Care Home: Rathbone Centre, The

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What the care home does well The management of the home is strong, it gives residents confidence and stability in the service. The service operates in the best interests of residents, it advocates on individuals behalf to make sure that experiences are more positive when using statutory services. The home understands the importance of enabling younger adults to achieve their goals, follow their interests, and be integrated into community life and leisure activities in a way that is directed by people using the service. The service understands and actively promotes the importance of respecting the rights of people with learning disabilities. Fairness, equality, dignity, respect and autonomy are all recognized as central to the care and support being provided, the staff team employed reflect all these principles in practice. Staff have the skills to support residents make informed decisions. Residents are kept informed to enable them take risks , they learn from their own mistakes and grow as individuals. What has improved since the last inspection? The home has made improvements to the interior and exterior of the premises. Bathrooms and shower rooms were refurbished and have new blinds fitted. The front drive was re landscaped, the area for pedestrians is now safer. What the care home could do better: The service has some areas of shortfalls. We made a requirement in the report to address these. The service needs to make some improvements to documentation. Changes to individuals needs are responded to appropriately, however care plans and risk assessments must always reflect any of the changes that occur in health needs. Key inspection report Care homes for adults (18-65 years) Name: Address: Rathbone Centre, The 8 Chatsworth Way West Norwood London SE27 9HR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Mary Magee     Date: 2 7 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.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: Rathbone Centre, The 8 Chatsworth Way West Norwood London SE27 9HR 0208-670-4039 02086559568 a.preston@rathbonesociety.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Lambeth Elfrida Rathbone Society care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 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 - Code LD Date of last inspection Brief description of the care home Rathbone is a care home registered to provide care and support for six young adults with learning disabilities. It is owned and managed by the Lambeth Elfrida Rathbone Society, a registered charity. The home is accommodated in a large detached Edwardian house with lots of character and set in a leafy area of South East London. It is conveniently situated and close to public transport and the local shopping area of West Norwood. A mature well maintained garden is located at the rear. Charges for services are £ 852.29 per week. 6 Over 65 0 Care Homes for Adults (18-65 years) Page 4 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: This key inspection was completed over one day, it was announced at short notice of our impending visit to the service. We met with the manager, service manager and four support workers. We talked to three residents present. Two residents invited us to to look at their bedrooms. We toured all the communal areas. We looked at documentation supplied, the records we looked at include care plans, staff files, and policies and procedures for the home. The manager sent us a completed quality assurance self assessment report earlier in the year. We received information during the year from the manager about incidents that took place in the home. Also received was information from social workers, and from health professionals. All of this is used in the inspection report as evidence of the quality of the service. Care Homes for Adults (18-65 years) Page 5 of 30 Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 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 8 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is careful about pre admission arrangements. They make sure that no person moves to the home without having his/her needs fully assessed before moving there. Evidence: We explored the admission process for people that use the service. Before agreeing admission the home carefully considers the needs assessment for each individual person and the capacity of the home to meet their needs. One person admitted to the service has complex needs with a history of numerous placement breakdowns, and episodes of behaviors that other homes find too challenging. The management team of the home worked closely with the local authority care management team prior to the admission of the resident. They did this in order to develop appropriate guidelines and risk management strategies. Care managers spoken to during and following this admission were confident of the homes ability to support this individual despite the many risks posed. A care manager involved was spoken to earlier this year, she said, Rathbone are willing to work with the individual, and in the best interest of the person, many other homes would find the challenges too daunting. We observed the positive Care Homes for Adults (18-65 years) Page 9 of 30 Evidence: interaction between residents and staff, relationships are professional, and staff demonstrate that each person is respected as an individual. We found that staff have a good understanding of the needs of each resident. Communication with residents is excellent, behaviors and mood changes in residents staff recognize as triggers of some underlying cause. The aims of the home is to offer support to adults with learning disabilities in order that they might develop and grow as individuals and fulfill their lives as they choose. We found numerous examples of how these aims are met. Three of the residents met with the inspector individually. The home promotes dignity and respect, we were told the service makes individuals feel valued. People they find receive support that enables them to make informed decisions and avail of choices from a range of available option. We recognize the progress made by individuals and how this was achieved by a staff team that continue to work through care plans that consider individual needs and interests. The home continues to make sure that residents are placed at the heart