Care Home: PIA 4 Milverton Terrace

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What the care home does well The home seeks referral and assessment information from social workers and wherever possible new people are encouraged to visit and get to know the others at the home before deciding to live there. Care plans are in place containing good levels of information to help staff to meet people`s needs properly. The care plans are regularly reviewed to check that they contain the relevant information to meet people`s needs effectively. The daily records are well designed to help staff to monitor people`s individual needs and personal goals. The people at the home are supported to go out places they like and take part in the life of the community. Everyone goes shopping to choose their own clothes and personal items and most take part in shopping for groceries. People are supported to gain access to health professionals, such as GP, nurses, speech and language therapists, dentist and opticians so that their health needs are met properly. There have been no complaints at the home since the last inspection. Staff are trained to recognise and report suspicions of abuse so that people are protected from harm. The new manager has made efforts to make the home more homely. Pictures have been hung in various areas of the home and bedrooms have been personalised to reflect individual`s interests and personalities. This work is ongoing. The bathrooms are suitably equipped to meet the needs of people with disabilities, e.g equipped with grab rails and a hoist. Where necessary extra equipment is provided for people, such as specialist bed and wheelchairs. What has improved since the last inspection? The new manager is in the process of issuing contracts of terms and conditions to people and arranging for relatives and advocates to see them so that they are clear about their rights and responsibilities. Staff were seen to respect everyone`s privacy and dignity. The people at the home were supported to be appropriately dressed when in communal areas so as not to compromise their dignity. Safety film has been added to glass window panes in a person`s bedroom to stop glass from breaking and becoming a safety hazard. The manager has agreed to arrange for this film to be added to more window panes as a precautionary measure to reduce the potential for any injuries. Bathrooms and toilets were well stocked with soap and paper towels to encourage good personal hygiene in the home. What the care home could do better: The information provided by the home (service user guide) does not currently includethe fees. The manager agreed to update the service user guide and issue a copy to relatives and advocates, so that everyone is clear about the charges for the service. People are encouraged to make choices about what they want to eat and where they want to go. There is scope for increasing the visual aids available to people who do not easily communicate verbally, to help them to make their choices known. The kitchen is not adapted to meet the needs of people with with physical disabilities and there is an industrial size cooker in place. This makes it difficult to assess and develop people`s cooking skills. The work surface behind the taps is going rotten and come away from the wall. Hence it is recommended that plans be made to refurbish the kitchen to improve it for the people using the service. Overall staff are provided with a good range of training opportunities to help them to carry out their work safely and effectively, such as first aid, food hygiene, safeguarding from abuse and equality and diversity. The manager confirmed that she intends to increase the number of staff trained in National Vocational Qualifications as less than 50% of the current staff hold these qualifications. The manager also said she would arrange for staff to be provided with skin care training and diabetes (sign language ) training. The manager reports that no one has had any pressure sores. As the home supports some people with physical disabilities a skin care risk assessment is recommended to assess and remedy any skin care needs at the earliest possible stage, to prevent the possibility of sores developing. The emergency lights are not being checked as regularly as necessary. The manager said that she would ensure that this area of practice is closely monitored to ensure that the tests are carried out routinely. This is necessary to ensure that the lights operate effectively in the event of a fire at the home. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: PIA 4 Milverton Terrace 4 Milverton Terrace Leamington Spa Warwickshire CV32 5BA     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: Kevin Ward     Date: 0 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 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 30 Information about the care home Name of care home: Address: PIA 4 Milverton Terrace 4 Milverton Terrace Leamington Spa Warwickshire CV32 5BA 01926882831 02476640146 dkelly@people-in-action.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): People in Action Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 8 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 8 The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 8 Date of last inspection Brief description of the care home Milverton Terrace is a registered care home providing short-term care with the aim of supporting people with learning disability wishing to live, with support, in their own home and wider community. The parent company, People in Action provide 24-hour care and support for service users living in the home. The home is a large converted house, close to the town centre of Leamington Spa. Shared accommodation consists of a lounge, dining room and kitchen. There is also a bathroom, toilet, laundry and office on the ground floor. There are two service user bedrooms on the ground floor, which are suitable for wheelchair users. Other service user bedrooms and the staff sleep in Care Homes for Adults (18-65 years) Page 4 of 30 Brief description of the care home room, and a shower/toilet facility are located on the first floor. There is a garden to the rear of the property. There is limited access to the front of the property for car parking. Entrance to the home at the front is via a series of steps up to the front door. There is wheelchair access to the property however at the side of the building. Current fees were not available in the service users guide at the time of this inspection. Any further information about current fees should be sought directly from the home. