Care Home: Peterhouse

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Peterhouse Sneating Hall Sneating Hall Lane Kirby Le Soken Essex CO13 0EW The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Pauline Dean Date: 1 7 0 9 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 Inspection report CSCI Page 2 of 33 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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. 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: Peterhouse Sneating Hall Sneating Hall Lane Kirby Le Soken Essex CO13 0EW 01255861241 01255861241 sneating@btinternet.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Reverend Graham Beresford Edwards Name of registered manager (if applicable) Reverend Graham Beresford Edwards Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 11 11 0 0 care home 11 learning disability physical disability Additional conditions: The home accommodates eleven people with learning disabilities who may also have physical disabilities. Date of last inspection 1 0 1 1 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 33 A bit about the care home The home is situated in a semirural location, offering extensive outdoor space. The home benefits from having its own occupational therapy suite situated in the courtyard from the main house. Accommodation is provided on two levels. A large communal lounge with access to extensive grounds is available. Bathrooms and toilets have been adapted to meet the needs of service users who require the use of wheelchairs. The home provides transport to facilitate the accessing of local community based activities. 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 Care Homes for Adults (18-65 years) Page 6 of 33 How we did our inspection: This is what the inspector did when they were at the care home This unannounced inspection of Peterhouse took place on 17th September 2008 over a 9 hour period. We were told at the inspection that fees range from £718.00 - £1,050.95 per week. Additional expenses are toiletries, outings and outings on holidays. These are paid for by the individual resident and are charged at cost. The inspection involved checking information received by Commission for Social Care Inspection (CSCI) since the last key inspection in November 2007. At the site inspection, records and documents were inspected and we spoke to the registered manager, assistant manager, cook, care staff and the people living at the home. In addition the Annual Quality Assurance Assessment (AQAA) completed in June 2008 was considered as part of the inspection process and a tour of the premises was completed. We were invited to join the residents for lunch. Care Homes for Adults (18-65 years) Page 7 of 33 Surveys were sent to the home prior to the inspection. Three surveys were completed by the people living at the home and two surveys were completed by staff members. Their comments are reflected in this report. During the inspection one person who live at the care home was spoken to in depth and a second resident was able to tell us what it was like living at Peterhouse. The assistant manager and three care staff were spoken with during the inspection. What the care home does well Within the AQAA the home states that they feel that they have good Personal Care Plans. This was evidence at the inspection when we found detailed documents which clearly detailed care instructions for care staff to support and enable residents to improve their independence and their quality of life. A priority is given to ensuring residents make choices. This was evident at the inspection, when residents were seen to select clothes, chose what they wanted to eat and decide what they wanted to do during the day. Care Homes for Adults (18-65 years) Page 8 of 33 Residents are encouraged to take part in daily activities and tasks in the home and during the inspection we saw residents laying the table and assisting in the kitchen. Other tasks such as making their beds and taking their laundry to the laundry were seen detailed in their care plans. These tasks are seen as a way to promote confidence, physical ability and responsibility. What has got better from the last inspection As was found at the last inspection, residents are offered a diet, which is varied, wholesome and nutritious. The home has introduced and reviewed the planned menus and consideration is given to the likes and dislikes of residents. Ongoing decoration and maintenance ensures that the premises are in a good state of repair inside and out. Care Homes for Adults (18-65 years) Page 9 of 33 We found that the home continues to promote training. The majority of staff have completed a National Vocational Qualification and ongoing basic training courses are offered to all staff. All three staff members spoken to at the inspection said that there were good training opportunities. What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 10 of 33 If you want to speak to the inspector please contact Pauline Dean Commission for Social Care Inspection Eastern Region Office CPC1, Capital Business Park Fulbourn, Cambridge CB21 5XE 01223 771300 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 11 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 12 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 . People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who come to live at Peterhouse have the information they need to make a choice to live at the care home and they can be assured that their needs are met. Evidence: As was found at the last inspection Peterhouse had not had any admissions for several years. Peterhouse has a detailed Placement Policy which details the records and information to be collated when admitting a new resident to the home. The care need assessments covered health, personal and social care needs and identified the individuals family and social history, their medical history, their method of communication and their family and social contacts. Information in the form of the Statement of Purpose and the Aims and Objectives of Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: Peterhouse are given to a propective resident alongside the Residents Guide. These docments are detailed with pictures and photographs to enhance the information provided. Within the Annual Quality Assurance Assessment (AQAA) it was stated that the home would expect a detailed assessment of needs from the placing authority and Peterhouse would conduct their own assessment which would be completed by carers and relatives if possible. The registered manager said that the home would expect a prospective resident to visit Peterhouse before moving in. In the AQAA it was stated that Prospective residents are expected to make at least one visit to Peterhouse and they would normally then spend an agreed number of separate visits involving an overnight stay. Three Have your say about... surveys were completed by residents living at Peterhouse. In this survey they were asked the question - Were you asked if you wanted