of the service. Examples were seen of enabling and supporting individuals to pursue interests and choices were seen, further information on these in Standards 15,16. The ethos of valuing people and giving people with learning disabilities the same opportunity as any other members of the community is an objective that the home successfully achieves. Systems are in place that includes person centre approaches plus the support of a team of dedicated and skilled staff. A resident that experienced a relapse recently was admitted to hospital. The management team continued to support the person while hospitalized, and advocate on his behalf. The most recently admitted resident told us that he was consulted on the placement before he moved there. Care Homes for Adults (18-65 years) Page 10 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. The care and support arrangements at the home are good and help deliver positive outcomes for residents. Staff communication with residents is good, they have a good understanding of individuals needs and respond appropriately. Written care plans and risk assessments are not always reliable as they do not reflect changes that arise in support needs. Evidence: We selected the care plans developed with two residents. Care plans are person centred and are agreed with the individuals that choose to live at the home. Plans are written in plain language, are easy to understand and look at all areas of the individuals life. The care plan for resident A includes a comprehensive risk assessment, which was recently reviewed. Risk management is excellent, with areas of potential risk highlighted and appropriate management protocols in place to support these. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: The service demonstrates excellence in this area, it has a can do attitude and risks are managed positively to help people using the service lead the life they want, the resident is kept informed of the risks and of the outcomes. The care management team involved with the placement of resident A were confident in the ability of the home to support this person despite some of the challenges presented. Any limitations on freedom, choice or facilities were agreed and in the persons best interests. This individual understands and agrees the limitations, these are fully documented and reviewed regularly. Guidance is recorded on managing episodes of challenging behavior. There are guidelines too in place on when the resident is missing, police guidelines too on assistance to return to the home when absconding. The resident is no longer on a CPA, and a psychologist recently assessed his needs. As a result it was agreed to cease the psychology input. The care plan is person centred and tailored along the way to respond to the individual needs. Daily progress notes were viewed , these were clear and demonstrated the progress and well being of the individual. The resident told us of his input in decision making, and the information, communication and assistance provided by staff to help with this. We examined how the individual is supported with managing his finances. Support with budget management is a key area of the care planning arrangements and development need. The resident spoke of a desire to live in supported housing when he is ready. he has made good progress in the home. We found examples of resident involvement in the running of the home. An interview took place with a prospective candidate, the resident was asked to assist with this staff interview. A second resident selected for case tracking was interviewed. According to records seen the care plan and risk assessment were recently reviewed. Recently she experienced a fall, and as a result had a fracture in her foot. For the first two months she found that her mobility was very limited. Her bedroom is on the ground floor but there is no lift access to the kitchen upstairs. The resident said that she was supplied with all the necessary equipment and additional support that she needed. The resident has an allocated key worker that she finds she relates well to. She commended staff for the manner in which they supported her at this difficult time, taking meals to her room,and helping her to keep her spirits up. The care plan contains very little information on the the impact of the accident and the subsequent increase in support needs. The care plan was reviewed recently but yet it did not detail the additional support Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: needs of the resident. Care plans must be kept updated to accurately reflect any changes in need or circumstances. People living at the home know, and are able to see, the records the home holds about them. Care Homes for Adults (18-65 years) Page 13 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. The home offers younger adults the opportunity to lead meaningful lifestyles, appropriate to their peer group. The routines are flexible, non regimented. The rights and responsibilities of residents are recognized. Individuals are enabled to develop more independent living skills, pursue their goals and aspirations. Support staff play a key role in supporting individuals to achieve positive outcomes. Evidence: We found that central to the homes aims and objectives is the promotion of each individuals right to live an ordinary and meaningful life, appropriate to their peer group, in both the home and the community, and to enjoy all the rights and responsibilities of citizenship. Residents access and enjoy the opportunities available in their local community, such as using public transport, library services, the local cafes, and local leisure facilities. We heard how the service is committed to the principles of inclusion, and promotes and fosters good relationships with neighbours and other Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: members of the community. Many examples were seen of how the home demonstrates that it understands the importance of enabling younger adults to achieve their goals. Also that it enables and encourages residents to follow their interests and be integrated into community life and leisure activities in a way that they choose. One resident expresses that he prefers to when in the local community to mix with people that do not have learning disabilities, he is supported to pursue his choice. We found examples of staff helping this person achieve a lifetime ambition, they