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means that people who use the service experience good outcomes. This was a key unannounced inspection, which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for people. The inspection focused on assessing the main key Standards. As part of the inspection process the inspector reviewed information about the home that is held on file by us, such as notifications of accidents, allegations and incidents. Five people living at the home returned questionnaires giving their views on the service. Care Homes for Adults (18-65 years) Page 6 of 30 The inspection included seeing everyone living at the home. Due to the communication needs of some people living at the home it was not possible to get a clear impression of their views of the service. The inspection also included case tracking the needs of two people that live at the home. This involves looking at their care plans and records and checking how their needs are met in practice. Discussions took place with four staff on duty, as well as the manager. A number of records, such as care plans, complaints records, and fire safety records were also sampled for information as part of this inspection. An annual quality assurance assessment was completed and returned by the provider in time for this inspection, providing the managers views of the homes performance during the last year. The home charges one thousand two hundred and ninty two pounds per week. What the care home does well: What has improved since the last inspection? What they could do better: The information provided by the home (service user guide) does not currently include Care Homes for Adults (18-65 years) Page 8 of 30 the fees. The manager agreed to update the service user guide and issue a copy to relatives and advocates, so that everyone is clear about the charges for the service. People are encouraged to make choices about what they want to eat and where they want to go. There is scope for increasing the visual aids available to people who do not easily communicate verbally, to help them to make their choices known. The kitchen is not adapted to meet the needs of people with with physical disabilities and there is an industrial size cooker in place. This makes it difficult to assess and develop peoples cooking skills. The work surface behind the taps is going rotten and come away from the wall. Hence it is recommended that plans be made to refurbish the kitchen to improve it for the people using the service. Overall staff are provided with a good range of training opportunities to help them to carry out their work safely and effectively, such as first aid, food hygiene, safeguarding from abuse and equality and diversity. The manager confirmed that she intends to increase the number of staff trained in National Vocational Qualifications as less than 50 of the current staff hold these qualifications. The manager also said she would arrange for staff to be provided with skin care training and diabetes (sign language ) training. The manager reports that no one has had any pressure sores. As the home supports some people with physical disabilities a skin care risk assessment is recommended to assess and remedy any skin care needs at the earliest possible stage, to prevent the possibility of sores developing. The emergency lights are not being checked as regularly as necessary. The manager said that she would ensure that this area of practice is closely monitored to ensure that the tests are carried out routinely. This is necessary to ensure that the lights operate effectively in the event of a fire at the home. 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 30 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 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are being provided with the information they need to ensure they understand their rights and responsibilities whilst at the home. Evidence: The new manager explained that where placement at the home is not the result of an emergency, people are supported to visit the home before moving in and provided with opportunities to meet the other people who live there. This was verified by a person currently living at the home. Two peoples files were checked and contained evidence to show that proper referral and assessment information is sought from social workers before people move in. Both files also contained records to show that peoples placements are periodically reviewed with their personal involvement as well as that of social workers and relatives. Both files included a copy of the new service user guide. The manager explained that relatives are shown a copy of the service user guide for their advice and information. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: Relatives sign the file to confirm they have seen this information. The service user guide does not contain the current fees. The manager said that she would arrange for this information to be added and for the service user guide to be issued to relatives, to keep them up to date with peoples financial commitments. The manager explained that the contracts have just been reviewed and that she is in the process of seeking relatives agreement and signatures. Two of three contracts seen had already been signed by relatives. The contracts and the service user guide have been illustrated with pictures to help people to make the information easier for them to understand. Care Homes for Adults (18-65 years) Page 12 of 30 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. Peoples needs are planned for and reviewed so that they provided with the care and support they need. People are encouraged to take part in every day decisions that affect them so that they can excersise control over their lives. Evidence: Two peoples care plans and records were also sampled from other peoples files. Both care plans contained good levels of information, including their likes and dislikes and their preferred care routines. This is particularly important for people who have difficulties telling people what they want so that their known wishes can be respected and their needs met in the manner they like. Risk assessments are in place covering a good range of everyday hazards, such as Kitchen safety, use of hoists, bathing, fire and community access. A specialist bed and mattress has been provided for a wheelchair user and a hoist is in place to support safe transfers. A bed rail assessment had not been completed for the person Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: concerned. A risk assessment is necessary to ensure that the person is not placed at risk of getting trapped or falling out of bed. The manager agreed to write a risk assessment straight away with advice from an Occupational Therapist and to ensure that this becomes common practice in future for other people requiring the use of bed rails. The following day the manager confirmed that the risk assessment had been completed. The manager said that she would also devise a skin care risk assessment for monitoring the skin integrity of wheelchair users where necessary. The manager confirmed that no one at the home has had bed sores. One persons care plan was seen to contain helpful guidance on how to sensitively respond to the occasional challenges that the person presents. Comments by staff demonstrated a good understanding of this persons needs and they were observed to act sensitively and in accordance with this advice when providing support to the person concerned. The care plans and risk assessments had recently been dated to indicate they have been reviewed and monthly review reports were seen as evidence that peoples progress is being monitored. This includes reviewing progress to meet personal goals to achieve greater independence, as well as considering their needs and health care issues. Staff were seen to encourage people to make choices about what they wanted to do during the day and what they wanted to eat for breakfast. People confirmed that they are included in their care reviews so that they can be party to any decisions and goal setting and further evidence of this was seen in the review records. House meeting notes show that regular meetings are being held with the people at the home to check that they remain happy and to enable them to make everyday plans, such as planning activities. Several peoples records show that the home has made use of the Speech and Language Therapy service to support people to communicate their needs. One person has recently received support to develop a communication passport which they take about with them. This contains information about the persons individual ways of communicating their needs so that others can better understand what is being conveyed to them. A white board is in place for one person, providing a visual aid to remind them of activities they have planned for the afternoon. The manager said that she intends to introduce a staff photo board to keep the people at the home informed of which staff are rotad to be working with them each day. Similarly the manager said that she would be introducing pictures or photographs to help people with high communication support needs to make choices when planning meals and activities. Care Homes for Adults (18-65 years) Page 14 of 30 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 take part in a satisfactory range of activities and take part in the life of the community. People take part in planning their meals so that they are provided with food they enjoy. There is scope for increasing the use of visual aids for people who are unable to communicate verbally to assist people to express their choices more easily. Evidence: The people at the home either attend day services or receive support from staff at the home to access the community or engage in activities at home. Comments by staff and entries in peoples records indicate that people are supported to access a suitable range of activities. One persons show that in the week the prior to the inspection they had been shopping in town, out for lunch, beauty treatment and the cinema. Other examples of activities provided to people included theatre trips, parks, feeding ducks, Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: drives out, seeing singers, DVDs puzzles, games and meals out. The manager explained that plans are in place for a party with people from another home run by People In Action to take place shortly. The manager said that she intends to introduce an activities board with photographs of people involved in favoured activities to help people to remember what they have planned each day. The manager confirmed that birthdays are celebrated and where possible relatives are included in birthday celebrations at the home. Other seasonal celebrations are also celebrated such as Halloween. The manager said that a new years eve buffet was arranged to celebrate the new year. The manager explained that people are supported to keep in touch with relatives. A person at the home confirmed that they are supported to visit a relative and friend on a regular basis and further verification of relative contact was seen in peoples records. Similarly review notes show that the home encourages relatives and advocates to stay involved and support people to make plans for their future. The manager explained that the home seeks to support people to meet their religious needs were appropriate. This was