Care Home: Sandalwood

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What the care home does well Staff will know about your needs and what you like to do. You can have a choice of food and how you want to spend your day. Staff will keep you safe and listen to what you want and what you have to tell them. You will be able to enjoy being yourself and staff will help you keep in touch with people who are important to you. What has improved since the last inspection? The home was welcoming and homely. New carpets have been fitted throughout the home. The lounge and dining area has been recently decorated. Some new furniture has been purchased and the manager stated there are plans to have a new suite in the lounge within the year. What the care home could do better: Staff must make sure that information about you is only seen by certain people, your care plans need to be updated and reviews need to be undertaken. Appropriate risk assessments to keep you safe need to be in place. The home must make sure your finances are used appropriately for you and not used for the benefit of the home. New staff need to receive some training at the time of induction to make sure they know what to do if you have an accident and hurt yourself. Recruitment procedures need to be more robust so that full details of staff working in the home are in place, this is to make sure you are safe at all times. An action plan needs to be in place in the home so that in an emergency, arrangements are available of where you may go in the event you are unable to return to the home for any reason. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Sandalwood 81 Almners Road Lyne Surrey KT16 0BH 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: Vera Bulbeck Date: 0 5 0 5 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. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 32 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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.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: Sandalwood 81 Almners Road Lyne Surrey KT16 0BH 01932568623 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : alan.peeroo@surreypct.nhs.uk Welmede Housing Association Ltd care home 5 Number of places (if applicable): Under 65 Over 65 5 0 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD The maximum number of service users who can be accommodated is: 5 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 32 A bit about the care home Sandalwood is a large detached bungalow located in the village of Lyne in Surrey. The home is owned and managed by Welmede Housing Association and provides accommodation and care to five gentlemen who have a learning disability. All bedrooms are single occupancy and have a washbasin no rooms have ensuite facilities. Communal areas consist of a large lounge with separate dining area, a good size, homely kitchen and two bathrooms with toilets and two further toilets. There is a large, well-maintained, enclosed garden to the rear of the property and parking for several cars to the front of the building. 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 Care Homes for Adults (18-65 years) Page 6 of 32 How we did our inspection: This is what the inspector did when they were at the care home This report relates to the key unannounced inspection carried out by Mrs Vera Bulbeck on the 5th May 2009. The registered manager was present for the inspection. A number of requirements were made at the previous key inspection on the 8th May 2007 and the registered manager confirmed at the time of the Annual Service Review on 30th May 2008 these had been met. For the purpose of the report the individuals using the service are referred to as service users. The home had submitted the Annual Quality Assurance Assessment (AQAA) prior to the inspection, which was well documented and gave appropriate information about the service generally. The inspector arrived at the service at 10.30 and was in the home for five hours and thirty minutes. It was a thorough look at how well the home is doing. It took into account the information provided by the home and any information that CQC had received about the service since the last inspection. The inspector spent time talking and observing the staff members and individuals in order to gain their views and opinions about the service. The inspector Care Homes for Adults (18-65 years) Page 7 of 32 looked at how well the service was meeting standards and has in this report made judgments about the standard of the service. Documents sampled prior and during the inspection included the homes Annual Quality Assurance Assessment (AQAA), care and person centred plans, risk assessments, medication procedures, staff files, a variety of training records, health and safety records and several of the organisations policies and procedures including the complaints and safeguarding procedures. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. The fees payable are two thousand and eighty six pounds per week per person and do not include personal items. Care Homes for Adults (18-65 years) Page 8 of 32 What the care home does well What has got better from the last inspection The home was welcoming and homely. New carpets have been fitted throughout the home. The lounge and dining area has been recently decorated. Some new furniture has been purchased and the manager stated there are plans to have a new suite in the lounge within the year. Care Homes for Adults (18-65 years) Page 9 of 32 What the care home could do better Staff must make sure that information about you is only seen by certain people, your care plans need to be updated and reviews need to be undertaken. Appropriate risk assessments to keep you safe need to be in place. The home must make sure your finances are used appropriately for you and not used for the benefit of the home. New staff need to receive some training at the time of induction to make sure they know what to do if you have an accident and hurt yourself. Recruitment procedures need to be more robust so that full details of staff working in the home are in place, this is to make sure you are safe at all times. An action plan needs to be in place in the home so that in an emergency, arrangements are available of where you may go in the event you are unable to return to the home for any reason. Care Homes for Adults (18-65 years) Page 10 of 32 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Vera Bulbeck 33 Greycoat Street London SW1P 2QF 02079792000 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.