arranged and supported him to go abroad and reestablish contact with a relative. When difficulties were experienced and the outcome was not good staff continued to support the resident through this difficult period. According to residents choice and decision making the involvement of friends and families is guided by what resident chooses. The organization continues to have a strong presence in the local community and is recognized as a lead in promoting cultural and leisure activities for people with learning disabilities. Art lovers are encouraged to pursue this by exhibiting in art galleries. Rathbone run a local youth club for people with learning disabilities, many of the residents love to attend this. Support staff actively seek information to enable people to access education and work, including supported employment, and paid employment where they have the capacity. One of the residents is waiting to start employment when she is well enough. Some residents sit on the local authority forum to represent people with learning disabilities. Outcomes for people are positive, and there is evidence that they are enjoying the life opportunities that they experience while living at this home. The service actively supports people to be independent and involved in all areas of daily living in the home. We recognise that some of the people previously resident in this service have now moved to more independent living. two residents spoke of their desire to move eventually to more independent living. Residents are involved in the domestic routines of the home. They take responsibility for their own room, and laundry tasks. Residents take responsibility for shopping, planning meals, and meal preparation. Good practice include individuals being supported to be independent in daily living skills, the process following training and support. Each resident chooses meals that they like, planning shopping and preparation is done with the assistance of the key workers. Individuals have storage facilities for perishable food which is labeled and stored in suitable conditions. The key worker plays a vital role in educating residents on healthy eating. For one resident that has obesity problems the key worker promotes her welfare by encouraging weight reducing meals. Staff aim to promote meals that are well balanced and highly nutritional, however meals prepared are according to the individual tastes of residents. Residents spoken to say that they appreciate support and guidance about a Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: balanced health diet. 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. People using this service receive support that is reliable and consistent and that responds to changing needs. The principles of respect, dignity and privacy are consistently put into practice. Evidence: We found that practices in the home are flexible in response to residentssupport needs. Consideration is given to delivering the service in accordance with individual need, the diversity of residents; gender, age, sexual orientation, race, religion and disability. The evidence we gathered demonstrates that staff ensure that care is person led, personal support is flexible, consistent and is able to meet the changing needs of the residents. While speaking to three residents we gained the following views. These are that staff respect personal preferences, and that they have a sound knowledge about each individual, and their personal needs. We found that when changes take place to individuals mobility then this is responded to appropriately. However the recording is not maintained up to date on all changes that arise. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: Recently a resident had a fracture in her foot that affected her mobility. Consultation took place with relevant health professionals. Staff responded to recommendations made on the treatment and support needs of the person referred to. None of this information was reflected in the recently reviewed care plan. Also made were the changes necessary in the short term, as a result of no access to communal areas, bathing assistance. Aids and equipment were provided to encourage maximum independence for this resident. The physical and emotional health of residents is monitored closely and recorded. If there are any issues of concern or potential complications highlighted, prompt action is then taken and appropriate referrals made to health care professionals. A good example was seen of this recently. We were kept informed of the changing needs of a resident that presented in challenging behaviour. The condition deteriorated to an extent that placed the other residents at risk, an urgent hospital admission was required. Staff at the home continued to support the resident during his hospital stay and liaise with care managers and psychiatry. They are keen to ensure that representation is made on his behalf. Contact was made with the relevant authorities to make sure that no other service users experience this response. Residents are encouraged to manage their own health care including sight, oral and annual check ups. They have the opportunity to access all NHS health care facilities in the local community. Regular appointments are seen as important in the home, and there are systems to ensure they are not missed. Three residents require assistance with administration of medication. The records of the medication procedures were seen. Audits are completed of medication received every month. We are informed by the manager that this audit includes a check of medication held at the home. Two residents attend the GP and health checks independently.Support staff where required to enable the other residents attend their appointments. Evidence was present of appointments with a range of health care professionals to enable service users remain healthy. The service uses the local authority health action plans for some residents, for others simple easy to follow records of all appointments with health professionals. It is recommended that the format used for recording healthcare appointments is consistent throughout the service. 