verified in the records of a person who is regularly supported by staff to worship at a local church. Comments by people at the home confirmed that they are encouraged to go shopping to choose their own clothing and personal items. Staff explained that people are encouraged to develop their independence, in keeping with their personal goals. One person was seen to make a cup of coffee and another spent the morning thoroughly tidying their wardrobe with support from staff. Some people also take part in food preparation and several people said they enjoy baking cakes. Comments by people at the home confirmed that they are involved in planning the menu and that they enjoy the food provided. Recent menus indicate that people are being provided with a reasonably varied and balanced menu. A member of staff explained that the menu is planned with people every Sunday and takes account of any individual preferences and dietary needs. As previously noted the manager said that she would be introducing visual aids (e.g. photographs of meals) to help some people to make their mealtime choices known more easily. Care Homes for Adults (18-65 years) Page 16 of 30 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. The people living at the home are provided with the support they need to meet their personal and health care needs and suitable arrangements are in place for the safe keeping of medication. Evidence: The people at the home were seen to rise in an unhurried fashion in the morning and staff were observed to assist them to choose what they wanted for breakfast. Everyone was well groomed and dressed in age appropriate modern clothing indicating that staff seek to support people to maintain a good self image. One person was also seen to wear nail varnish and make up, in keeping with her care plan. All personal care tasks took place behind closed doors to preserve peoples privacy and dignity and staff were seen to knock on peoples bedroom doors and wait before entering. A baby alarm is currently used to monitor a persons seizures during the night. It is left switched on so that staff can listen in and respond should the person have a seizure. The manager said that she would research other devices that are now on the market which are designed to trigger an alarm at the point a person has a seizure and do not require staff to listen in all the time. This would be less intrusive help to preserve Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: greater privacy. Entries in records and comments by staff and the manager indicate that proper support is given for people to receive support from medical professionals. For example a wheelchair user has recently received visits form a physiotherapist to assist them to maintain the correct bedtime posture and continues to receive regular appointments with a psychiatrist to monitor their epilepsy medication. A protocol for the use of medication in the event of a seizure had been reviewed and updated and the manager said that she would be arranging for it to be promptly agreed and signed by the consultant psychiatrist. Other Health records show that people have been supported to access local health professionals for routine check ups and treatment, such as dental checks, eye tests and flu vaccinations. The home is also making use of the speech and language therapy service to assist in the development of communication aids and to help people express their needs effectively. Safe storage arrangements are in place for medication. The cabinet was tidy and well ordered. Creams are dated when they are opened so that it is possible to check when they have expired. Two creams were checked and found to be in date. A stock taking record was seen for PRN (as needed) medications. A check of a persons tablets against the stock check record and medication sheet found the number of tablets balanced correctly. The manager agreed to keep a running balance of PRN medications that are not blister packed to make it easier for staff to check the balance at a glance. Where PRN medications are given this is recorded on the medication sheet and PRN protocols are in place advising staff of the conditions under which medication should be given. One person at the home is prescribed medication to help to manage their behaviour. A sample examination of recent medication records indicates that this is not being overused and comments by staff indicate that they are aware of other strategies to adopt first, in keeping with the persons care plan. Staff at the home confirmed that they continue to receive medication training, complete a workbook and are assessed by the manager before they are allowed to give out medication. The manager keeps a report of her observations which were seen on staff files. The manager agreed to devise a written assessment form to underpin her observation reports so that it is clear which elements of the medication practices have been assessed. Care Homes for Adults (18-65 years) Page 18 of 30 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. Suitable arrangements are in place for dealing with complaints and staff are trained to recognise and report suspicions of abuse so that people are protected from harm. Evidence: There have been no complaints made to us since the last inspection and the manager reports that no complaints have been made directly to the home. The Homes compliments and complaints records contained two recent compliments from relatives regarding the service provided by the home. A complaints procedure is in place at the home and an illustrated copy of the complaints procedure is also available in the service user guide. As previously noted, the manager said that she would be sending a copy of the revised service user guide to peoples relatives so that they have up to date information (including current fees and complaints procedure). Staff training records show that staff are provided with access to Safeguarding from abuse training and whistleblowing training to equip them to recognise and report any