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 11 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 12 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 . Prospective individuals and their representatives have accurate information about the home in order that they can make an informed choice about moving to the home. The homes admission and assessment procedures ensure that individuals needs are appropriately identified and met and people can visit the home prior to residency. Evidence: The homes Statement of Purpose and Service user Guide have been updated since the previous key inspection and the improvements in the documents have been maintained to include large print and up to date photographs of the home and the local community. Both documents detailed the current facilities and services offered by the home. The manager stated that further changes to the documents are on going so that the improvements make them more accessible to service users living at the home. There have been no admissions to the home since 2001. All the service users have been residing at the home for some years and their care needs assessments were developed whilst in the care of the previous care service provider. There was evidence to support that initial assessment details for individuals moving into the home had been undertaken prior to the individuals admission to the home. Welmede have an Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: admission and assessment policy and procedure to ensure that all prospective service users have a care needs assessment prior to admission to the home to ensure that the homes staff would be able to meet the service users needs. The policy includes encouraging prospective service users to visit the home, meet with the other service users and have an overnight stay if they choose to prior to moving to Sandalwood if that was their choice. In the AQAA it states they have a move in policy, which is made available to prospective new admissions and is supported by a service users guide. A thorough assessment would take place whether the service user would be able to accept or be accepted by the current group of occupants. The home also receives a visit from the Lord Chancellors Official Visitors, as part of the Office of the Public Guardian. The Official Visitor will visit and see service users and speak, as well as viewing the service users finances, bedroom and their personal property. Care Homes for Adults (18-65 years) Page 14 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 . The support, personal care needs, goals and aspirations of individuals needs be kept up to date and evidenced as regularly reviewed and monitored to ensure that service users changing needs are identified and met. Evidence: The manager agreed that a service users file could be better, for example the file was not up to date regarding care support and how his needs were being met. Risk assessments not up to date to reflect hazards presenting in his life. No clear guidelines or agreed working practices regarding his support. During the key inspection it was identified that routines in the home remained to a large extent as task based and not led by the service user living at the home. The home has a key worker system in place and service users are taken out in the mini bus often. The bedrooms were viewed and found to be clean, personalized with a number of personal possessions. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: The two care plans sampled identified that the risk assessments were generic and did not accurately reflect the hazards being presented in the individual’s life. There was some evidence to support that individuals are supported to make an informed choices. It has been required that arrangements must be made to ensure that all care plans and risk assessments for each individual are reviewed and up to date to promote and make proper provision for the care, treatment and supervision of individuals and ensure that their changing needs are identified and met and to ensure the safety and well being of individuals at all times. In the AQAA to evidence what the home is doing well it states the service users have access to more community facilities for example expanding their network of friendship with shopping trips to the butchers, the farm shop and the supermarket. Once a month service users get to meet with old and new friends at the Get Together Club disco in New Haw Community Centre. The staff are able to understand the body language and signs of each individual and can determine their likes and dislikes through their message sending behaviours. In the past there was a picture dictionary of almost everything, this was destroyed during an outburst by one of the service users. The manager stated they are in the process of completing another dictionary, as it was a very useful tool previously and service users were able to make more choices, particularly regarding the menu and choosing food they prefer to eat. The home is beginning to take service users into department stores, bowling alley and to the hairdressers. This is with two members of staff supporting service users. 