to move into the home? Two people said No to this question and one person said Yes. One person who had said No however said I like living here. A third person confirmed that they had been asked if they wanted to move into Peterhouse. A second question on the surveys was Did you get enough information about this home before you moved in so that you could decide if it was the right place for you? Two people answered Yes, whilst the third person said No clarifying that their local authority had made the placement. We were told that new residents woul be admitted to the home on a trail basis, which is normally a six month period. Care Homes for Adults (18-65 years) Page 14 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 . People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use this service should be assured that their care needs will be met through care planning, risk assessment and staff support. Evidence: At this inspection we inspected three personal care plans which contained detailed care plans under the title of a Personal Programme Plan. Within each file seen we found detailed information outlining the care and care needs of each resident. Guidance and instructions for caring for the individual were noted with examples of detailed and concise instructions seen. An example of this was with regard to a resident feeding and drinking and for another resident information about the Makaton signing they use. On each file information sheets were kept and staff were expected to complete these Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: records after each shift. A diary was used to remind staff to read these notes. Weekly activity records were seen on each file and these records detailed activities completed in the home and outside the home. These were linked into care planning goals, aims and outcomes. Within the AQAA it was stated that each personal care plan is reviewed every six months or as needed and evidence was seen of reviews and changes to care plans on these files. It was said that priority is given to ensuring resident have choice and this was further evidenced within the activity record keeping. Residents living at Peterhouse have very complex needs and only one resident is able to vocalise and make an informed choice about what they wish to do each day. However, during this inspection we observed staff enabling and empowering residents to make choices. For example residents were able to choose where they sat and what they wanted to do e.g. listen to a particular CD or watch TV. Risk assessments were seen in all three care plans sampled. Risk assessments in place were seen to cover mobility, medication, drinking, accessing the grounds and ponds, manual handling and personal care issues. A good example of a risk assessment was around the management of a resident who may bite or injure others. The measures in place had reduced the risk from a medium risk to a low risk. Care Homes for Adults (18-65 years) Page 16 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 who use the service experience good quality outcomes in this area. This judgment has been made using available evidence including a visit to this service. People who use this service are assured that they are able to make choices with staff offering support and guidance with regard to their daily routine and leisure activities and contact with their family. People who use this service are provided with a varied and healthy diet to promote good health. Evidence: One resident was able to tell us of their work on the farm, doing gardening and building work and cleaning cars. They said that they enjoyed doing these things. They were also able to access the local community and regularly attended a local friendship club. Three residents at Peterhouse frequently attend the Gateway Club and they were Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: able to go to the Busby Club if they wished. We were told that residents are encouraged and supported to attend a local church and church activity groups such as a music group. One resident said that they had enrolled for a Healthy Living course at the local adult community college. They said that they had previously attended a cookery course which they had enjoyed and we were told that they are able to assist with preparation of vegetables. Two holidays are planned for this year. One had taken place in April 2008 and the second was planned for October 2008. We were told that these are in Norfolk, which had been chosen for the ease of accessibility to the home. We were told and found that residents are supported and encouraged to maintain contact with their relatives. One resident had birthday celebrations planned and they told us that their family would be visiting. The AQAA stated that visitors are welcome at any time and meals are provided free of charge. At this inspection we were able to speak with the homes cook. They told us that had started working at the home in April 2008. They were employed from 09:30 to 14:00 hours Monday to Friday. They said that they had a basic food hygiene certificate and had catering experience from running their own catering business. Within the home we saw a variety of fresh, frozen, dried and tinned food supplies. The home uses a wholesalers, a local supermarket and a greengrocers and there is a variety of branded and own labeled goods. Fridge and freezer temperatures check are taken weekly. Overall, the record keeping was in good order, although there were gaps in the recordings when the cook had been on holiday. A recommendation was made to the registered manager that the frequency of the temperature checks is increased to daily checks. Peterhouse had a 3 week rotational menu. A main choice is listed with some alternatives added, for example mashed potatoes is served instead of rice for those who prefer this. The cook said that the likes and dislikes of residents are considered and a list of likes and dislikes was on display in the kitchen. At the inspection we discussed the quantity of food served and the cook said that she served appropriate size portions to each resident having got to know their preferences. They told us that a large Sunday joints would be purchased and this would be divided into two or three as needed. Records of meals taken were seen on care planning files and a variety of food was served at breakfast, lunch and teatime. At this inspection we were invited to join residents for lunch and we were therefore able to observe the lunchtime meal. This was a pleasant family affair with staff seen assisting and eating with residents. Residents were served their meals on a plate and the quality and quantity of the meal was adequate, for all seem to enjoy their meal. We were told that the Environmental Health Officer (EHO) had visited in January 2008 Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: and no recommendations had been made. Care Homes for Adults (18-65 years) Page 19 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 