Care Home: Salingar House

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What the care home does well The home always ensured that peoples` needs were assessed prior to admission. This enabled staff to be sure the home could meet the persons` needs and gave them direction in how to care for them. Although the home had not had any new residents since the last inspection the process remained the same. Staff were clear about how they promoted peoples` independence and choice and provided care to people in ways that respected privacy and dignity. The staff members knew the residents well and were observed speaking to people in a courteous manner. Management and staff have developed very good relationships with residents and encourage them to maintain contact with family and friends. A resident said in a survey, `sometimes I visit my friend and sometimes she visits me`. The atmosphere in the home was relaxed and friendly and there were lots of signs of wellbeing. Residents enjoy a range of leisure pursuits and holidays tailored to meet their needs. Salingar House provides a spacious and pleasant environment for people. It is clean, warm, well presented and has plenty of communal space. Residents have either their own flat with a separate kitchen, a flatlet with kitchen area added to the living space, or their own en-suite bedroom. One person said, `I keep my flat tidy and I have my own washing machine`. The home provides nutritious and well planned meals for people and has won a healthy heartbeat award for the last two years. Catering staff scored 85 percent in the local authority`s food safety management assessment, which was a very good achievement. The home has a complaints procedure and manages to sort out niggles quickly before they escalate into complaints. The local authority has a good recruitment, induction and training programme. Staff members all say they receive the training required for them to complete their jobs. There has been a very low staff turnover in the last year, which means there is consistency for residents and the staff team as a whole. Staff members told us they received regular supervision and felt supported by the manager. What has improved since the last inspection? The homes quality assurance system has improved and there was evidence that people were consulted about the running of the home. The manager confirmed that staff have received safeguarding of adults training and in discussions staff were clear about what to do if they witnessed any poor practice or abuse. What the care home could do better: Care plans could be made even more personalised as staff know the residents really well but don`t always write this information down. There are also other documents in the care files that have information and guidelines for staff about behaviour management. The information could all be pulled together and written in personcentred care plans. Although health care needs of residents were met, the health action plans produced by staff should be broadened to include the full range of health needs the person has. This will enable staff to plan appointments and health care in a more systematic way. Nutritional risk assessments should also be part of the initial and ongoing assessment process. This will help staff to focus attention on particular needs as they arise so care won`t be missed. `As directed` instructions on the Medication Administration Record should be made clearer so staff can be sure they are following the prescriber`s instructions. Residents had access to a range of community facilities but evening and weekend leisure pursuits were limited. This should be explored with staff and residents to try to address and enable residents wishes to be accommodated. The manager should ensure that the action plan produced to complete refresher mandatory training is carried out. This will ensure staff have up to date skills and knowledge. It is acknowledged that flooding of the training centre has affected the training programme. Care staff members should have a minimum of six formal supervision sessions a year. This will give them the opportunity to discuss things at regular intervals and enable supervisors to monitor their practice. Key inspection report Care homes for adults (18-65 years) Name: Address: Salingar House 2 Logan Close Midmere Avenue Kingston Upon Hull East Yorkshire HU7 4DG     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: Beverly Hill     Date: 1 2 0 8 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 32 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 32 Information about the care home Name of care home: Address: Salingar House 2 Logan Close Midmere Avenue Kingston Upon Hull East Yorkshire HU7 4DG 01482825778 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Catherine.spivey@hullcc.gov.uk Kingston upon Hull City Council care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Salingar House is situated on the Bransholme estate in Hull. There are a variety of local community facilities close at hand. The home is close to a bus route. The home offers long term and respite care to a maximum of eleven people of either gender whose primary need is a learning disability. It is a Local Authority run home. The environment is warm and friendly and the care provided is based on individual need. The home consists of three self-contained flats and eight single bedrooms - four of which have mini kitchens. Four of the bedrooms have en-suite bathrooms (with toilet and bath) and the other four have en-suite bathrooms (with toilet and shower), all meeting the minimum requirements regarding living space. The communal areas consist of a lounge, a dining room, a rehabilitation kitchen and an Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 11 Brief description of the care home area designated for arts and craft work. There is a private garden with seating accessed via the dining room. Car parking is available at the rear of the property. The weekly charge payable by people to live in the home is between 61 pounds and 94 pounds. Placing authorities from which people originate make supplements to the weekly fee. The private fee would be 951 pounds a week. Respite care ranges from 47.53 to 83.09 per week dependent on the age of the person. Information about the home, and the services it provides, is available in the homes statement of purpose and service user guide. These documents are displayed in the home and available from the manager. 