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 . Service users are able to exercise some choice in the daily routine, staff are able to communicate well by understanding the body movements and facial expression, to support service users in taking part in planned social and recreational activities and the dining arrangements. Service users are supported to maintain bonds with family and friends. The home offers an improved healthy and balanced diet. Evidence: It was evidenced through sampling a daily record book that staff have continued to support service users in the local community and promote opportunities for service users to take part in social activities. Each service user has a planned activity programme and some service users walk to the farm shop to buy vegetables, and visit the local butchers shop to buy the meat for their meals. The staff in both shops are getting to know the service users and speak to them by name. They also visit the supermarket for the main shopping. Service users have other outside interests Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: including horse riding, swimming and ten pin bowling. The deputy manager stated all service users like to go for a ride in the homes vehicle. The manager stated since new staff have been working in the home the service users are now able to have more time with one to one outings. The manager also stated that service users did not have a holiday last year because of staff shortages. However they had twenty six outings to various places of interest to the service users. It was observed that all service users were supported to have lunch at the same time and a staff member advised that at lunchtime it was viewed as general practice for everyone to wait for all individuals to have their lunch together. The manager was aware of peoples rights to exercise choice, fairness, dignity, respect and freedom of movement in the home and have assured the commission that these aspects of service users care and support will be maintained in the home at all times. There was evidence to support that service users meaningful relationships are promoted by staff and the home continues to support individuals to maintain links with family and friends and people significant to them. The Chairman of the Friends of Botleys visits the home two or three times a year and acts as an advocate for service users who do not have any contact with family. The inspector was informed that once a month service users attend the Get Together Club disco in New Haw Community Centre and meet old and new friends from surrounding homes. Staff confirmed that some service users have been supported to help with the food shopping for the home. The staff have introduced a weekly dinner menu which is set out in colourful pictures of meals on a board in the kitchen, which service users can identify and are supported by staff to make informed choices about what they would like to eat. The manager stated that they did have a full dictionary of pictures, however this has been destroyed in a recent service users outburst, and as a result they are now producing a new picture dictionary with some pictures taken from the internet, this will not be completed for at least six months. When completed the picture dictionary will be laminated so that it will be stronger and less likely to be damaged. In the AQAA it states services users are encouraged and supported to access wider community facilities. People with challenging behaviour the emphasis is on engaging them as much as possible, that is meaningful to them and add a reward to make a worthwhile endeavour. As an example when they come back from the swimming pool, ensure there is a nice cup of tea with a couple of biscuits waiting for them. Or asking a service user to tidy their bedroom followed by a promise such as when we finish tidying your bedroom you can help me make a cup of tea. Staff are able to take some service users to different stores to buy clothing and footwear, and to try goods on. 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 . Service users health care needs are generally met, however the recording of health care needs to be improved. Medication procedures are being followed and administered to all service users in a safe and appropriate way at all times. Evidence: The records of health care appointments within the two care plans evidenced that the service user was supported to attend health care appointments both inside and outside of the homes environment. The recording of the appointments needs more attention and this was discussed during the inspection with the manager. The staff supporting service users are able to communicate well and have a good understanding of their needs. This is by facial expression, body language and signing. The inspector was informed that the home is not currently supporting any service users with the administration of controlled medicines and no service user self medicates. Records evidenced that systems were in place for the ordering, stock taking and returns of medication. During the sampling of the medication administration charts it was observed that medication is being administered by the shift leader member of staff or the deputy manager who has control of the ordering and the Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: training of staff. In the AQAA it states each individual service user has their own key worker who they relate well to. The staff team are of diverse backgrounds, therefore the home is able to offer choice and variety of food particularly taking into account weight gain for some service users. The staff cook food which, has less fat for example, cook less fry ups and roast potatoes, cook boiled potatoes instead. Apart from Sunday when all service users enjoy the Sunday roast. The home has increased the fruit intake, this has helped with health problems as well. 