Care Home: Richmond Residential Care Home

What the care home does well Those residents spoken with said that they had been given useful information when they moved in and this had helped them to settle into the home. There are clear rules and guidelines so that people are aware of their rights while staying in the home. We looked at the assessments carried out prior to and during the admission phase. These were very comprehensive and included all aspects of the persons care including assessment of any risk factors that the person may experience in their daily life. This sort of assessment helps the staff in the home to meet the persons needs. Each person is invited to the home for visits prior to moving in so that they can be clear about the make up of the accommodation and the people living in the home. This also gives a chance for staff to get to know the person. Each resident has a care plan and these were well written and personalized. Residents said that staff supported them well and we observed staff to mix and support residents in their daily interactions.Residents said that they felt relaxed and free to come and go on a daily basis. They were also involved with staff in choosing activities they wanted and also meals. Residents said that they liked the home and that they found staff easy to talk to. One person said: `I like to spend time in my bedroom but i go and watch TV of a night time. I go for a walk sometimes. The food is good and it varies daily and you can choose. staff are good. I can talk to them. Staff give me a lift to the doctors`. One of the staff is designated to organize some activities for residents. On the day of the inspection there was a trip organized locally to an art gallery. One resident said: `Its alright here. Very busy of a morning. Staff are good - nice people. We come and go as we please. I`m having my hair done today. The staff can be busy when you want to talk but they are helpful most of the time. We have some activities and we go out. We went to Cheshire oaks recently`. Another said: `We can have visitors. My daughter comes regular to visit`. Care records evidenced that people are supported to attend GP appointments and also to attend for other health checks such as dentist and opticians. Residents said that they attend for psychiatric review and are supported in this by staff who will also provide transport. We looked at the care of one person who has poor mobility and found the care plan supported Independence by ensuring the provision of disability aids. Also the home meets with current legislation by providing disability access at all areas as well as the grounds. This shows that the home are considering a diversity of care needs and are trying to meet these.There is a complaints procedure available for people in the home. Those spoken with were very relaxed around staff and said that they were listened to so that any concerns could be addressed. Staff spoken with have received training in how to recognize and report abuse and were knowledgeable about this. The manager has had previous experience at reporting and managing an allegation of abuse and was able to relate to this.These factors help ensure that residents are kept safe. All areas seen were clean. We were invited to look at some of the residents bedrooms and found these to be very personalized and well maintained so that individual lifestyles were reflected. Those people spoken with had keys to their rooms and said that privacy was respected. Staff spoken with clearly understood the care needs of the people in the home and could explain their role in providing support. We observed the staff to be warm and supportive in their interactions with the residents and this was confirmed as consistent by speaking to residents. Staff files seen and staff spoken with evidenced ongoing support around training which is monitored through regular supervision sessions with the manager. This shows that the staff have the basic skills to care for people in the home. We asked how the service promotes peoples views and suggestions and was told about the regular community meetings so that residents can air any views or concerns. The service also canvases opinions of residents through surveys so that people can provide feedback about the service and feel more involved in the running of the home. We found that the management of health and safety in the home was good. The pre inspection information [AQAA] completed states that all safety certificates are up to date and some of these were spot checked on the inspection. This ensures that the environment for people is safe and maintained. What has improved since the last inspection? There has been no major changes to the service since the last inspection. There were no previous requirements. What the care home could do better: Residents spoken with had not got a copy of the care plan. This was discussed as it is important for each resident to understand the care plan and how staff can intervene to help them achieve any care goals they might have. The manager said he would review this. Not all areas of risk were met with consistent management. For example one resident was assessed as `risk of scalds` from hot water outlets but it was observed that there are no thermostatic controls on baths. This may be a barrier to residents having the freedom to choose when to have a bath or shower. The care is generally organized to encourage independence but currently residents arenot encouraged to do their own laundry and this could be introduced so that this area of self care is promoted. Currently none of the residents are supported to self medicate and this was discussed. The homes policy includes reference to self medication and this should be encouraged where possible. Currently there is no risk assessment available as the basis for encouraging Independence in this area. The medication storage area is new as the manager has moved into a new office and the medication storage has moved with him. The medication cupboards are secured by louvre doors and a padlock. The doors appear rather flimsy and need reviewing in terms of security. We observed that not all communal bathrooms and toilets had liquid soap provided and none had paper towels. These are strongly recommended in order to reduce the risk of cross infection in the home. Likewise the laundry was inspected and there is a lack of appropriate hand washing facilities. We also tested the temperature of the hot water outlets in one of the baths and found this to be very hot to touch and in excess of 43C which is recommended. The introduction of thermostatic controls / valves to bath and shower hot water outlets must be implemented so that residents can be more independent without incurring excessive risk of scalds. We looked at some staff files and found that the checks required for each staff prior to employment had been made and that staff were recruited thoroughly. The files did not always contain relevant identification for each staff such as photo ID and birth certificate. The manager was referred to the requirements under schedule 2 of the Care Home Regulations. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Richmond Residential Care Home 80 Penkett Road Wallasey Wirral CH45 7QW     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: Michael Perry     Date: 3 0 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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: Richmond Residential Care Home 80 Penkett Road Wallasey Wirral CH45 7QW 01516393050 Telephone number: Fax number: Email address: Provider web address: david.wakefield4@ntlworld.com Name of registered provider(s): Type of registration: Number of places registered: Milecertain Limited care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: 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: Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 20 Date of last inspection Brief description of the care home The home is a large detached house, which offers personal care to 20 residents with mental health problems. The home is decorated to a high standard, and has well cared for gardens. Both the interior and exterior of the house are well maintained. Residents lead an open flexible lifestyle within the home; some of the residents attend college and local community centres on a daily basis. The home is close to the local amenities, pubs, cafes, shops and bus station. The home has a strict policy on non-prescribed drugs and alcohol; both are not allowed to be brought into the home. The fees for the service are 421 pounds weekly. 20 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: Before we visited the home the manager filled out a form [Annual Quality Self Assessment, or AQAA] we sent and returned this. It had a lot of information about the home and how the people are supported to live their lives. We visited the home without telling the staff we were coming so that we could see how things work normally. We spoke with many of the people who live there and watched how they spend their day and how the staff support them. We looked at the records kept on people who live in the home and other records to do with how the home is run. Care Homes for Adults (18-65 years) Page 5 of 30 We looked around the home to see if it was clean and a nice place to live and some of the people living in the home showed us their bedrooms. What the care home does well: Those residents spoken with said that they had been given useful information when they moved in and this had helped them to settle into the home. There are clear rules and guidelines so that people are aware of their rights while staying in the home. We looked at the assessments carried out prior to and during the admission phase. These were very comprehensive and included all aspects of the persons care including assessment of any risk factors that the person may experience in their daily life. This sort of assessment helps the staff in the home to meet the persons needs. Each person is invited to the home for visits prior to moving in so that they can be clear about the make up of the accommodation and the people living in the home. This also gives a chance for staff to get to know the person. Each resident has a care plan and these were well written and personalized. Residents said that staff supported them well and we observed staff to mix and support residents in their daily interactions.Residents said that they felt relaxed and free to come and go on a daily basis. They were also involved with staff in choosing activities they wanted and also meals. Residents said that they liked the home and that they found staff easy to talk to. One person said: I like to spend time in my bedroom but i go and watch TV of a night time. I go for a walk sometimes. The food is good and it varies daily and you can choose. staff are good. I can talk to them. Staff give me a lift to the doctors. One of the staff is designated to organize some activities for residents. On the day of the inspection there was a trip organized locally to an art gallery. One resident said: Its alright here. Very busy of a morning. Staff are good - nice people. We come and go as we please. Im having my hair done today. The staff can be busy when you want to talk but they are helpful most of the time. We have some activities and we go out. We went to Cheshire oaks recently. Another said: We can have visitors. My daughter comes regular to visit. Care records evidenced that people are supported to attend GP appointments and also to attend for other health checks such as dentist and opticians. Residents said that they attend for psychiatric review and are supported in this by staff who will also provide transport. We looked at the care of one person who has poor mobility and found the care plan supported Independence by ensuring the provision of disability aids. Also the home meets with current legislation by providing disability access at all areas as well as the grounds. This shows that the home are considering a diversity of care needs and are trying to meet these. Care Homes for Adults (18-65 years) Page 7 of 30 There is a complaints procedure available for people in the home. Those spoken with were very relaxed around staff and said that they were listened to so that any concerns could be addressed. Staff spoken with have received training in how to recognize and report abuse and were knowledgeable about this. The manager has had previous experience at reporting and managing an allegation of abuse and was able to relate to this.These factors help ensure that residents are kept safe. All areas seen were clean. We were invited to look at some of the residents bedrooms and found these to be very personalized and well maintained so that individual lifestyles were reflected. Those people spoken with had keys to their rooms and said that privacy was respected. Staff spoken with clearly understood the care needs of the people in the home and could explain their role in providing support. We observed the staff to be warm and supportive in their interactions with the residents and this was confirmed as consistent by speaking to residents. Staff files seen and staff spoken with evidenced ongoing support around training which is monitored through regular supervision sessions with the manager. This shows that the staff have