Care Home: Robert Street (12)

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What the care home does well We talked to people who live at the home. They told us they are very happy living at the home; they also told us they always make decisions about what they do each day. One person said, "It`s very nice here." Another person said, "It`s good. We choose what to do and when to go out." The home successfully promotes independence and involves everyone in all aspects of daily living. Each person has their own menu which has been planned with support from staff. People cook meals individually; some evenings people cook independently and other evenings they cook with support from staff. People told us they have lots of opportunities to go out and enjoy their daytime activities. People live in a homely, pleasant and safe environment and are given real ownership of their home. The majority of staff have worked at the home for many years and know people very well. The staffing consistencies have provided people with stability and continuity of care. People who live at the home told us staff treat them well. One person said, "The staff are really nice." Another person said, "It`s good because we always mix with the staff and they make you laugh." People said the home is well organised and eveyone is involved in the running of the home. What has improved since the last inspection? At the last inspection we identified that the ceiling in the dining room needed repainting and doors were being wedged open. The dining room has been decorated and doors are no longer wedged open. Staff and the manager told us training has improved. A new training manager has been employed, and they identify when training is due and notify staff and the home. One staff said, "Opportunities are quickly made to fulfill all training needs." Another staff said, "We receive very good training packages." What the care home could do better: More information should be recorded about what people have been doing. This will provide evidence as to whether a person`s needs are being successfully met and make sure their quality of life and welfare can be properly monitored. Care plans should be easier to use so they are better working tools and people`s needs are properly identified. Any incidences of medication errors must be reported and advice should be soughtfrom appropriate healthcare professionals. This will make sure the risk to people is minimised. The registered provider must make sure the home has a more robust system for recording, reporting and dealing with incidences that affect the well being of people who live at the home. This will make sure incidents are properly managed and people`s safety is protected. Any incidences that affect the wellbeing of people who live at the home must be reported to CSCI. This will make sure we can monitor people`s welfare. The registered provider should have better systems in place to make sure monthly visits are carried out by a representative of the organisation. This will make sure the quality of the service is properly monitored. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Robert Street (12) 12 Robert Street Harrogate North Yorkshire HG1 1HP     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: Carol Haj-Najafi     Date: 2 0 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Robert Street (12) 12 Robert Street Harrogate North Yorkshire HG1 1HP 01423541888 01423541889 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Henshaws Society for Blind People Name of registered manager (if applicable) Miss Emma Claire Brook Type of registration: Number of places registered: 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: 5 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 category: Learning Disability Code LD, maximum number of places 5 Date of last inspection Brief description of the care home Robert Street is a large terraced property occupying three floors. It provides accommodation in five single rooms, on the two upper floors, for adults under 65 years of age with a learning disability and visual impairment. Communal space is provided on the ground floor. There is a small garden area to the rear of the premises. The home is close to the centre of Harrogate with easy access to all local facilities. Information about the home and details of fees can be obtained directly from the home. Care Homes for Adults (18-65 years) Page 4 of 32 care home 5 Over 65 0 5 Care Homes for Adults (18-65 years) Page 5 of 32 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: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations- but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The last key inspection was carried out in January 2007. Before this unannounced visit we reviewed the information we had about the home which included an annual quality assurance assessment (AQAA) that the manager completed. We used this information to help us decide what we should do during our inspection visit. Care Homes for Adults (18-65 years) Page 6 of 32 Surveys were sent out to people who live at the home and other people who have an interest in the service. We received 4 surveys from people who live at the home, 3 staff and 1 care management survey. Comments from the surveys have been included in the report. One inspector was at the home over two days. The first day we were at the home between 10:00am and 2:00pm. We spoke to the manager, looked at communal areas of the home, and looked at care plans, risk assessments, daily records and staff records. The second day we were at the home between 3:00pm and 6:00pm, and spoke to the people who live at the home and three staff members. People who live at the home showed us their bedrooms. We spent a total of 7 hours at the home. The manager confirmed that the weekly fees for the home range between 741 and 790 pounds. Feedback was given to the manager at the end of the visit. What the care home does well: What has improved since the last inspection? What they could do better: More information should be recorded about what people have been doing. This will provide evidence as to whether a persons needs are being successfully met and make sure their quality of life and welfare can be properly monitored. Care plans should be easier to use so they are better working tools and peoples needs are properly identified. Any incidences of medication errors must be reported and advice should be sought Care Homes for Adults (18-65 years) Page 8 of 32 from appropriate healthcare professionals. This will make sure the risk to people is minimised. The registered provider must make sure the home has a more robust system for recording, reporting and dealing with incidences that affect the well being of people who live at the home. This will make sure incidents are properly managed and peoples safety is protected. Any incidences that affect the wellbeing of people who live at the home must be reported to CSCI. This will make sure we can monitor peoples welfare. The registered provider should have better systems in place to make sure monthly visits are carried out by a representative of the organisation. This will make sure the quality of the service is properly monitored. 