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 . Service users who use the service can be supported to express their concerns and have access to a complaints procedure. New staff should have the appropriate vulnerable adults training as part of the induction process. Service users finances is the service users personal account, it is not appropriate to buy items that the home is responsible to purchase. Evidence: The home have an up to date complaints procedure which is also in a pictorial format to support service users on how to make a complaint or raise a concern if they are dissatisfied and a complaints book detailing the chronology of events for investigating complaints was sampled. It was evident that the majority of individuals living in the home would not be able to tell of any dissatisfaction with the service provided, and would be reliant on staff recognizing that they were unhappy. The local authority multi agency procedures for safeguarding adults dated 2005 was available. The inspector advised the manager to get an up to date copy of Surrey multi agency procedures. The inspector noted the home has a policy statement regarding reporting abuse, which was noted to be in accordance with the local authorities multi agency procedures in order to safeguard service users in their care. Training records evidenced that staff had undertaken safeguarding vulnerable adults training and where updates to training were necessary these had been booked. However two new members of staff need to complete their training sooner than the Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: course booked allows. This training is part of the mandatory training, which should be undertaken during the induction period or very soon afterwards. The courses booked has a time lapse of several months, which is not appropriate for staff providing care for vulnerable adults. Welmede have a whistle blowing policy and procedure in place. It was noticed in the service users financial records that several items had been purchased for the home out of service users personal accounts. These included various items flowers, pillows, towels, mattress covers and cushions. When the inspector discussed this with the manager and deputy manager the response was the service users have a lot of money in their account. This practice is not acceptable and the home should provide these items as stated in the National Minimum Standards (Standard 26). In the AQAA it states the home makes staff aware of related procedures, such as staff concern, whistle blowing policy, harassment and bullying, dealing with abuse, consent protocol, management of violence and aggression and robust finance procedures, aimed at protecting both staff and service users. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The physical design and layout of the home enables service users to live in a generally safe and comfortable environment. Opportunities for service users to be more involved in their daily routines and more involvement in the maintenance of the garden. Evidence: During the tour of the premises, all the service users bedrooms had been cleaned, care and attention to detail within the room had been recognized. Several personal items in the bedrooms had been purchased by service users, as their choice. The lounge/dining area has recently been decorated with some new furniture. New carpets have been laid throughout the home. There are plans to purchase new lounge furniture within this year. The bedrooms have all been fitted with air conditioning so that during the summer months the windows remain closed so as not to disturb the neighbours. Each bedroom has also been fitted with triple glazing. A radiator in one of the bedrooms needs attention and the doors have a key facility, however none of the service users are able to hold a key. It was noticed in one bedroom there were no pillows on the bed. The inspector asked why there were no pillows and the deputy manager stated the service user does not like a pillow. When the inspector checked the care plan there was no reference to the service user not using a pillow. More details need to be included in the care plans. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: The inspector advised the manager that opened packs of cereals should be stored in a sealed container to ensure no insects can crawl inside, and to seek advise from the Environmental Health Officer. The home in general was found to be nicely decorated, homely and comfortable for the service users. The garden was spacious and keep to a good standard. The staff and service users grow vegetables and flowers in pots and troughs in the garden. The garden is a nice area for the service users to enjoy. The service users have a pet Guinea Pig who lives in the summerhouse in the garden and has ample people looking after him. The service users share the cost of feeding him and he is very happy in his home with plenty of space. In the AQAA it states unfortunately the poor summer last year did not help the homes plans to develop growing organic vegetables. However using pots a lot of tomatoes, sweet peppers, onions, Cucumbers and a small variety of salad and herbs. The huge pine tree in the front of the building has been removed. This has increased the light in the front of the home, also this will enable the staff and service users to develop further beds and shrubs. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . New staff in the home are not currently fully trained to support service users who use the service. Recruitment practices need to improve to protect service users living at the home. Evidence: The home is currently supporting five service users. Some new care staff have been appointed, which has been beneficial to the improvement of the home and the reconsideration of the ethos of the home. It was observed that there were sufficient staff available on the day of the inspection. The manager advised that the rotas have been reviewed and based around delivering outcomes for service users receiving care. Welmede have a recruitment and selection policy and two staff files were sampled who had been recently employed by the home. The files contained the majority of relevant checks to confirm a safe vetting process to ensure the protection of service users receiving care. Some details were missing including references on the last employment details and obtaining a reference from that person, photographs were also missing from files. The home needs to ensure they are following the Care Homes Regulations 2001, Amended version 2004, Schedule 2. Following the previous inspection Welmede have supported staff to undertake mandatory training and the commission have been advised that all staff will be Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: undertaking the Learning and Disability Award Framework Induction and Skills for Care in order to improve staff practice and ensure that staff have the skills and abilities to provide the care and support needed by the individuals living at the home. The manager advised that Welmede had organized that all staff whether existing or newly appointed will be provided with an induction pack and will be supported to undertake the induction programme. The deputy manager confirmed that she had booked the two new members of staff on some mandatory training courses. Both members of staff have worked in the home since March 2009 and neither had completed a first aid course which is mandatory and should be completed within a short time frame. The inspector spoke with two new members of staff who stated they had not received an induction, and it was not clear if the staff in the home had received a copy of the General Social Council and Care (GSCC) document. 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 management and administration of the home is working well. The health and safety of all persons living in the home is promoted through the general health and safety checks undertaken. Evidence: The manager currently works part time due to health reasons but was present during the unannounced visit to support the deputy manager. Discussion took place regarding some of the issues that need addressing. The manager and deputy manager stated they would be looking at how they will be working towards addressing the issues pointed out at the time of the feedback and were able to demonstrate that they were aware of the shortfalls within the service and were proactive during the inspection to highlight the service shortfalls. The plans for improvement in the service were discussed openly and indicated that the improvements would be based on providing an increased quality of life for individuals living at the home with the focus on person centred care. The Regulation 26 visit was sampled and these are undertaken monthly. Health and safety checks within the home have been maintained and records were sampled. The Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: gas safety, electrical certificates and a current insurance indemnity certificate were sampled and all documents up to date. The inspector affirmed the procedures that the home must report any incidences to the commission under Regulation 37 notifications of any event that affects the well being and welfare of people in the home. The inspector also informed the manager and a sample was provided by the inspector of a recent Regulation 37 notification, which was not legible. The copy sent to the commission should be clear and readable. It is acknowledged that the Welmede Housing Association and the manager and deputy manager have made efforts to improve the service and facilities offered to people in their care, however there remain shortfalls which must be addressed that continue to potentially affect the health, safety and welfare of individuals and staff. The home produced a very detailed quality audit in 2008, which high lights some of the shortfalls discussed. It also highlights the very proactive approach the home has towards the service users and the care provided in the home. In the AQAA which was very well documented, it states the staff have been able to develop a process where by the staff are able to deliver the support for each individual service user and endeavour to take service users where they feel safe to attempt activities previously not attempted, for example swimming which four service users now enjoy. There will be about 70 of staff by the end of the year with a NVQ qualification. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes  No  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 Description 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 Description Timescale for action 1 34 19 The registered person should 03/07/2009 obtain the information and documents as specified in paragraph 1 - 9, Schedule 2. The registered provider should operate a thorough recruitment procedure to ensure the protection of service users. 2 35 18 The registered provider must 10/07/2009 ensure that at all times suitably qualified, competent and experienced persons are working in the care home for the health and welfare of service users. All staff should be suitably trained and have completed mandatory training. Recommendations These recommendations are taken from the best practice described in the National Care Homes for Adults (18-65 years) Page 30 of 32 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 23 The registered person ensures that service users are safeguarded from financial abuse. The home to provide essential items for service users as stated in The National Minimum Standards. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone : or 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) 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. Care Homes for Adults (18-65 years) Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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