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: The quality rating for this service is 2 stars. This means that the people that use this service experience good quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last Key Unannounced Inspection on 7th August 2007 and Annual Service Review on 9th June 2008. It includes information gathered during a site visit to the home, which took approximately eight and a half hours. During the day we spoke to people living in the home to find out what life was like for them at Salingar house. We also spoke to the registered manager, care staff, a programme worker and a visiting health professional. Information was also obtained from surveys received from residents (completed with assistance from their key workers), staff members and a visiting health and social care professional. Comments from the surveys and discussions have been used in the report. Care Homes for Adults (18-65 years) Page 6 of 32 We looked at assessments of need made before people were admitted to the home, and the homes care plans to see how those needs were met while they were living there. Also examined were medication practices, leisure and occupational pursuits, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. We would like to thank the people that live at Salingar House, the staff team and management for their hospitality during the visit, and also thank the people who completed surveys and had discussions with us. 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 the 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. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Care plans could be made even more personalised as staff know the residents really well but dont always write this information down. There are also other documents in the care files that have information and guidelines for staff about behaviour Care Homes for Adults (18-65 years) Page 8 of 32 management. The information could all be pulled together and written in personcentred care plans. Although health care needs of residents were met, the health action plans produced by staff should be broadened to include the full range of health needs the person has. This will enable staff to plan appointments and health care in a more systematic way. Nutritional risk assessments should also be part of the initial and ongoing assessment process. This will help staff to focus attention on particular needs as they arise so care wont be missed. As directed instructions on the Medication Administration Record should be made clearer so staff can be sure they are following the prescribers instructions. Residents had access to a range of community facilities but evening and weekend leisure pursuits were limited. This should be explored with staff and residents to try to address and enable residents wishes to be accommodated. The manager should ensure that the action plan produced to complete refresher mandatory training is carried out. This will ensure staff have up to date skills and knowledge. It is acknowledged that flooding of the training centre has affected the training programme. Care staff members should have a minimum of six formal supervision sessions a year. This will give them the opportunity to discuss things at regular intervals and enable supervisors to monitor their practice. 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 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. People continued to have their needs assessed prior to admission to the home. This enabled staff to decide whether they could meet the persons needs and to check out compatibility with other residents. Evidence: There has been no changes to the pre-admission assessment process since the last inspection. People are only admitted to the home after a full community care assessment has been completed by the local authority with input from health professionals when required. There had not been any new admissions to the home since the last inspection but the manager described the admissions process. This involved ensuring assessments were obtained to assist in deciding whether the home was the most appropriate place to meet the persons needs. Staff would consider the persons compatibility with other residents. Trial visits would be arranged over a period of time during the new residents introduction to the home to enable them to meet other residents and staff. The visits would include overnight stays. The manager would continue to make visits Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: to the person and their home to complete care planning information. We looked at three care files during the visit to confirm that the above process had been carried out. They included a full range of assessments and care plans. The information enabled care staff to formulate detailed plans of care to support the person and meet their needs. 