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. The home operates robust safeguarding procedures that protect vulnerable people from abuse or neglect. Residents have an open and transparent complaints procedure that is accessible to them. Evidence: All complaints made and the actions taken in response to them are fully recorded. A review of the number and nature of complaints made is used. The home learns from any areas of shortfall brought tot their attention, in order to improve its service. They pay particular attention to any themes within complaints that refer to dignity, respect, fairness, autonomy and equality. Residents say that they are extremely satisfied with the service, feel safe and well supported. Two residents did however speak of leading a more independent lifestyle by living in supported housing. We met with three staff members. They demonstrated that they know the importance of taking the views of residents seriously, and of listening to and responding to issues raised. The complaints log was examined, the service has a low number of complaints (5) in two years. The majority of complaints relate to one residents experiences. The home has robust procedures to safeguard residents from neglect or abuse. The history of the service demonstrate that management and staff are competent at Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: following the appropriate procedures if there are any concerns or issues of concern. New members of staff were introduced to the team in the last twelve months. The reports received from two practitioners familiar with the home are that staff generally can be relied upon to always take the appropriate action to respond to any concerns about a residents welfare. The staff team is managed by senior staff that have a competency at managing situations and giving due consideration to the vulnerability of the impact on other residents. There is no form of restraint used in the service. We heard from the management team that new staff members have a senior member of staff on duty to refer to should any challenging situations arise. New staff are fully vetted before they commence work at the home. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to offer a relaxed homely environment where people can feel comfortable and safe.The home has a good hygiene procedures in place. The service is not suitable for people with mobility difficulties as there is no lift. Evidence: We toured the premises, and viewed all communal areas. Two residents invited us to view their bedrooms. Bedrooms were personalized and individuals displayed items that represented their hobbies and interests. The home is in a detached spacious property with lots of traditional features. it has a large well stocked garden to the rear. The ground floor has the main office, this also accommodates the domiciliary care service too. The office we observed can be very busy. The home is well sited and closely located to public transport and shops so that people using the service can freely access community facilities and services. The main office acc The emphasis is on residents developing independence, therefore residents take advantage of developing traveling skills and using public transport to attend community facilities and services. Residents find that the home provides an environment that is homely and comfortable, and appropriate for the particular lifestyle they choose and that it meets Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: their needs. It is unsuitable for people with mobility difficulties, there is no lift. One resident had a variety of aids supplied recently to help with her mobility while she recovers from an injury to her foot. She was confined to areas on the ground floor during her convalescence. Bedrooms and bathrooms are arranged over the ground, the first and second floors. The lounge and the kitchen are located on the first and second floors. Should a resident develop long term disability in relation to mobility the premises will not be suitable. The home received a 5 star rating from a local authority food hygiene scheme and has a good cleaning regime. Perishable food items were stored under suitable conditions. Within the past 12 months the service continued with improvements. The front driveway has been widened and resurfaced, making it safer for those on foot. The home has fully redecorated and re-floored the bathroom, shower room and top floor toilet. In the kitchen work surfaces were replaced and the walls partially re-tiled. There are hard wearing carpets laid throughout communal areas. The fire system panel was upgraded recently. The service is considering the future of the service, also whether to relocate the service to a a more accessible premises. it is also evident that residents have progressed well, and may be ready for more independent living. Bathing and toilet facilities are located at convenient positions in the building. Improvements were made to the first floor bathroom with new screen and window blinds fitted. The home was clean but there were some carpet stains visible in the lounge, these should be cleaned. Interior decor was satisfactory. 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. The organization promotes equality and diversity, and reflect this fully in the staff team employed. The home seeks to employ support staff that relate well to the peer group. Vetting procedures are good and safeguard vulnerable adults. The service employs staff that have the right attributes. Staff require training and development to enable staff develop appropriate skills and knowledge. Evidence: The organization is an equal opportunities employer. Residents are involved in the recruitment process. One interview was taking place during our visit. We were told how this is used to employ the most suitable staff. By getting the views of a resident present for the interviews the information is used to inform the selection process. A person with learning disabilities reports back on skills of communication such as eye and body language from the candidate, The service seeks to employ staff that can demonstrate their qualities, and that can engage and communicate with residents. The organization has continued to pro actively target some recruitment towards people with physical or learning disabilities in order to promote a more diverse and representative staff team. The organization currently employs four people with learning disabilities and three people with physical disabilities, some of these staff Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: work at the home. The service recognizes that support staff need to be more representative of peer/age of resident