaken person centred care training and that the home has reformatted all care plans in a new person centred Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: format. Care staff on duty at the time of the inspection visit confirmed that they had attended person centred care training. The two care plans viewed were person centred and followed a person centred format. Care plans had been reviewed. Care plans contained information about, and risk management plans in respect of, health needs as well as personal care, social and independence skills training. The home uses a key worker system. Each care plan contained risk assessments relevant to the needs identified and incorporated into the persons care plan. Management of risk positively addressed safety issues whilst aiming for improved outcomes for people using the service in terms of skills development and independence. Observation during the inspection visit confirmed that people are able to make decisions and that these are respected and acted upon by the home. Due to the level of cognitive and communication needs of the people who live at Overbrook it was not possible to have an indepth discussion with then. The inspector spoke with one person who stated they were happy and that they could do what they wanted. Resident meetings are not held due to the individual needs of the people who live at the home. Care plans contained information about peoples individual likes and dislikes and discussions with staff demonstrated that they were aware of peoples likes and dislikes. An example being that one person was known not to like rice and therefore would be having her evening meal of curry with a jacket potato instead. The persons care plan was viewed and this also stated that she disliked rice. Care staff also commented that additional staff are provided two afternoon shifts per week to enable more individual activities and outings and if one person decides they do not want to go then they can stay home and other people can still go out. People do not have the cognitive ability to manage their own finances and all appointeeships except one have now been transfered to the social services deputyship officer. The process is now commencing to transfere the final person to the deputyship officer. There was evidence that personal money is spent of things that people like and enjoy. Bedrooms were highly personalised reflecting their occupants interests. Records of what people had spent their money on confirmed that people are supported to make choices about their lives and what they do. The support people receive in relation to their personal finances is recorded in care plans. The inspector viewed the arrangements in respect of personal finances and the procedures and records are appropriate and well maintained. Care Homes for Adults (18-65 years) Page 14 of 33 Care Homes for Adults (18-65 years) Page 15 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to live the lifestyle they choose, and are supported to maintain regular contact with family and friends. People are offered meals they enjoy, which are varied and healthy. Evidence: Information from care plans, discussions with care staff and observations during the inspection visit are considered. Following the previous inspection a requirement was made that the home must ensure service users have access to suitable transport for all planned activities. At the time of the previous inspection people were not able to attend all day service sessions as the home did not have sufficient staff able to drive the house car. The home is now fully staffed with approximately half the staff being able to drive the house car. Evidence Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: seen and discussions with staff indicated that the requirement has been met. Everybody has an individual weekly programme of activities that includes a range of day services and leisure activities, intended to help develop and maintain life skills and provides opportunities for socialisation away from the home. A list of weekly planned activities was seen on the wall. On the day of the inspection people attended services as per the list seen. Discussions with care staff and one person who lives at the home confirmed that they enjoy these activities. During the unannounced visit by the inspector to their home three people went to day services for the afternoon and the fourth person went with staff to take them to day services in the house car. Within their bedrooms people have a variety of home entertainment equipment and relaxation equipment. During the inspection visit people were noted to be able to spend their time as they wished. The location of the home is on a main road with local shops, two pubs and a community centre within walking distance. There are always two, and sometimes three staff on duty therefore support to attend community events is available. Some people are funded additional one to one time which is provided by external staff. Whilst viewing financial records the inspector saw evidence of money spent on outings and refreshments. People are involved in assisting care staff with food shopping in the local shops and use local health facilities. Staff rotas confirmed staffing numbers. Care plans contained records of activities both in the home and local community that people have undertaken. The home has a house car capable of transporting everyone living at the home. The arrangements for the funding of the house car were discussed with the deputy manager and people pay for fuel dependent on the amount of individual use they have made of the house car. People did not have a holiday last year however the deputy manager is considering holidays for this year, with it being likely that two people will have a holiday on the island and the other two further afield. People are supported to celebrate life events and are able to invite friends and family to visit them at the home. The homes routines tend to be organised around the people who live there with meal times flexible to meet peoples individual preferences and routines. Information in care plans included peoples preferred times of getting up in the morning and going to bed at night. Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: The home does not employ separate catering staff so care staff take turns to cook each day. Information in care plans stated what support people require in respect of meals and food preparation. Special cutlery was seen to be available for one person requiring this to promote their Independence. People have lighter lunch meal or take packed lunches to day services and have a main cooked meal in the evenings. Records showed that meals are varied and nutritious. Care plans included and care staff were aware of peoples individual likes and special diet needs. The home has been awarded five stars (maximum five stars) for food hygiene by the local environmental health department. Care Homes for Adults (18-65 years) Page 18 of 33 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. People receive personal care and support in the way they prefer and their health needs are met. Medication is appropriately stored and recorded although more information should be provided about when as required medication should be given and a requirement is made that staff should sign medication administration sheets when additional medication is to be given that has not been included on the record sheets provided by the pharmacist. Evidence: Information about personal and health care needs and that provided was viewed in care plans. Discussions with staff are also considered. The arrangements for the storage and administration of medication were viewed with any related records. Care plans contained detailed information as to how people should be supported with personal care routines and these should ensure that peoples personal care needs are met and their rights to dignity and privacy are maintained. Care plans stated what help people required and what they could do for themselves maximising the opportunities for maintenance and development of personal care skills. The home operates a key Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: worker system. People living at Overbrook are independently mobile. The bathing facilities are appropriate for the people who live at the home. Times for getting up and going to bed are flexible with various times seen recorded in care plans viewed. Interactions observed during the inspectors visit to their home indicated that people felt relaxed with care staff. The home has a consistent staff team who have got to know the people who live there so would recognise if someone were unwell and not their usual self. Evidence of personal care is recorded in daily recordings made by care staff and indicated that peoples personal care needs as identified in their care plans are met. People living at the home are registered with local GPs and support is provided from care staff to make and attend appointments. Care plans contained a record sheet that indicated that people are able to see Chiropodists, Dentists, Opticians and Doctors when required. Both care plans viewed contained Health Action Plans and additional information that could be provided to hospital staff about personal and communication needs. Following the previous inspection a recommendation was made that a review of medication procedures to ensure that all records are current, storage of medication is secure, records of staff competency in administering medication are dated and reviewed. At the time of this unannounced inspection all medication was found to be stored correctly. The key to the medication storage cupboard is now passed from the senior to the senior on each shift and held by them throughout the shift. The home does not currently have any controlled medication however if any were required then the controlled medication storage box must be secured to the wall. The medication administration records were viewed and with one exception had been fully completed. Medication coming into the home is recorded on the Medication Administration Records. It was noted on the Medication Administration Records that some medication, mineral and vitamin supplements recommended by the peoples GP but not prescribed by the GP (as not available on prescription in liquid format and must be purchased by the person) have been added to the medication administration records. The person adding this has not signed the prescription and there was no letter from the GP confirming the recommendation that the person receive this. The home stated that this had been discussed with the persons GP and the telephone call had been recorded in the persons health information. Two staff must sign any additions to the medication administration records. The home uses a pre-dispensed system for tablets with liquid medication dispensed at Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: the time of administration. None of the people living at the home self medicate, therefore all medication is administered by care staff who have received external training and been deemed competent. Some medication such as pain killers is prescribed to only be given when required. The home has as required guidelines but these do not provide specific information as to how care staff should decide if the medication is required. Further information must be added to the as required guildlines as to when people who are unable to verbally request this may require additional medication. The inspector was shown the distance learning packs that staff have completed as part of their update training in medication. Care Homes for Adults (18-65 years) Page 21 of 33 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. People at the home are able to complain and should be protected from abuse. Evidence: The provider has a complaints policy which is made available to people or their representatives. There is also information as to how to complain available in the hall at the home. The complaints policy should ensure that all complaints are appropriately investigated within twenty-eight days. The home maintains a complaints book and has received no complaints in the past twelve months. No complaints have been received at the Commission in respect of Overbrook. Throughout the inspectors visit people who live at the home were seen responding verbally and non-verbally to staff, making requests and suggestions. Staff have a good understanding of the individual communication methods of the people who live at the home and would be in a position to realise if people were unhappy. Staff spoken with were aware