who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use this service can be assured that they will receive personal care and support in a sensitive and respectful way and their physical and emotional health needs will be met. Evidence: We were able to speak with three care staff during the course of the inspection. All three carers said that they had a good understanding of their residents. They were able to tell us about the residents and had a clear understanding of what they like to do. An example given was that residents were able to have a lie in or go to bed later. This was noted in their care plan and incorporated into their daily living. During the day staff were seen to knock on doors before entering berooms and residents privacy and dignity was upheld. All three residents who had answered the question - Do the staff treat you well? had answered always in their completed Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: surveys and they had said that carers listen and act on what they say at all times. All of the residents are registered with a GP and evidence was seen in care planning records of visits by and to consultants and health professionals including dentist, chiropodist and opticians. One resident had attended the local physiotherapy department and new hoist slings, shower equipment and a wheelchair are being considered. All residents are now said to have a Health Action plan as produced by the local Primary Care Trust. Medication practices and procedures were sampled and inspected. The home uses the Monitored Dosage System (MDS). The medication and administration records for three residents were inspected and this was found to be in good order. At the time of the inspection, the home did not have any Controlled Drugs. Medication Administration Records (MAR) were in good order with an audit completed of medication entering the home. A medication returns book is used to record and return unwanted medication to the pharmacy. 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 who use the service experience good quality outcomes in this area. This judgment has been made using available evidence including a visit to this service. People living at the home can be assured that their concerns will be listened to and acted upon and that they will be protected from abuse. Evidence: Copies of the Complaints Procedure and the Whistle blowing Policy were seen on the day of the inspection. The Complaints Procedure can be found in the Statement of Purpose. Both of these documents needed updating to reflect the Commissions details and these were completed and copies were sent to CSCI. Within the AQAA it was stated that there had been an emphasis on the Whistle blowing Policy raised at staff meetings. The updated copies met the requirements and detailed the action to be followed in the event of a complaint being made. The registered manager said that they had not had any complaints since the last inspection. The updated copies met the requirements and detailed the action to be followed in the event of a complaint being made. The registered manager said that they had not had any complaints since the last inspection. Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: We informed the home that the Commission had received an anonymous complaint since the last inspection. Each of the concerns as raised by the complainant were raised with the home. The concerns raised were about staffing levels, recruitment and retention in the home; residents from the homes sister home - The Retreat choosing to spend their time at Peterhouse; Regulation 37 notifications; the management of challenging behaviour by a carer; laundry service; nutritional needs ; residents sharing bedrooms; access to the gardens and lack of choice. All of these issues were considered in detail and the outcome of our findings are to be found within the appropriate outcome areas of this report. Some recommendations were made and are noted in this report. However, overall regulations were found to be met. 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 . People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. The home is satisfactorily maintained, providing residents with a homely, safe and hygienic environment that suits their needs and lifestyles. Evidence: At this inspection we undertook a tour of the premises. We visited residents bedrooms, bathrooms and toilets and communal areas. Overall, the premises were clean, light and airy. Residents bedrooms were personalised with pictures and paintings on the wall and there was evidence that residents had their own belongings such as photographs, videos and CDs in the room. Currently there are two bedrooms which are shared rooms. One of these rooms has its own en-suite shower room with a wash hand basin and toilet. When we went into this room we noticed a slight odour. The assistant manager who was present acknowledged this and said that it possibly came from the en-suite facilities. It was agreed that this would be investigated further. Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: Issues around the management of residents in these rooms with regard to their privacy and dignity and their personal care needs were discussed. These were issues that had been raised in the complaint. Consideration has been given to this within the care plans of each resident. Whilst it is recognised that it does present some restrictions on accessing the room at all times, we were told that this is kept to minimum by utilising the shower room for privacy and personal care needs. 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 who use the service experience good quality outcomes in this area. This judgment has been made using available evidence including a visit to this service. People living at the home can be assured that staff will have sufficient skills, knowledge and support to meet all of their needs and they are fully supported and protected by the home’s recruitment practices and procedures. Evidence: At this inspection we considered the staffing levels and the retention of staff at Peterhouse. One of the concerns raised by the complainant was that staffing levels and staff retention at Peterhouse was not meeting the needs of the residents. The registered manager confirmed that two people had gone on maternity leave. They said that a replacement had been found for one of the persons on maternity leave and two night staff members had covered the remaining hours. A third person had left in April 2008, and they had been replaced by bank staff and new staff who had been appointed to fill these vacancies. Unfortunately two of those appointed had not found the work to their liking and they had left . The third person appointed however had been recruited in September 2008 and they were settling into the work well. Their staff file including their recruitment and induction training was inspected at this inspection. Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: Staff rotas were reviewed and the registered manager said that the home expects to have three to four carers on duty throughout the day, two management - registered manager and administrator, cook, cleaner, gardener & maintenance person. The registered manager said that a minimum of three carers would be on duty each day. Staff rotas seen for August and September detailed a minimum of three carers on duty each day. We were told that staffing levels are adjusted to take account of outings and trips which take place. At night there are rostered one awake and one asleep carers on duty and the registered manager said that they are available and on call at night often sleeping in their private accommodation at the home. The registered manager said that there had been recent problems with staff booking last minute leave. This had been raised at a staff meeting and staff have been told that this is not acceptable. At this inspection we discussed that needs of residents and the impact of residents from the sister home of The Retreat coming over to Peterhouse. The registered manager informed us that this practice had increased and it was no longer three to four times a week when the three residents came over to do activities in the home and in the activity room, but that as this home had had a member of staff off on long term sick leave of over three months this had increased. Whilst there had been an increase in residents to be cared for, there was no indication that residents needs are not being met. We were told that they are currently advertising this post and on recruitment they will review the current arrangements. Whilst it is not for this service inspection. it is not clear if if is the choice of the three residents from The Retreat to join the residents of Peterhouse each day. Within the AQAA it was stated that ten care staff have a National Vocational Qualification (NVQ) Level 2 or higher, two having a NVQ Level 3. The assistant manager has a NVQ Level 4 in care and management and the registered manager has a NVQ Level 4 in management. We found the staff recruitment practices to meet requirements. We sampled and inspected the files of two new employees. Evidence was seen of an application for employment with detailed employment histories. Completed professional and character references were on file with written confirmed Criminal Bureau Disclosure (CRB)clearance. Evidence was seen of the Skills for Care induction training either completed or ongoing and additional in-house training on Moving and Handling, Infection Control and Food Hygiene had been completed by a carer who has commenced working at the home in September 2008. The other employee had commenced working at Peterhouse in 2007 and their records showed that they had completed in-house training in Safeguarding Adults, Handling of Medication, Moving and Handling and Infection Control. They had completed the Skills for Care induction training and a certification of completion was seen on their file. During this inspection we were able to speak with this member of staff and they confirmed that they had completed their induction training and basic training courses had been made available Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: to them. They said that they really enjoyed working at Peterhouse and they felt there was a good staff team. They said they had regular supervision sessions with the assistant manager and should they have any concerns they would raise them with the assistant or registered manager. Two members of staff had completed the Commissions surveys and each told us that they felt they had training relevant to their role and it enabled them to keep up to date with new ways of working. One carer said Training and Personal Development are ongoing and relevant. 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 who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. The active involvement of the manager within the home ensures that residents benefit from good day-to-day management of the home. Quality assurance processes ensure that residents’ views on the home are sought and acted on and health and safety practices protect staff and residents. Evidence: The registered manager told us that they hold a NVQ Level 4 in management and are about to complete their NVQ Level 4 in care. They are in day to day contact with this home and the homes sister home. In the last year an assistant manager has been appointed assist with the management of the home. They hold a NVQ Level 4 qualification in management and care. We were told that the home has weekly staff meetings. This was confirmed by two Care Homes for Adults (18-65 years) Page 29 of 33 Evidence: carers who outlined recent discussions on annual leave and training opportunities. The care and management of the residents was also discussed at these meetings. Minutes were seen of recent meetings and these evidence what we were told. Concerns raised in the anonymous complaint were raised with the registered manager and assistant manager at this inspection. Following an investigation we were shown staff records which were with regard to the management of challenging behavior, reduced staffing levels on a Sunday and moving and handling practices. For each concern it was evident that appropriate action had been taken and detailed staff records and incident and accident logs confirmed this. At the inspection we found quality monitoring and quality assurance systems in place. In July 2008 quality assurance questionnaires had been produced and sent to relatives of residents at Peterhouse. In addition a pictorial survey had been produced for residents to complete. We were told that as these questionnaires are completed and returned they are considered and actioned as needed. In addition as stated earlier in this report there are weekly staff meetings and a staff suggestion box has been introduced. Issues raised this way could be discussed at staff meetings. We found the home to have safe working practices. There is an ongoing training and development programme of both basic and specialist training such as Makaton training which has taken place this year. Health and safety certifications are completed as required and at the inspection we sampled the hot water temperature check records, the fire alarm testing, the emergency lighting testing and records of weekly fire drills. All were in place and in good order. Health and safety certifications are completed as required and at the inspection we sampled the hot water temperature check records, the fire alarm testing, the emergency lighting testing and records of weekly fire drills. All were in place and in good order. Care Homes for Adults (18-65 years) Page 30 of 33 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 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 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 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. 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. Care Homes for Adults (18-65 years) Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!