Care Home: Seabank House

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What the care home does well People living at Seabank House told us they like living at the home and that they like their bedrooms. The management style within the home supports and guides the staff team to be focused on outcomes for the people receiving their care and support. Discussion with staff, observations of staff with service users and an examination of a selection of records indicates that the opinions of the people using the service are sought and valued in all areas of the homes life. People continue to be supported to take part in activities in the community including day services Monday to Friday, work placements and leisure facilities at weekends. Staff were very enthusiastic about their work and felt the best bit of their work was supporting the people who live at Seabank House. They knew the needs of the people they supported and presented as caring, responsible and knowledgeable about each persons needs and choices. Staff spoken with during the visit and those who returned surveys said that they are happy with the support provided by the manager and with the training opportunities. The staff spoken with described the service as "homely" and said they feel that the people who live there make choices in their day to day lives. Some comments were "I think Seabank House offers a brilliant service. Its a lovely place to work." "The staff get on well with each other and there is good communication between them." What has improved since the last inspection? There have been a number of improvements at the home since our last visit. The manager has improved the overall organisation, structure and storage of documentation required by the Care Homes Regulations 2001. There have been improvements to the home environment with a number of areas having been redecorated. New carpeting has been fitted in some areas. The outdoor area has been made a more presentable area. The financial records of the people using the service were clear and accurate and a system is in place for documenting decision making for large purchases. Further systems have been put in place to consult with the people using the service. There is a clear training plan in place for staff and since the last visit staff have received training in a number of areas. Staff spoken with were happy with the training they are receiving and considered it to be suitable for the work they undertake at the home. The staffing levels are appropriate to support the needs of the people using the service. What the care home could do better: The contracts and the statement of purpose need to record the extra amounts payable for additional services not covered by the care homes charges, such as costs due to staff accompanying the people using the service on outings. This is to ensure that people using the service and their representatives are clear about what additional costs they made need to pay and to protect the people using the service from financial abuse. The statement of purpose also needs to be updated so that people have the most up to date information to help them make decisions about the home. The behaviour management plan should be further developed for the person identified during this inspection. This is to ensure that staff have access to the written information they need to appropriately support this person. Further information on the preferred methods of communication of people living at the home should be documented and developed to include symbols and preferred signs e.g. using makaton for some people who choose to use it. This will ensure the staff team are able to communicate effectively with the people living at the home. The administration directions for the medication identified during this visit is to be clearly recorded by the pharmacist. To ensure that at all times medication is administered appropriately. Where a person self administers medication staff should sign to say they have received the completed medication containers and record whether all have been taken as this will provide a means of ensuring that the person is continuing to be able to appropriately self administer. Some bedrooms need to be redecorated and one persons room needs a new carpet. Bathroom areas have been identified as requiring new flooring and ventilation is needed in the laundry to reduce any risks from air borne infection. A weekly record should be made of the checks of hot water and provisions put in place to reduce the risk from hot radiators. This is to provide further evidence that a safe environment is being provided. The remaining staff who have not had their training updated in the administration of rectal diazepam and safeguarding vulnerable adults must be provided with this training in order to ensure that staff have the knowledge and skills available to appropriately support people using the service. All new staff need to be provided with induction training to ensure they have the knowledge and skills to be able to appropriately support the people living at Seabank House. At this visit one new member of staff had not received this training. Key inspection report Care homes for adults (18-65 years) Name: Address: Seabank House 111 Seabank Road Wallasey Wirral CH45 7PD     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: Beate Field     Date: 3 0 0 3 2 0 1 0 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 35 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Seabank House 111 Seabank Road Wallasey Wirral CH45 7PD 01515120887 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ms Helen Gifford Name of registered manager (if applicable) Ms Helen Gifford Type of registration: Number of places registered: care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 9 Date of last inspection Brief description of the care home Seabank House is a large detached house in Wallasey. The home is registered to provide personal care for nine adults with a learning disability. Bedroom accommodation is provided in one shared room and seven single rooms. Bedrooms are located on the ground and first floor. Toilets and bathrooms are located on both floors of the home. There is a lounge, kitchen and dining room. Parking is available on the road at the front and side of the home. The home is within easy reach of New Brighton and Liscard town centre. There is a wide range of facilities such as shops, churches, community centres, a library and public transport within walking distance. The owner Helen Gifford is also registered as the manager of Seabank House. A copy of the Care Homes for Adults (18-65 years) Page 4 of 35 9 Over 65 0 Brief description of the care home statement of purpose and service user guide, which describes the services offered at Seabank House was displayed at the front entrance. At the time of the visit the fees were GBP308 to GBP614 per person a week. The fees do not include, hairdressing, clothing, holidays and further items. The owner has been asked to make all additional costs clear within the statement of purpose and the service user guide. Care Homes for Adults (18-65 years) Page 5 of 35 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 star. This means the people who use this service experience good quality outcomes. This visit to the home took place over 6 hours and involved two inspectors. It was unannounced. Before the visit, we asked the manager to complete a detailed questionnaire about the home that we call an annual quality assurance assessment (AQAA). This gave us lots of information about developments at the home and statistical data that we used to plan our visit to the home. We also sent out surveys to people living at Seabank House, to staff and to professionals working with the home to find out their views about it. At the time of writing this report, four surveys from staff and four from people using the service had been returned to us. During our visit, we talked with people who live at the home and with staff. We observed how staff were providing support for the people living at Seabank House and Care Homes for Adults (18-65 years) Page 6 of 35 we walked around the building to see its facilities. We also spent time looking at records and policies and talking with the person in charge to see how the home was being run. Following the inspection we also spoke with the manager of the home. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? There have been a number of improvements at the home since our last visit. The manager has improved the overall organisation, structure and storage of documentation required by the Care Homes Regulations 2001. There have been improvements to the home environment with a number of areas having been redecorated. New carpeting has been fitted in some areas. The outdoor area has been made a more presentable area. The financial records of the people using the service were clear and accurate and a system is in place for documenting decision making for large purchases. Further systems have been put in place to consult with the people using the service. There is a clear training plan in place for staff and since the last visit staff have received training in a number of areas. Staff spoken with were happy with the training they are receiving and considered it to be suitable for the work they undertake at the home. The staffing levels are appropriate to support the needs of the people using the service. Care Homes for Adults (18-65 years) Page 8 of 35 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Adults (18-65 years) Page 9 of 35 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 10 of 35 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 11 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not always have the most up to date information about Seabank House to help them make decisions about whether the home would be the right place for them to live. Evidence: No new people have moved into Seabank House since our last visit there and the majority of residents have lived at the home for a number of years. Previous visits to the service have shown that appropriate assessments have been completed prior to a person moving to the home. The contracts provided by the home generally include the recommended information but clearer information still needs to be included in it about what goods and services that people living in the home would be expected to pay for themselves. During the visit we found that on a recent trip out the people who use the service had paid for the staff to accompany them. This potential cost needs to be detailed in the contract and made clear in the statement of purpose. Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: An information brochure about the service is available to tell people about Seabank House and the support they can expect if they live there. This helps everyone to decide if Seabank house is the right place for the person to live in and if their needs and choices can be met there. This brochure is called a statement of purpose and the manager had developed this document with the use of pictures to help people to understand the information it contained. The statement of purpose would also benefit from being updated further with accurate information about staffing levels people can expect at the home, details of services offered with activities and social support, meals and staff training. At the moment, this document does not identify the fees charged for living there and the address for the commission needs to be updated so people know where to contact us if they need to. Care Homes for Adults (18-65 years) Page 13 of 35 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. Staff support the people living at Seabank House in the way they prefer and assist them to take part in all aspects of life at the home. Evidence: Individual support plans were in place for all of the people living at Seabank House. We looked at four of these during our visit. They were easy to read and gave individualised information relating to the choices each person had made. The support plans had been updated with regular reviews of the support provided. The plans build a picture of the important things to the people who live at Seabank house. The support plans provided individualised information about what makes the person happy, sad, frightened and angry. The support plans contain information about the support the person needs with their personal, social and health care needs. This helps to make sure that staff have the up to date information to provide the support each person needs, in the way they prefer. Daily records were detailed and show how care plans have been followed by staff. Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: The records for one person showed that occassionally they can display challenging behaviour such as slapping and biting. Records showed that staff have managed this behaviour appropriately, however the care plan did not fully detail all the actions staff take to manage this behaviour. Staff use diversion to manage this behaviour but this is not fully recorded in the care plan. This information should be recorded so that staff have the information they need around how to support the person with this behaviour. Staff have developed support plans to identify each persons preferred methods of communication. One plan indicated the person uses Makaton, a form of sign language developed for people with a learning disability to use. The plan would benefit from being developed further to show the signs and pictures the person regularly uses to help staff clearly identify what they are saying. All staff should have training and guidance on the use of this specialised communication tool so that they are all aware of how to support people who like to use Makaton. A communication plan for a further person using the service also needed to be developed further. We met some of the people living at the home who indicated they were happy living there. We observed good relationships and rapport between the staff and people living at Seabank House. They were happy and relaxed in the company of the staff. Surveys returned by 4 people living at the home show that they are happy with the service provided. They said that when they are not taking part in organised activities during the day they are free to make choices about what they do during the evening and weekend. They also said the staff treat them well. Records and staff spoken with indicated that the people using the service take part in all aspects of life at the home. They get involved with daily domestic tasks such as laying the table for tea and helping with shopping and choosing meals. There are regular meetings with the people using the service where they decide on future activities, issues such as decoration and make their views known about any equipment they want for the home. The most recent record showed that the people using the service would like new outdoor chairs and a table. Staff reported that the manager has said these items will be being purchased in time for the warmer weather. Care Homes for Adults (18-65 years) Page 15 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Seabank House are supported to take part in appropriate activities so they have opportunities for their social and personal development. Evidence: People living at Seabank House are supported by staff to take part in group activities and one