of the procedure they should follow should a person or their representative make a complaint. The home has copies of the Islecare Ltd adult protection and whistle blowing policies. Staff spoken with during the inspection were aware of the adult protection policy and procedures and clear about their responsibilities to report issues of concern without delay. Information including contact phone numbers for external agencies is provided Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: in the hall of the home. The deputy manager and staff on duty confirmed that they have received safeguarding training. Training information indicated that two care staff had not undertaken safeguarding training during 2008 and the deputy manager is to follow this up with the providers training coordinator. Three of the four people who live at the home have contact with a family member who would be able to raise issues on their behalf. The personal finances and employment procedures followed should help ensure that people are protected from abuse. Care Homes for Adults (18-65 years) Page 23 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of accommodation within the home is good providing people with a comfortable and homely place to live which meets their individual and collective needs. Evidence: The home is located on the main road through Wotton within walking distance of local shops, two pubs and the community centre. The home is a large property owned by a local housing association. The deputy manager showed the inspector the landlords gas safety check and other documents relating to maintenance and safety checks. The inspector viewed the homes communal rooms and first floor bedrooms and bathroom. The home is safe, well maintained and at the time of the unannounced inspection clean. Care staff undertake all domestic tasks and encourage the people who live at the home to participate. The home meets peoples needs in a homely and domestic way. Bedrooms are all single with communal areas, lounge, dining room and kitchen appropriate for the people who live at the home. The home has a rear garden, which is mainly laid to lawn with pathway and hand rail around the garden and patio areas adjacent to the rear door. There is level access to the front door from the house to the garden and ramped access from the back door to the garden. The home is maintained with the help of a handyman and gardener employed by the provider. Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: Everybody has their own single bedroom, none of which is ensuite, however bathrooms and WCs are located close by bedrooms. Bedrooms seen were pleasantly decorated and individually personalised. The homes laundry is situated in a separate room away from the kitchen although laundry must be carried through the kitchen to the laundry. Care staff stated that all laundry is taken in bags through the kitchen. The equipment is domestic and appropriate for the number and needs of the people who live at the home. Care staff confirmed that they have adequate supplies of disposable gloves, aprons and any other infection control equipment required. Substances hazardous to health were seen on the top of the bathroom cupboard not locked away. The deputy manager locked these away during the inspection visit. Care Homes for Adults (18-65 years) Page 25 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a consistent staff team, provided in sufficient numbers and with the necessary skills to meet their individual and collective needs. Evidence: The inspector viewed staff files and training information. Interactions with people who live at the home and staff on duty were observed and the inspector spoke privately with staff on duty in the afternoon. People were seen to be relaxed around care staff and one able to respond verbally stated that they liked the care staff. Interactions observed during the visit indicated that people and staff have a warm friendly relationship with people feeling able to approach staff and initiate physical contact. Following the previous inspection a requirement was made that the registered manager must ensure that staff receive regular opportunities for formal supervision as part of their training and development. Care staff spoken with confirmed that they have regular supervision. The inspector was shown the supervision plan for 2008 and records of supervisions were seen in staff files viewed. The deputy manager stated that she would be undertaking supervisions and that she had already completed the Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: first of these. This requirement has therefore been met. Another requirement made following the previous inspection that agency or temporary staff employed in the home must be suitably qualified, competent and supervised and records maintained to this effect. The deputy manager and care staff on duty confirmed that agency staff have not been used for a long time. Should the homes existing staff be unable to cover for holidays or sickness then staff from the providers domiciliary care service are used. These staff know the people who live at the home and the provider is aware of their skills and competencys. This requirement has therefore also been met. The manager stated on the homes AQAA that there are nine permanent care staff and the manager employed at the home. Staff rotas and discussions with staff confirmed there are always at least two and sometimes three staff on duty. One staff member sleeps in during the night with support available on call. Some people have been assessed as requiring additional one to one support and this is provided by the providers domiciliary care service not by the homes care staff. This ensures that people get their allocated time of individual activities. Staff spoken with felt that the staffing levels and arrangements were appropriate to meet the peoples needs and that activities relating to social and leisure are possible during the evenings and weekends. The home has not needed to use many bank staff as staff cover each others annual leave and occasional sickness. The home has a consistent staff team with the deputy manager stating that only one new staff member has joined the home since the previous inspection. This person was transfered from a similar home owned by the provider that