suspicions of abuse. The manager said that she intended to reinforce the policy with staff at the next staff meeting in January 09. A copy of the organisations policy was seen to be easily available in the office. The manager stated that the homes Safeguarding policy is currently being reviewed by senior managers to ensure it Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: remains up to date. The manager agreed to seek a copy of the multi agency procedures to set the context for the homes procedures. One member of staff has been appropriately referred to Warwickshire Social Services Department under the Safeguarding procedures when there were concerns relating to activities outside the home. There have been no reported allegations of abuse involving anyone living at the home. Staff confirmed that they do not engage in physical restraint of anyone at the home though they are trained in physical Intervention in case this is necessitated. Staff training records show that staff are being provided with training to respond appropriately to any behavioural challenges that may be presented from time to time. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Positive efforts are ongoing to make the environment more homely so that people benefit from a clean and comfortable home to live in. There is scope for improving the kitchen facilities to make these more domestic in style and so that people are provided with greater opportunities to develop their cooking skills. Evidence: At the time of the site visit the central heating boiler had broken down. The manager had taken action to report the matter and sought back up heating to keep bedrooms and the lounge warm. A senior manager also provided support to arrange further back up heating for other communal areas and authorised the prompt installation of an electric shower to enable people to maintain their personal hygiene satisfactorily. The following day the manager reported that the central heating had been repaired and was fully operational again. Positive work has started to improve the environment and make it more homely and this work is ongoing. Several bedrooms have been redecorated to make them look nicer and in keeping with peoples chosen colours. Bedroom contained evidence to show that they have been supported to personalise them to their own liking with personal pictures, and belongings and other equipment, such as music players and TV Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: sets. The hallway has also been decorated and pictures have been hung in various areas of the home. Some pictures had been removed by a person at the home and the manager said that she would arrange for the pictures to be re hung with more permanent fixings so that they can not be easily removed. The kitchen is functional but not very attractive and is not specifically designed and equipped to meet the needs of the people using the service, e.g the surfaces are not adjustable to the height of wheelchair users and the large industrial style cooker is not easy for people to learn to cook on. The kitchen sink unit is rotting behind the taps where water has leaked between the seal and the sink. The manager said that she would arrange for this to be repaired. Similarly the manager agreed to address a list of other minor maintenance issue identified during the site visit. The bathrooms were clean and suitably equipped with grab rails and lifting equipment to help people with disabilities to bath safely. The manager agreed to arrange for the bath panel in one of the bathrooms to be painted, varnished or tiled to seal the wood and to make it look nicer for people. The manager also said she would arrange for the bathrooms to be painted in warmer colours to make these areas more appealing for people. The bathrooms and toilets contained soap and paper towels for people to maintain good hygiene practices and stocks of protective clothing, gloves and bags were stored in these areas to make them easy for staff to gain access to when carrying out personal care tasks. The manager agreed to arrange for a holder for a plastic soap dispenser to be hung above the sink in one of the toilets so that people did not have to walk across the room for soap, which might discourage hand washing. Cleaning schedules are in place for day and night staff to sign to record that they have undertaken cleaning and domestic tasks as required, to support the maintenance of a clean home. Care Homes for Adults (18-65 years) Page 22 of 30 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. Staff are being trained to equip them for their work and satisfactory recruitment procedures are in place to ensure that only suitable staff are employed at the home. Evidence: Staff explained that the staffing levels are amended according to the needs of the people being assessed at the time. The recent rotas show that there are typically between four and five staff on duty. Comments by staff and observations made during the site visit indicate that this enables staff to satisfactorily meet the needs of the people currently using the service. In addition to the manager there is deputy manager and an assistant manager to ensure that staff are properly supported and supervised. Three staff on duty confirmed they are being provided with ongoing training updates designed to support safe practices, such as fire safety, food hygiene, moving and handling, first aid medication and safeguarding against abuse. This was also verified in staff training records provided by the manager. Similarly the training records show that staff have been provided with a good range of training courses to support good care practices, such as equality and diversity training, positive approaches to Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: challenging behaviour, mental health awareness and makaton (sign language). Only two staff have received skin care training to date and the manager said that she would seek suitable training on this subject for other staff. There is also