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 had their assessed needs planned for, which took into consideration areas of risk management. This enabled staff to have clear guidance in how to support people and helped to ensure that care was not missed. Evidence: We examined three care files during the day and each contained a wealth of information from assessments, risk analysis, profiles and personal histories to enable staff to formulate plans of care. Care files were organised and information was easy to locate. The care plans seen were in two parts and part one detailed a list of daily living activities at one side, for example personal care, with a tick box selection of, always, usually, sometimes or never to indicate how much support the person required. There was then scope to comment in a summary box. Part two detailed the individual activity and what staff had to do to assist the person to complete it. Generally these were completed well but staff could make them even more personalised by adding information about preferences, likes and dislikes that are included in personal profiles and other parts of the care file. There were clear instructions for staff and they did Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: describe what the person was able to do for themselves. For example one care plan for personal care told staff that after shampoo was applied the resident rubbed this in himself and he washed his own hands and face. The care plans included specific information from health professionals. Separate from the care plan, but in the same care file, were behaviour guidelines on specific topics. For example one person had these for care at night, eating and swallowing, personal care and some behavioural issues. To improve, this information could be incorporated into the main care plan so all the information is in one document. This would ensure that new care staff could obtain all the relevant information they need to support the person from the care plan. To improve the care plans further, they could be more person centred and developed in a format more easily understood by the residents to enable them the opportunity to contribute to them more thoroughly. However, overall the care plans detailed peoples needs, were kept under review and updated when changes occurred. Risk assessments were completed for a range of activities and issues. These were kept under review. The risk assessments enabled the staff team to look at areas that posed a risk and put plans in place to minimise it. This supported people to be as independent as they were able and to make choices about their way of life. Surveys from staff did comment that more could be done to promote greater independence for some residents and this was discussed with the manager. She was aware of this and was looking at how to address it. In daily recordings there was evidence that people were able to make choices about aspects of their lives. The recordings also reflected the care that staff provided during each shift. There were no set routines about rising or retiring although some residents had their own clearly defined routines and preferred these without any changes. In discussions staff were very clear that Salingar House was the residents own home and this was to be respected, we have to ensure as much choice as possible - ask people and reinforce it in meetings and one person likes to choose particular staff each day for particular tasks. They told us that residents had a choice of male or female carer. Residents have monthly meetings and minutes seen showed that they had input into how some of the services were provided. They were asked for suggestions about outings, whether there were any concerns or complaints, preferences for holidays and information about new furniture and staff/management changes was shared. Information from other relevant meetings was also shared with residents. Care Homes for Adults (18-65 years) Page 14 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 were supported to live enriched lives by maintaining contact with family and friends, accessing community facilities, participating in life within the home and making choices for themselves. Evidence: There was evidence that people were supported to live enriched lives. Some comments in surveys were, I have lots of friends here, I like living here, sometimes I visit my friend and sometimes she visits me, sometimes I dont want to go out, I have just been to Butlins for my holiday and I would like to go to CASE in the evening but its not open. Each resident had a weekly programme that they had helped to develop. This included housekeeping activities such as laundry and tidying their bedrooms, but also included leisure activities and in some cases occupational pursuits. People accessed community Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: facilities such as, sheltered workshops, gardening clubs, swimming, bowling, local and city shops, and pubs and cafes. One person was a member of a walking club with Mencap, another liked to attend church and other people attended a city farm to learn how to care for the animals. In-house activities were built into the programmes such as art and craft sessions and work completed was on display in the home. Residents signed agreement to their programmes when they were able. One resident stated in a survey, I like to follow my timetable - I helped to make my timetable. The home had a rehabilitation kitchen equipped with a cooker and washing machine. Some residents were supported to complete their laundry whilst another had their own washing machine in their flat and had developed independent skills in this area. Some residents used the kitchen to make their own packed lunches for their days at various centres and clubs. Staff spoken with stated they had tried to ensure that people developed their cooking skills but this had mixed results, as residents enjoyed the food provided by catering staff employed by the home. This is an area that staff say they would like to develop further. One resident was planning to move to a more independent living arrangement and this would be the opportunity for staff to further develop the persons skills. The home employed programme workers during the day and they supplemented the care staff in supporting people to complete their weekly programmes. There was limited scope for evening and weekend activities, which could impact on choice for young people and needs to be explored with residents and staff to see if can be addressed. We enjoyed a discussion and a coffee with four residents during the day and they told us about their life at Salingar House. Five residents had enjoyed a recent holiday to Butlins and two others had days out instead, which far better met their needs and wishes. Residents looked well cared for and happy and were very chatty, joining the inspector at intervals, throughout the day. Staff clearly had built up good relationships with residents and although key worker documentation had lapsed in some of the files examined, we were assured this one to one support occurred. Meals were prepared by catering staff in the main kitchen. Menus contained a variety of choices and alternatives, and were available in pictorial form. The main meal was provided in the evening, which suited the residents lifestyles. The dining room was spacious and set out with individual tables and chairs. Special diets were catered for. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: The home had achieved a, Healthy Heartbeat award for the last two years for ensuring a healthy option on the menu and catering staff had scored 85 percent in the local authoritys food management assessment system. This was a very good achievement. Care Homes for Adults (18-65 years) Page 17 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. People had access to a range of community and hospital health care services, which enabled their health to be monitored and ensured they received treatment as required. Staff ensured residents health and personal care needs were met in ways that promoted privacy and dignity. Evidence: There was evidence that health and personal care needs were met in ways that respected privacy and dignity. Residents had a choice of male or female carer. Staff were sensitive to peoples needs and this was confirmed in a discussion with a health professional, who stated, the staff are in tune with her. Staff told us how they tried to work with people and their mannerisms and gave an example of how a hospital appointment was planned meticulously with hospital staff and the consultant for 3-4 weeks prior to the date to ensure it went smoothly. People had access to a range of health professionals and their advice was referred to in care plans. Basic health action plans had been produced, although these could be Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: built upon and the manager acknowledged there was still some work to be done to ensure they fully included all the health care needs. We did not see evidence of nutritional screening/risk analysis although one person, and occasionally another, had issues that could affect their nutritional intake. One person did have a risk assessment and behaviour guidelines for the possibility of choking when eating and drinking but nutritional risk assessment should be part of the initial and ongoing assessment process. The home managed medication well. It was signed on receipt into the home on the medication administration record (MAR), for those medicines in a monitored dosage system, and on a separate stock control sheet for liquids and other tablets dispensed in original containers. Stock control was managed appropriately and there was a system in place for returns to the pharmacy. It was noted that some medicines were written, as directed on the MAR. The prescriber needs to be contacted to ensure that directions give clear instructions for staff. This will help to avoid mistakes. Staff responsible for administering medicines have received training. Care Homes for Adults (18-65 years) Page 19 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 are protected from abuse by staff training and adherance to policies and procedures. Evidence: The home is owned and managed by the local authority and as such uses the corporate complaints policies and procedures. This has been formatted in easy read and Braille. The procedure makes it clear that all complaints will be investigated and hopefully resolved within specific timescales. Staff spoken with were aware of what to should concerns or complaints be raised with them and residents spoken with named particular staff members they would approach if they were unhappy with anything. Neither the home nor the Commission had received any complaints since the last inspection. The home had a copy of the multi-agency policy and procedure for safeguarding adults from abuse. The manager confirmed that all staff had received training in how to safeguard adults from abuse although training records had not been updated to fully reflect this. In discussions staff were clear about the actions to take should it be disclosed to them, or they witness, any poor practice or abuse. Some staff were due for refresher training. The manager had completed more in depth training specific to their referral and investigation role. They were also due to complete a train the trainer course to enable her to cascade the training to other staff members. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: Since the last key unannounced inspection there had been one safeguarding of adult referral made to the local authority safeguarding team. This related to a medication error. The staff reacted appropriately and sought medical advice when the error was noticed. Care management completed a monitoring visit to the home and a staff member received medication re-training and supervision. Peoples finances were protected from abuse by ensuring practice follows written council procedures and guidelines. Few people rely on their finances being looked after by the home, but most do have personal allowance held in safekeeping. People were able to access funds readily when they requested it. Records in place for handling finances were not inspected on this site visit. Care Homes for Adults (18-65 years) Page 21 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. The environment provided people with space and scope to be as independant as possible, whist also enabling them to come together with other residents when they choose. The home was clean, safe and well-maintained. Evidence: Salingar House is able to accommodate up to eleven people. The home comprises of three individual flats, four flatlets and four bedrooms. The flats have a separate kitchen, bathroom and bedsit area, the flatlets have a combined kitchen/bed/sitting room and a separate bathroom, and the four individual bedrooms each have a shower en-suite. People have been assessed to determine which area of space suits their needs. In addition to the baths or showers in the bedrooms, the home has two bathrooms and a walk-in shower room. There are additional toilets on both floors. Communal areas consisted of a lounge, a dining room, a rehabilitation kitchen, and an area designated for art and craft work. In addition there is a quiet room for people to see visitors in private or for staff to use when having reviews. Residents had recently chosen two new settees to replace those in the lounge and were awaiting their delivery. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: People spoken with were very pleased with their accommodation and some residents showed us their rooms. The bedrooms were nicely furnished and were personalised to varying degrees dependent on the choice and taste of the occupant. One resident had his own fridge and washing machine and was working towards independence in completing laundry. Staff have two offices, one of which is for the manager, and there is a sleep-in room upstairs equipped with bathing facilities. There is an enclosed garden to the rear/side of the property, which has patio furniture and paved areas. There is space for several cars at the rear or on the street at the front of the building. All ground floor windows have concertinaed grills that look a little unsightly but the manager explained they were fitted after a spate of attempted break-ins and afford the home some protection. It is a very clean and tidy home and staff obviously work hard to maintain standards. Care Homes for Adults (18-65 years) Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were supported by a consistent, and well recruited staff team, in sufficient numbers to meet their health and personal care needs. Staff were generally well trained and competent in their roles, however, a gap in refresher training and the amount of formal supervision some staff received could mean that they are not as up to date as they could be and practice may be affected. Evidence: Staff retention is good and the residents continue to benefit from a consistent staff team. There are two carers and one senior carer on duty thoughout the day and two carers at night with a senior sleeping in, for support in any emergency. The manager was supernumerary and worked Monday to Friday but she stated she would work a senior carer shift to cover for holidays or short notice absences. In addition to care staff there were two programme workers, one for thirty hours a week and the other for sixteen hours. Their role was to support residents with their social and occupational needs inside and outside the home. The home employed two cooks and two domestic workers. One of the catering posts was vacant. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: There have been times when casual staff have been employed to fill gaps but the manager confirmed they used the same agency each time and requested the same staff members. Casual staff were usually employed on a one to one basis to support a specific resident when they accessed respite care. The manager advised that the local authority was examining a system of restructure and regrading of residential care staff at present and there may be changes when this is completed. Currently there are sufficient care staff to meet the health and personal care needs of residents. Staff told us that there were no programme workers at weekends or in the evenings to support people with activities they may want to participate in. This could impact on peoples choices about their lifestyle and, when and what, community facilities they can access. It was clear from observations and discussions with residents and staff that good relationships had been built between them. We observed genuine affection, which is understandable, as some staff have worked at the home for a number of years and know the residents and their families very well. Of the four staff members spoken with on the day, two had worked at the home for thirteen years, one for eleven years and another for four years. Residents told us that staff were kind to them and helped them to do the things they wanted to do. A health professional spoken with on the day praised staff for their professional manner. The local authority training plan includes mandatory and service specific training and staff have access to a training department and training officers. The training plan is produced annually with information collated via an appraisal system. Surveys received from staff members indicated they received training that was relevant to their role, equipped them to meet individual needs and kept them up-to-date. Individual logs were maintained of the mandatory and specific training each staff member had participated in. The staff training files we examined showed that they had participated in a range of training such as, epilepsy management, Autism, Downs Syndrome, suprapubic catheter care, diabetes, equality and diversity, therapeutic crisis intervention and risk analysis. Some staff had completed awareness sessions in mental capasity legislation. There was evidence that some mandatory refresher training was overdue. The manager acknowledged that this had lapsed due to the flooding of the training centre two years ago and the catch-up system this had produced. She had completed an action plan with information about outstanding training and was to put this into practice. According to information received from the homes annual quality assurance Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: assessment (AQAA), 86 percent of care staff have gained a national vocational qualification (NVQ) in care at levels 2 or 3. This is an excellent achievement and exceeds standard 35, which requires that the home has 50 percent of care staff trained to this level. Staff received formal supervision with the manager or a senior care officer and stated they were well supported by management. Discussions included a check on key worker records, health and safety issues, staff rotas, information from meetings, training and development needs and praise for their contribution. Most staff had received between three and five sessions in the last year. Care staff should have a minimum of six sessions a year. This is to ensure their practice is monitored and they have a forum to discuss issues at regular intervals. Despite some shortfalls, staff spoken with stated the manager was very approachable and had an open-door policy, which meant that there were discussions and contact on a day to day basis. The local authority had corporate recruitment policies and procedures. All checks were carried on on new staff members to ensure they were suitable to work with vulnerable adults. 