closed and the inspector remembered meeting the staff member and viewing the recruitment records at that home. The deputy manager described the homes recruitment procedures. They stated that potential staff would be invited to visit the home and meet the people who live there. Interactions and responses from the applicants and people who live at the home would be assessed and included in the decision as to whether to appoint people or not. The procedures would indicate that a thorough recruitment and checking process is in place, that people who live at the home would be involved in the process and that unsuitable people are not employed at the home. The provider has a comprehensive induction procedure and this includes all new staff working supernumerary until they are deemed competent and also have undertaken essential training such as safeguarding, infection control, fire awareness, moving and handling and health and safety. The deputy manager stated that seven of the nine care staff have at least an NVQ level 2 in care and the remaining two care staff are due to commence their NVQs. The Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: inspector spoke privately with the care staff on the afternoon shift and one confirmed that she had an NVQ and the other that she was waiting for the assessor to visit to start her NVQ. Care staff confirmed to the inspector that they have undertaken all update training and that they felt they had the necessary skills and experience to meet peoples needs. The homes training matrix for 2008 was on the office wall and indicated that all training had been completed with the exception of safeguarding training for two care staff. The deputy manager stated that she would contact the training coordinator to arrange for this training to be completed. The deputy manager stated that some training is now being provided in the home and this can be more geared to the needs of the people who live there and enables staff without transport to attend more easily than when training was provided at the providers island office. The provider has a training coordinator and should a specific need be identified then training to meet the need is organised. Care Homes for Adults (18-65 years) Page 28 of 33 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. People benefit from a well run service. The provider should ensure that policies and procedures are reviewed at least yearly and that notifications as required under Regulation 37 are completed. The home must also ensure that all substances hazardous to health are stored securely at all times. Evidence: The home has a registered manager who was registered by the commission in September 2008 although she had been managing the home for a period of approximately one year before that time. Unfortunately the registered manager is now unavailable for health reasons. The provider failed to notify the commission as required under regulation 37 that the manager would be absent form the home for a period of longer than twenty-eight days. The experienced deputy manager is now managing the home with the support of a manager from another home owned by the provider. Support from the area manager is also available to the deputy manager who has worked at the home for over nine Care Homes for Adults (18-65 years) Page 29 of 33 Evidence: years and knows the people who live there well. The home has met the four requirements and three recommendations made following the previous inspection in January 2007. Following this inspection two requirements are made. Other areas that could improve the service are identified in the relevant sections of the report. The evidence indicates that people are able to make decisions and supported to live the lifestyles they choose. A representative of the provider undertakes a monthly visit to the home with the written reports of these visits being seen during the inspection visit. Within care plans were copies of service user questionnaires completed by the people who live at the home. Due to the level of cognitive disability of the people who live at the home it would not be feasible to undertake formal service user meetings. Three of the four people who live at the home have regular contact from relatives and it may be appropriate to consider having relatives meetings as part of a formal quality review of the service. The registered manager completed the homes Annual Quality Assurance Assessment that was returned to the commission within the required timescales. This was discussed as some parts had not been fully completed and others contained limited information. The AQAA stated that the home had all the necessary policies and procedures however these were last reviewed in January 2007. Policies and procedures should be reviewed yearly and updated when necessary. Throughout the inspection visit a number of records were viewed. These have been identified in the relevant section of this report. Records were well maintained and appropriately stored. The only concern in respect of health and safety identified was the failure to secure all substances hazardous to health. A number of containers of cleaning chemicals were located on the top of a lockable cupboard in the first floor bathroom. The key to the cupboard was seen in the door of the cupboard. Inside were some more substances hazardous to health and infection control equipment. Once brought to the attention of staff these were stored securely during the inspection visit. The home must ensure that all substances hazardous to health (COSHH) are stored securely at all times. Care Homes for Adults (18-65 years) Page 30 of 33 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 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 The home must ensure that two staff sign the additions to the medication administration records. More detail must be added to as required medication guidlines to clearly state when additional medication should be given to service users. To ensure that people receive the correct medication. 18/02/2009 2 42 13 All substances hazardous to health (COSHH) must be stored securely at all times. So that people are safe. 18/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 32 of 33 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. 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