scope for increasing the number of staff trained in diabetes so that they have a clear understanding of this subject. In the Annual Quality Assurance questionnaire the manager reports that in the region of 35 of staff hold National Vocational Qualifications, which is less than the recommended level of staff trained in these subjects (50 ). The manager stated a commitment to address this shortfall and reports that three more staff are starting this training very shortly. An agency worker on her second shift confirmed that she had been made aware of the fire procedures and was being supported by experienced staff to get to know people and their needs. However she had still to see peoples care plans summarising their needs. The manager said that she intended to devise an induction checklist for shift leaders to follow when inducting agency staff on their first shift to ensure that all the relevant information is shared with them in a timely manner. Two staff recruitment records were checked. In both cases the records show that Criminal Record Bureau checks or POVA first (banned workers list) and two employment references have been taken up before people have started work at the home. This is necessary to ensure that people are supported by suitable staff. Care Homes for Adults (18-65 years) Page 24 of 30 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. Overall, suitable arrangements are in place for supporting the quality of the service and the safe running of the home. Evidence: The new manager has a number of years experience of working with people with learning disabilities and is currently completing the National Vocational Qualification in Care, level 4. The manager said that she also intends to complete the Registered Managers Award. The qualifications are necessary to equip managers to carry out their role effectively. Comments by staff confirmed that they receive regular planned supervision to support them in their work and identify training needs. This was also verified in staff supervision records. Similarly staff confirmed that meetings are held to discuss policy and practice issues in the home. The manager said that questionnaires have been sent to the people at the home and Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: staff to seek their views of the service. The manager explained that she is awaiting the report of the consultation process to be completed by managers at head office, so that she can see if there are any issues to addressed. Regular monitoring visits are carried out by a senior manager. The reports of these meetings show that they are used to sample and check a varied range of records and practices in the home. The reports of these meetings are passed to the manager to address any shortfalls, which are recorded in a managers action plan (seen on file). Daily medication and money checks are in place as part of the shift handover record, which also includes checking diary appointments and making plans with staff arriving on shift. The manager said she intends to develop more audit tools to support her to monitor the work of the home. Two peoples money records were seen. Staff record the reason for any expenditure and keep receipts, to account for peoples money correctly. The records are checked each month by the assistant manager and periodic audits are also carried out by staff of the Finance department. Comments by staff and people at the home confirmed that they had been shown the fire evacuation procedure and that periodic drills take place at the home. The fire safety log shows that alarms are being routinely tested on a weekly basis but there remains a need to ensure that the emergency lighting system is tested each month, as this is often missed.The new manager said that she would monitor this closely to ensure that the emergency lights are routinely tested each month. The hard wiring in the home has been tested during the last 2 years and records are in place to show that electrical equipment has recently been checked by a contractor to ensure that household appliances remain safe to use. Hot water temperatures are being routinely monitored to check that people are not placed at risk of scalding and shower heads are cleaned out each month to reduce the possibility of legionella developing in the hot water system. Fridge and freezer temperature records are being maintained for the purpose of checking that these appliances are running at the correct temperatures to keep food fresh. Care Homes for Adults (18-65 years) Page 26 of 30 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 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 Proceed with plans to add fees into the service user guide and to issue this information to the people at the home and their relatives or advocates so that everyone is clear about their rights, responsibilities and entitlements. Proceed with plans to increase the use of visual aids and pictures to assist people to make decisions and choices, e.g. to choose meals and activities. Proceed with plans to produce an activities board with photographs to remind people of their plans for the day. Arrange for a copy of the local multi agency safeguarding procedures to be made available in the home to set the context for the homes procedures and to make sure that current contacts for reporting safeguarding allegations are correct. Plans should be made to refurbish the kitchen with a view to designing and equipping it to make it easier for people to develop their cooking skills. Arrangements should be made to increase the number of staff trained in skin care and diabetes to further support good care practices in the home. 2 7 3 4 12 23 5 24 6 35 Care Homes for Adults (18-65 years) Page 28 of 30 7 42 Action should be taken to ensure that the emergency lights are tested every month as recommended by the fire officer to ensure that they are working in the event of a fire at the home. Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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