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 has systems in place to consult with residents and other people connected with the home. There has been a gap in reporting notifiable incidents to the Commission. This must improve so we can monitor and follow up any action the home takes. Evidence: The registered manager was experienced and had been in post since 2004. There was evidence that she kept herself up to date with relevant training, including this year, mental capacity legislation and deprivation of liberty, health and safety, infection control and, equality and diversity for managers. She had received training in how to transform teams using person-centred philosophy. This had been embraced by staff and included supervision and team meetings using person-centred tools. There were plans to filter it into all areas of practice, for example care planning and reviews. Staff told us the manager was very supportive and her management style enabled them to approach her with any issues. Staff said they, looked forward to coming to Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: work and that it was a friendly and homely atmosphere with, good team work. Sharing information had improved and the respect they had for each other enabled them to be open when completing the person-centred analysis of their team. There was some uncertainty expressed in surveys regarding the restructuring and regrading exercise. The manager advised that there is to be a change in management of the home in the near future. Residents and staff have been informed and the post is to be advertised. The current manager will still be available for support to the new manager during a transition phase. The home had a quality assurance process that consisted of audits of the environment and systems in the home, and questionnaires to residents, relatives, staff and professionals. Identified shortfalls were addressed in action plans. The manager had completed the annual quality assurance assessment (AQAA) required by the Commission. This told us that through listening to residents some changes have been made to the format of menus so they are in picture form and look more interesting, more activities in-house have been arranged and an arts and craft space has been developed. There is also a staff photograph board on display and new settees have been ordered for the lounge. As a result of feedback from relatives more soft furnishings have been introduced and bushes blocking the light in a residents bedroom have been trimmed back. This shows us that residents views are listened to and acted upon. The home was a safe place for people to live in and staff to work in. Equipment was serviced and repairs attended to quickly. Fire alarm checks and drills were carried out and staff received mandatory training, although there were some gaps in refresher training. Risk assessments were in place. The responsible individual visited the home monthly and through speaking with residents and staff, examination of documentation, and via a tour of the building, they satisfied themselves the home was being managed effectively. Reports were completed of their visits. There has been four occasions when incidents have occurred in the home and, although the manager took the correct action, they did not notify the Commission in line with regulation 37 of the Care Homes Regulations. The type of incidents that are notifiable was discussed with the manager. 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 42 37 The Commission must receive reports of incidents that affect the welfare of residents. This will enable us to monitor situations and check out any actions the home takes. 11/09/2009 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 6 Staff should make the care plans even more personalised by detailing the preferences about care support that is known to them and located in other documentation in the care file. Separate behaviour guidelines could be incorporated into the main care plan sections. This will help new staff locate information more readily. Weekend and evening activities for residents should be explored to enhance the choices available to them. Nutritional risk assessment should be part of the initial and ongoing assessment process. This will enable staff to analyse any ongoing nutritional needs and information gathered during the assessment can be used to enhance Page 30 of 32 2 3 14 19 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 plans of care. 4 19 Health Action Plans should be broadened to include the full range of health needs. This will help staff to plan routine and specific health care interventions in a systematic way. As directed medication should have clear instructions for staff. This will ensure the correct dose is given and prevent mistakes. Refresher training in mandatory areas should be completed in line with the homes action plan. This will ensure all staff have up to date skills and knowledge to care for vulnerable adults safely. Care staff should receive a minimum of six supervision sessions per year. This will enable practice to be monitored and give staff the opportunity to raise issues at regular intervals. The manager should ensure they are familiar with the range of, notifiable incidents. This will help them fulfil their management responsibilities in relation to regulation 37 and enable the Commission to monitor the homes actions. 5 20 6 34 7 35 8 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) 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. 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