group. It has achieved this, but as a result it has experienced a number of changes in the regular team. The new staff require more training and development to equip them with suitable skills. We examined the personnel files for three new support staff. Application forms were fully completed with supporting documentation held alongside.For each new member of staff there was evidence of the receipt of references, an Enhanced CRB Disclosure, proof of work and immigration status, as well as proof of identity. Also retained were outcomes of interviews. Each staff member had a copy of job description and a contract of employment. Three of the new support workers had previous experience with this client group and have settled in well in the team. Residents spoken to were positive about new staff members and find them to be supportive in their role. Management were satisfied that new support staff were qualified and experienced, and that this was demonstrated at interviews and in references. Documentation was not on all of the files to provide evidence of the training and qualifications held by new staff members prior to appointment. We received evidence of this following the inspection. We heard from the manager of the skills within the staff team and of the training given. According to the information we received, staff receive a full induction upon joining the organization, components of which are an introduction to Rathbone and CQC policies and procedures and risk assessments. The service risk assessments cover all aspects of risk that a worker may be exposed to including likely contact with substances hazardous to health, medication and potential abuse. Additional activity and manual handling risk assessments are completed where necessary. Staff are expected to shadow experienced members of staff for at least two weeks before commencing work independently. There was a lapse seen in the training provision, service has not provided as much training as usual in 2009. We found that several areas are overdue, but that these are planned for December 2009 early 2010. We were informed that December training was completed before this draft report was written. December training included First Aid, and fire training. Four of the six support workers have achieved NVQ level 2 in care, one worker has NVQ level 3. The service should ensure that support staff have received the planned training by the end of January 2010.. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is well run, and is managed in the best interests of residents. Effective systems are in place to evaluate the service, gain residents views and inform future planning. Evidence: The manager has 15 years experience in the field, he has NVQ4 and is RMA qualified. He has been in post for 6 years and knows the user group, families and professionals involved in the care of the residents of the project. We received comments from a number of social care professionals over the year , they all report on his ability to act in the best interest of the resident. We found throughout the inspection that residents have confidence in the management. Residents we spoke to said,We find him patient, I am often demanding, but he always listens to me. The manager as deputy director is involved in a number of other organisational projects too. All complaints by residents and families are taken seriously and dealt with sensitively and within agreed timescales. The service have worked hard to ensure that there is an effective quality assurance Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: process, and that it is appropriate to the needs of residents. They developed a forum for all people using Rathbone services, this includes residents at the home and outreach service. The process consists of a service user consultation day, and is facilitated by an independent facilitator for these days. Recommendations and comments from this process have resulted in direct changes to the staff handbook, and the organizations working practices. All records are constructed and maintained in accordance with the Data Protection Act 1998. The health and welfare of residents and staff are promoted. Health and Safety procedures including Fire Safety and COSHH are taken very seriously. We viewed the following records, records of regular fire drills, and that fire alarm and fire fighting equipment is regularly services and maintained. Risk assessments for the premises are reviewed and updated as necessary on a regular basis. Designated workers have responsibility for particular areas, and their regular checks and findings are passed to the manager, and monitored via formal supervision. All staff receive training on health and safety. We recommend that health and safety audits are undertaken at frequency recommended in accordance with health and safety policies and procedures procedures. The staff team undertook fire safety training early December 2009. Some residents still access their money from personal accounts via bank cards, support staff assist them to undertake this. This has the potential to lead to financial abuse. We heard that the service plans to address this issue. The manager said that those that need support to access their money should be asked to change to book accounts to reduce the risk of financial abuse. 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 1 6 15 Care plans and risk assessments must be kept under review, updated to accurately reflect any changes in need or circumstances. To reflect clearly and accurate any changes that arise 31/12/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 It is recommended that the format used for recording healthcare appointments is consistent throughout the service. The lounge carpet is stained, and should be cleaned as part of the cleaning programme Appropriate supporting documentation in relation to training and qualification delivered should be confirmed by the end of January 2010. it is recommended that health and safety audits are undertaken at the frequency recommended in health and Page 28 of 30 2 3 30 35 4 42 Care Homes for Adults (18-65 years) 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 safety procedures. 5 42 Residents that need help with accessing cash from machines should be discouraged from this to avoid the potential of financial abuse. Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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