the basic skills to care for people in the home. We asked how the service promotes peoples views and suggestions and was told about the regular community meetings so that residents can air any views or concerns. The service also canvases opinions of residents through surveys so that people can provide feedback about the service and feel more involved in the running of the home. We found that the management of health and safety in the home was good. The pre inspection information [AQAA] completed states that all safety certificates are up to date and some of these were spot checked on the inspection. This ensures that the environment for people is safe and maintained. What has improved since the last inspection? What they could do better: Residents spoken with had not got a copy of the care plan. This was discussed as it is important for each resident to understand the care plan and how staff can intervene to help them achieve any care goals they might have. The manager said he would review this. Not all areas of risk were met with consistent management. For example one resident was assessed as risk of scalds from hot water outlets but it was observed that there are no thermostatic controls on baths. This may be a barrier to residents having the freedom to choose when to have a bath or shower. The care is generally organized to encourage independence but currently residents are Care Homes for Adults (18-65 years) Page 8 of 30 not encouraged to do their own laundry and this could be introduced so that this area of self care is promoted. Currently none of the residents are supported to self medicate and this was discussed. The homes policy includes reference to self medication and this should be encouraged where possible. Currently there is no risk assessment available as the basis for encouraging Independence in this area. The medication storage area is new as the manager has moved into a new office and the medication storage has moved with him. The medication cupboards are secured by louvre doors and a padlock. The doors appear rather flimsy and need reviewing in terms of security. We observed that not all communal bathrooms and toilets had liquid soap provided and none had paper towels. These are strongly recommended in order to reduce the risk of cross infection in the home. Likewise the laundry was inspected and there is a lack of appropriate hand washing facilities. We also tested the temperature of the hot water outlets in one of the baths and found this to be very hot to touch and in excess of 43C which is recommended. The introduction of thermostatic controls / valves to bath and shower hot water outlets must be implemented so that residents can be more independent without incurring excessive risk of scalds. We looked at some staff files and found that the checks required for each staff prior to employment had been made and that staff were recruited thoroughly. The files did not always contain relevant identification for each staff such as photo ID and birth certificate. The manager was referred to the requirements under schedule 2 of the Care Home Regulations. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are admitted following assessment and are given information so that they are able to make an informed choice about moving in. Evidence: We looked at the information supplied by the home at the point of people moving in. The service user guide is a useful document and is easy to read. Those residents spoken with said that this had helped them to settle into the home. There is a complaints procedure and there are clear rules and guidelines so that people are aware of their rights while staying in the home. We also looked at the assessments carried out prior to and during the admission phase. These were very comprehensive and included all aspects of the persons care including assessment of any risk factors that the person may experience in their daily life. For example on resident has poor mobility and is at risk of falling. This sort of assessment helps the staff in the home to meet the persons needs. The manager explained that each person is invited to the home for visits prior to moving in so that Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: they can be clear about the make up of the accommodation and the people living in the home. This also gives a chance for staff to get to know the person. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to make daily choices about there care although some aspects could be improved so that residents are better involved and can live more independently. Evidence: We looked at the care of two residents in some detail by looking at care records and also talking to them. Each resident has a care plan and these were well written and personalized. For example one care plan talked about the persons need to communicate anxiety and how this could be better channeled through building positive relationships. This resident said that staff supported him well and he was observed to have a good relationship with the manager and other staff present. These care plans are reviewed regularly by key workers and from looking at these it was easy to follow the care and how things were progressing. Residents spoken with had not got a copy of the care plan. This was discussed as it is important for each Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: resident to understand the care plan and how staff can intervene to help them achieve any care goals they might have. The manager said he would review this. Residents said that they felt relaxed and free to come and go on a daily basis. They were also involved with staff in choosing activities they wanted and also meals. Care records evidenced a good understanding of risk generally and how to put measures in place so that people could live as much an independent life as possible. For example the risk factors associated with one residents mobility had been well managed with suitable walking aids provided and staff awareness raised. Not all areas of risk were met with consistent management however. For example one resident was assessed as risk of scalds from hot water outlets but it was observed that there are no thermostatic controls on baths. This may be a barrier to residents having the freedom to choose when to have a bath or shower [see requirement under environment]. 