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 32 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 32 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. Peoples needs are properly assessed before they move into the home and they are assured their needs will be met. Evidence: The same people have lived at the home since the last inspection. At the last inspection we made a judgement that peoples needs would be properly assessed prior to admission. In the AQAA the manager explained the procedure when people move into the home. This includes, providing relevant information in their Service User Guide, arranging for people to visit the home and meet other people who live at the home, setting up and maintaining care plans and having initial review meeting to see if people are happy in the home. The home has a vacancy but as yet has not received a suitable referral so as yet they have not identified who will be moving in. Care Homes for Adults (18-65 years) Page 11 of 32 Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are encouraged and supported to take control of their lives. The care planning process is effective but the recording systems are complex. This restricts how the plans are used as a working tool and could lead to peoples needs being overlooked. Evidence: We talked to people who live at the home. They told us they are very happy living at the home; they also told us they always make decisions about what they do each day. One person said, Its very nice here. Another person said, Its good. We choose what to do and when to go out. People attend regular house meetings and talk about the home and how things are running. People who live at the home told us they all make decisions at the house meetings. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: The majority of staff have worked at the home for a long time and know the people who live there very well. They talked about peoples individual needs and gave good examples of how they provide person centred care. In the AQAA the manager told us they consult people who live at the home and make sure they participate in all aspects of life in their home. We asked the staff what the home does well; they all said the home encourages independence, and makes sure people have choice and can make decisions about their life. One staff said, Were good at helping people make decisions and achieve their goals. Another staff member said, We make sure people are happy and create opportunities. The home has a keyworker system, which staff and people at the home said works well. People who live at the home said they talk to their keyworker about what they want to do. One person said, I sit with (name of keyworker), and go through my file and decide what to do. We looked at three peoples care files. These contain some good information but not all care needs are identified. There was not sufficient information about peoples skills and support needs for general daily living. One person needs help when cleaning around the house. It was identified at a staff meeting and in a monthly summary that they need staff to be there when they do the cleaning but this is not recorded in the persons care plan, risk assessments or objectives. Each persons file contains a number of sections. These sections then have subsections. For example, a persons medical record has five additional sections to record appointments; staff said sometimes it could be confusing where to record the information. People have an individual service plan section. One person has information in their current file about boundaries. Their plan states see risk assessment. The manager acknowledged the information was no longer relevant and the risk assessment had been archived. Staff said it is hard to keep everything up to date because they handwrite each section. The files contain so much information that it is difficult to establish where everything is recorded. A complicated system limits ownership of the plan and its effectiveness as a living document. Everyone has an annual review. The review reports contain good information about peoples abilities and the support they need. Although not all key areas of need are covered these provide good information. Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: Individual objectives are identified and agreed with each person. These are seen as important tools to help people make decisions, and develop and maintain skills. Some of these were not used as effectively as they could be. The manager said these should be reviewed monthly. One persons objectives were last updated in August 2008. Another persons objectives, which were agreed before September 2007, had not been effectively reviewed. They had agreed to visit a specific place on a regular basis but had not visited it for over seven months. Staff record important information about people and should also record what people have been doing. These records are not filled in on a regular basis so it is not possible to monitor if peoples needs are being met. For example one persons record over a six-week period only contained five entries, only one of which contained details about the persons welfare. Other entries referred to change in review dates, a relative phoning, support in packing to go home and artwork. Another persons record had no entries for two weeks. One person had gone out to visit a friend but this was not recorded on the activity sheet or in their file. Monthly reviews contain a lot of information about what the person has been doing and if they have achieved their objectives. However, these were based more on the knowledge of the staff rather than what has been recorded the previous month. One persons monthly review stated that the there had been a decrease in activity at the home but there was no evidence to support this. The review also stated that the persons emotions had been all over the place but again there was not enough evidence to support this. Another review stated that there had been an increase in a pattern of behaviour but this was not evidenced. There should be sufficient information to monitor peoples welfare and determine if needs are being met. People who live at the home benefit in many ways because staff have worked at the home for a number of years and know people very well. The manager said this could be a reason that the care planning process was not as effective as it should be. The home has a very good system for promoting independence and assessing risk. The person and their keyworker identify goals. They then decide what support is required and whether to make a referral to the organisations rehabilitation team. People who live at the home talked about the support they had received from the rehabilitation team. One person who lives at the home told us they had recently Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: started using the oven independently and they can now make a variety of meals. Two people who go shopping together discussed the assessment process. This included using public transport, accessing specific shops and purchasing goods. They said it was very good because it gave them confidence and made sure they are safe. The risk assessments are reviewed regularly. Care Homes for Adults (18-65 years) Page 16 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home have a fulfilling and stimulating lifestyle. The home successfully promotes independence and involves everyone in all aspects of daily living. Evidence: People told us they enjoy living at Robert Street and have lots of opportunities to go out. One person said they enjoy going to Karaoke at the local pub with staff. Another person said they like going out with their friend but also like going out with staff. In the AQAA the manager told us they enable people to access an Arts and Craft Centre, Harrogate College, a Hydro swimming pool and other day centres/courses of their choice. People told us they enjoy their daytime activities. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: People also said they can spend time alone or with others. One person said they sometimes sit with staff and watch TV on an evening. People who live at the home told us they make decisions about what they do and choose what to do on an evening and weekend. They said they get up and go to bed when they want. As stated in the previous section, the home has a good system for assessing risk and promoting independence. Everyone talked about the specialist input from the rehabilitation service and said it is a very good service that successfully helps people develop their independence. In the AQAA the manager told us they support people to maintain appropriate contact and develop relationships with their family and loved ones. Daily records showed us that staff contact family members when it is appropriate. People are supported to be involved in all areas of daily living. Everyone told us they take responsibility around the house and cook their own meals. Each person has an allocated day when they do their food shopping and clean their room. They also are responsible for cleaning communal areas. Each person has their own menu which has been planned with support from staff. People cook meals individually; some evenings people cook independently, other evenings with support from staff. Staff told us they encourage people to look at nutrition when people are planning meals. Care Homes for Adults (18-65 years) Page 18 of 32 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. In the main, peoples health and personal care needs are well met although medication systems must be tightened to make sure people get the right advice from healthcare professionals. Evidence: Staff said the home is good at meeting peoples personal and healthcare needs. People who live at the home said they receive appropriate support with personal care. One person told us that staff have supported them to become more healthy in the last year. We looked at information that showed us peoples health is properly monitored. Healthcare records have good information about appointments and showed us that staff are vigilant and look for changes in well-being. We received a care management survey which told us the last review showed the persons placement at Robert Street was very satisfactory. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: The home supports people with medication administration and those who choose to self medicate. Systems are in place to make sure people can administer their own medicines safely. They are given a weeks supply of medication which is kept safe in a locked drawer in their room and risk assessments are in place. All staff have completed medication training Daily records contained details of two medication errors. One stated medication was found on the stairs and disposed of. Another stated that medication was not administered at the prescribed time. There was no evidence that staff had contacted a healthcare professional to seek guidance on the appropriate action to take. There was no evidence that this was reported to senior management or documented on an incident form. CSCI had not been notified of the errors. The lack of seeking professional advice could put people at risk. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are safeguarded. People are confident that they will be listened to and that appropriate action will be taken when necessary. Evidence: Surveys from people at the home told us they know who to speak to if they are unhappy. People said they talk to their keyworker, staff or the manager. Staff surveys told us that they know what to do if people have any concerns about the home. The manager confirmed they have not received any complaints since the last inspection and they have not had any safeguarding incidents. The manager said all staff have attended safeguarding training. Staff were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They were also able to describe the different types of abuse. Staff said they would report any concerns to the management team and they were confident they would deal with them promptly and appropriately. We looked at personal allowances for two people. The money held corresponded with the financial record. Personal monies are held individually and each person has a Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: record of transactions. Staff check these to make sure they are correct. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely, pleasant and safe environment. Evidence: People are given real ownership of the home. Each bedroom is personalised and people said others only come in when they are invited. Bedrooms are very different and reflect peoples tastes. People said they like their rooms. Communal areas are also personalised. Photographs are displayed and there are various items that have been made by people who live at the home. Everyone has a key to their room and the front door. Surveys from people who live at the home told us the home is always clean. We looked around the home which was tidy and looked homely. It was clean in some areas but other areas needed deep cleaning. Some paintwork and areas in the kitchen were dirty. The manager said they do not employ domestic staff, and people who live at the home would struggle to do the deep cleaning tasks. Staff do help clean the home but have limited time. The manager agreed to look at how best to deep clean the house to make sure the premises are hygienic. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: The home is well maintained, and furnished and, in the main, decorated to a reasonable standard. One bathroom was being re-plastered because there was a problem with the wall. Another bathroom had wallpaper coming away from the wall and needed decorating. The fire in the lounge did not work. Some people said the home was generally warm enough but sometimes downstairs was cold. At the last inspection we identified that the ceiling in the dining room needed repainting and doors were being wedged open. The home has addressed these areas. We checked water temperatures around the home. These were generally satisfactory. The hot water from one bath outlet was only 40c. The manager spoke to a contractor about this on the day of the inspection. In the AQAA the manager said equipment has been serviced or tested in line with manufacturers guidance or regulatory body. We looked at electrical equipment and fire equipment test dates; these were all up to date. Care Homes for Adults (18-65 years) Page 24 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are supported by a skilled, competent and caring staff team. Evidence: People who live at the home told us staff treat them well. One person said, The staff are really nice. Another person said, Its good because we always mix with the staff and they make you laugh. Surveys from people at the home told us the carers always listen and act on what they say. The manager and staff told us the home has a low turnover of staff and the staffing consistencies have provided people with stability and continuity of care. Staff told us staffing levels were good. All staff surveys said there are always enough staff. Currently the organisation only employs a manager and support staff to work at Robert Street but are in the process of recruiting a support worker with additional responsibilities. Everyone thought this would be beneficial to the home because then in the absence of the manager, a senior person would be available to make everyday Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: decisions. Staff said they enjoy working at the home and everyone works well together. Several people talked about the good atmosphere and good teamwork. Staff also said everyone has a good understanding of their role and they regularly meet with management to discuss how they are working. Staff said training and training opportunities are very good. Staff told us they receive training that is relevant to their role, and helps them understand and meet the needs of people living at the home, and keeps them up to date with new ways of working. When asked what the service does well. One staff said, Opportunities are quickly made to fulfill all training needs. Another staff said, Very good training packages. People said training had improved in the last year. A new training manager has been employed, and they identify when training is due and notify staff and the home. We looked at training records which confirmed people attend a good range of training courses. Only one staff member has not yet completed NVQ level 2 or above. A member of staff that has worked at the home for nearly a year talked about the recruitment and induction process. They confirmed that they attended an interview, and had to wait for a criminal records check and satisfactory references before they could start work. They also discussed the induction process which they said was very good. All staff surveys said their employer carried out checks, such as their CRB and references, before they started work. Care Homes for Adults (18-65 years) Page 26 of 32 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. The home is well managed and everyone feels well supported. People are safe but incident reporting is not always robust which could place people at risk. Evidence: People told us they are happy with how the home is managed. They said the home is well organised and eveyone is involved in the running of the home. The registered manager has completed the registered managers award, and is starting a management development programme with several modules, which will include recruitment, grievance, budgeting, and equality and diversity. People who live at the home attend regular meetings and are asked to comment on the quality of the home. We asked to look at monthly visit reports (Regulation 26 reports). A representative of the organisation should carry out visits to check that people are receiving a good Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: service. The last visit to Robert Street was in October 2008. Visits should be carried out at least monthly as part of the quality monitoring process. The manager usually tells us about important events that happen at the home. Since the last inspection we have received notifications when significant events have occurred. However, as stated under the personal and healthcare section, we were not notified when there were medication errors. We also established when medication errors occurred the reporting process was not satisfactory. The manager said an incident form was not completed when medication was found on the stairs but staff had completed an incident form when medication was not given at the correct time. There was no reference to the form or a copy of the form at the home. Forms are sent to the organisations head office and then returned when they have been seen by senior management. The organisation could not locate the incident form. The home should have a better recording and reporting process that evidences what action has been taken following an incident. The organisation should also have a better system for receiving and returning incident forms. This will make sure incidents are properly monitored, and the right people are made aware of significent events that occur in the home. No concerns around safe working practices were seen on the day of the inspection. In the AQAA the manager told us they have all relevant policies and procedures in place. Care Homes for Adults (18-65 years) Page 28 of 32 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 29 of 32 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 12 Sufficient information must be recorded about people who live at the home. This will provide evidence as to whether a persons needs are being successfully met and make sure their quality of life and welfare can be properly monitored. 31/03/2009 2 20 13 Any incidences of medication 31/03/2009 errors must be reported, properly recorded and advice sought from appropriate healthcare professionals. This will make sure the risk to people is minimised. 3 42 12 The registered provider must make sure the home has a robust system for recording, reporting and dealing with incidences that affect the well being of people who live at the home. 31/01/2009 Care Homes for Adults (18-65 years) Page 30 of 32 This will make sure incidents are properly managed and peoples safety is protected. 4 42 37 Any incidences that affect the wellbeing of people who live at the home must be reported to CSCI. This will make sure peoples welfare can be properly monitored. 31/03/2009 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 2 6 24 Care plans should be easier to use so they are better working tools and peoples needs are properly identified. All areas of the home should be decorated and maintained to a reasonable standard. This will make sure people live in a pleasant and safe environment. Systems should be in place to make sure, on occassions, the home is cleaned thoroughly. This will make sure people live in a clean and hygienic environment. The registered provider should have better systems in place to make sure monthly visits are carried out by a representative of the organisation. This will make sure the quality of the service is properly monitored. 3 30 4 39 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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