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. The home activity promotes a good social life in the home so that residents can enjoy some quality of life and be supported in their daily activity. Evidence: We found the daily life in the home to be very relaxed and homely. Residents were free to occupy any of the lounge areas and these are arranged to encouraged social interaction. We observed residents relaxing in these areas and chatting and reading or watching TV. All said that they liked the home and that they found staff easy to talk to. One person said: I like to spend time in my bedroom but i go and watch TV of a night time. I go for a walk sometimes. The food is good and it varies daily and you can choose. staff are good. I can talk to them. Staff give me a lift to the doctors. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: One of the staff is designated to organize some activities for residents. On the day of the inspection there was a trip organized locally to an art gallery. One resident said: Its alright here. Very busy of a morning. Staff are good - nice people. We come and go as we please. Im having my hair done today. The staff can be busy when you want to talk but they are helpful most of the time. We have some activities and they take us out. We went to Cheshire oaks recently. The manager reported at least 22 hours for organized activity weekly. Another said: We can have visitors. My daughter comes regular to visit. The service user guide for the home gives some guidance on how the home support peoples intimate relationships and this evidences that diverse lifestyles are encouraged and supported. The care is generally organized to encourage independence. For example residents can choose when to make a drink for themselves with facilities available in the lounge. Residents are also encouraged to set tables and some will occasionally be involved in washing up. Currently residents are not encouraged to do their own laundry and this could be introduced so that this area of self care is promoted. 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. Health care is well managed although there are some issues around medicines that need reviewing so that residents can be further encouraged to be independent. Evidence: We spoke to residents and looked at care records and found that health care is accessed and supported in the home. Care records evidenced that people are supported to attend GP appointments and also to attend for other health checks such as dentist and opticians. The manager reported that a consultant from the local hospital trust visits the home to review some of the more elderly residents. Other residents said that they attend for psychiatric review and are supported in this by staff who will also provide transport. We looked at the care of one person who has poor mobility and found the care plan supported Independence by ensuring the provision of disability aids. Also the home meets with current legislation by providing disability access at all areas as well as the grounds. This shows that the home are considering a diversity of care needs and are Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: trying to meet these. We looked at the medicines and from the records and observations made it is clear that these are managed safely. Medication administration records were clear. We did not see a list of staff signatures on the records so that these could be cross referenced on the medication records. Residents reported that they recieved their medications on time. We observed residents recieving thier medicines. Staff reported that they are trained in medicine administration by both watching a training DVD which provides background information and also by being shadowed by the manager for an extensive period before being considered competent to administer medicines. This assessment of competency by the manager is not signed off and this was discussed as it is part of the accreditation process of the training and should be completed. Currently none of the residents are supported to self medicate and this was discussed. The homes policy includes reference to self medication and this should be encouraged where possible. Currently there is no risk assessment available as the basis for encouraging Independence in this area. The medication storage area is new as the manager has moved into a new office and the medication storage has moved with him. The medication cupboards are secured by louvre doors and a padlock. The doors appear rather flimsy and need reviewing in terms of security. 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. There are policies and procedures and staff are trained so that peoples concerns are listened to and reported and they are protected Evidence: There is a complaints procedure available for people in the home. Those spoken with were very relaxed around staff and said that they were listen to so that any concerns could be addressed. We looked at the complaints recorded in the complaint book. There was only one complaint recorded and this was an incident between two residents that had been managed locally by staff. We discussed ways in which complaints could be better processed individually which would be better for recording all inputs and also outcomes and would be easier to audit. The manager said he would address this. We were shown policies and procedures around the recognition and management of allegations of abuse. Copies of the locally agreed procedures were available and staff had referenced these and were aware. Staff spoken with have received training in how to recognize and report abuse and were knowledgeable about this. The manager has had previous experience at reporting and managing an allegation of abuse and was able to relate to this. This helps ensure Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: that residents are kept safe in 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 is well maintained and clean so that people living there enjoy comfortable surroundings. Evidence: We toured the home and visited some residents in their bedrooms and spoke to other people living in the home. We found the home to be relaxed and welcoming and residents spoken to and observed were clearly at home and enjoyed the positive atmosphere. All areas seen were clean and the domestic staff on duty was also observed to be interacting and supporting residents. We were invited to look at some of the residents bedrooms and found these to be very personalized and well maintained so that individual lifestyles were reflected. Those people spoken with had keys to their rooms and said that privacy was respected. The external grounds are easily accessible. We spoke with one resident who has difficulty with mobilizing and the home have made it possible for this person to move freely around the home by providing ramped access for example. This shows that the management have considered people with physical disability and have taken time to Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: ensure they can access facilities in the home. Residents said that they had access to bathrooms and toilets. These are on each floor. We observed that not all communal bathrooms and toilets had liquid soap provided and none had paper towels. These are strongly recommended in order to reduce the risk of cross infection in the home. Likewise the laundry was inspected and there is a lack of appropriate hand washing facilities. We also tested the temperature of the hot water outlets in one of the baths and found this to be very hot to touch and in excess of 43C which is recommended. One of the care plans for a resident noted that there was a risk of scalding if the resident was left unsupervised. The introduction of thermostatic controls / valves to bath and shower hot water outlets must be implemented so that residents can be more independent without incurring excessive risk of scalds. 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 recruited and trained appropriately so that the care needs of residents can be met. Evidence: There were 20 people supported in the home at the time of the inspection by four care staff [including the manager]. Care staff have flexible duties and this was shown by one staff member organizing some of the activities in the home which meant she occasionally worked flexible hours to support this. The care staff are supported by domestic staff on a daily basis. Staff spoken with felt that they were supported by the management and that there was enough staff to carry out the care needs of the residents. Staff spoken with clearly understood the care needs of the people in the home and could explain their role in providing support. We observed the staff to be warm and supportive in their interactions with the residents and this was confirmed as consistent by speaking to residents. Most staff are involved with some training. eleven of the seventeen staff have completed a National vocational Qualification [NVQ] and most other staff are on these Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: courses. Staff files seen and staff spoken with evidenced ongoing support around training which is monitored through regular supervision sessions with the manager. This shows that the staff have the basic skills to care for people in the home. We discussed the homes induction program. Currently this consists of one day full induction followed by key sessions in statutory skills such as moving and handling and recognition of abuse. It would be recommended that the current induction pro gramme is audited against the common foundation standards from Skills for Care so that any changes or additions to the current induction pro gramme can be made.The manager has already started this process. We looked at some staff files and found that the checks required for each staff prior to employment had been made and that staff were recruited thoroughly. This ensures that staff who work in the home are fit to do so.The files did not always contain relevant identification for each staff such as photo ID and birth certificate. The manager was referred to the requirements under schedule 2 of the Care Home Regulations. 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. There are management systems in place to ensure standards are monitored and the home is run in the best interests of the residents. Evidence: The manager is David Wakefield. We spoke at length and he was able to give a clear outline of the current needs of the service in supporting residents with Mental Health needs and also outline how future developments would fit in with best practice. For example the introduction of the common induction standards for staff training so that training better reflects service need. We asked how the service promotes peoples views and suggestions and was told about the regular community meetings so that residents can air any views or concerns. The service also canvasopinions of residents through surveys so that people can provide feedback about the service and feel more involved in the running of the home. The manager discussed the various internal audits that are carried out including Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: regular environmental checks and also visits by the provider who is also a daily presence in the home. The provider completes a regular inspection and report [Regulation 26 report] which provides further feedback for the manager. We found that the management of health and safety in the home was good. The pre inspection information [AQAA] completed states that all safety certificates are up to date and some of these were spot checked on the inspection. This ensures that the environment for people is safe and maintained. The Health and Safety policy is available. Staff receive basic raining in Health and Safety and this was confirmed by the available training records as well as staff interviews. 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 20 13 The medicine storage cupboards must be replaced or reinforced to ensure that they provided safe and secure storage. so medicines can be secured safely. 10/12/2008 2 27 13 All Hot water outlets in baths and showers must be fitted with thermostatically controlled valves to help ensure a safe water temperature of 43C. To ensure resident safety and encourage independent use of the facilities. 31/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 All people living in the home should have a copy of their care plan so that they can be more involved and informed about their care. Care Homes for Adults (18-65 years) Page 28 of 30 2 8 All risks assessed should be considered with respect to removing any barriers and improving residents Independence. We would recommend that residents are assessed and provided wit support to managed their own laundry where possible. There should be a record of staff signatures in the medication records for cross reference purposes. The manager should review the arrangements for residents self medicating and this should be encouraged as it promotes Independence. The process needs to have a good risk assessment process. The training around medicines needs to be signed of by the manager so that staff are accredited to undertake medicine administration. 3 16 4 20 5 30 All communal toilets and bathrooms should be fitted with paper towels and liquid soap. This also includes the laundry area. All staff files should have evidence of identity such as photo ID and birth certificate. 6 34 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 © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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