to one activities. Support plans show what activities people enjoy. This information helps with planning the one to one and group activities to make sure suitable opportunities for taking part in activities are made available for everyone living at the home. Staff spoken with said there are sufficient staff to enable people to take part in activities as a group and individually. During our visit a person using the service who was not at day services was being accompanied by a member of staff on a community outing. The majority of people living at the home go to day services during the week. During Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: our visit we observed people getting ready to go to day services. They were happy to be going and looked well presented. Records show that community facilities are used by the people using the service. The people using the service have contact with their families supported. This is shown in records and confirmed by staff spoken with. Since the last visit to the home the garden area has been tidied and made a more attractive area. The garden still has uneven surfaces and would not be suitable for wheelchair users. This should be made clear in the statement of purpose for the home which describes the home and its facilities. The record of the last residents meeting shows that the people using the service would like garden gurniture to be provided. A discussion with the manager following this visit indicated that this is to be made available for the warmer weather. Support staff are responsible for all catering duties and encourage people to eat a balanced diet. The care plans we saw showed that special dietary needs are catered for. The menus showed that the meals provided are varied and balanced. Where special assistance is needed with eating this is detailed in the support plan and staff have received relevant training so that staff have access to the guidance they need. Care Homes for Adults (18-65 years) Page 17 of 35 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 are supported to look after their health so they can stay safe and comfortable in how they live their life. Evidence: Individual care plans were in place for all of the people living at Seabank House. We looked at four of these during our visit. They were easy to read and had been developed further following our last visit to the home. They provided staff with information that related to the choices decided and indicated by each person living at Seabank house. The support plans provide the staff team with individualised information about the most appropriate way to support people with their personal care needs and requests. Staff had introduced health action plans to show how people are supported to get health care appointments including specialised support from the dieticians and practice nurses. Daily records show that people using the service have access to health care professionals as needed. It was clear from meeting people living at the home that they had the help they need Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: from staff to maintain their personal cleanliness and appearance. The staff manage the medication for seven of the people who live at Seabank House. We found that medications were appropriately stored and were in general managed appropriately, with clear records of medication received and given or not given. This helps to reduce the risk of mistakes occurring and provides a clear audit trail to check people receive their medication correctly. One medication seen did not have administration directions from the pharmacist. The person in charge explained that this medication is given at different doseages to reduce sickness and discomfort following advice from the dietician. The administration directions for this medication are to be clearly recorded by the pharmacist following advice from the dietician. Where a person self administers medication staff should sign to say they have received the completed medication containers and record whether all have been taken as this will provide a means of ensuring that the person is continuing to be able to appropriately self administer. Some people need specialised assistance with their medication and it should only be given by staff that have up to date training on how to administer the medication safely. At our last visit we identified that some staff had received this specialised training but others had not had this for some time. At this visit 4 staff have undertaken this training and a training date has been identified for further staff to receive this. Records show staff who give out medicines to people living at the home have received up to date training on how to do this safely. Staff on duty confirmed to us that they had completed this training course and were up to date in medication administration. Care Homes for Adults (18-65 years) Page 19 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are suitable procedures in place to ensure the people using the service are safeguarded from abuse. Evidence: A copy of the complaints procedure for the home was available. The record of complaints showed that no complaints had been made since our last visit to the home in August 2009. People using the service who returned surveys knew who to speak to if they are not happy with the service. Since our last visit to the service some staff have received training to update their knowledge in safeguarding adults from abuse. A date for training, which would have meant all staff had received it was cancelled due to bad weather. A further date has been arranged. Staff on duty at the time of our visit discussed the local safeguarding procedures and what they would do if they ever had concerns. They were able to demonstrate an understanding of how to protect vulnerable adults from abuse. Appropriate written guidance around the protection of adults from abuse was available at the home. Assessments are available to show which of the people living at the home are capable of making their own decisions and who needs support or advice from their next of kin or an advocate regarding how they spend their money. Some people had confirmed Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: they were happy for items to be purchased on their behalf and some relatives had identified they would like to be consulted regarding any planned purchases of large items. There is also an assessment form to record decsion making when it comes to permission for the purchase of large items such as furniture, holidays and spending money and equipment. Since our last visit to the service there had been no such expenditure. The manager is clear that she must ensure that evidence is available to indicate people living at the home have given permission for the purchase of such items. In order to show that the people who use the service are having their finances appropriately safeguarded there needs to be evidence that where an individual is unable to make important decision about their finances for themselves an appropriate advocate/ relative is consulted and a clear assessment is carried out. The assessment form available at this visit would allow the manager to record this information. Care Homes for Adults (18-65 years) Page 21 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further improvements are needed to the environment in order to provide the people using the service with a safe and comfortable home. Evidence: Since our last visit to the service there have been a number of improvements to the overall appearance of the home. Communal areas and a number of bedrooms have been redecorated. New carpeting has been provided in the living room and in some bedrooms and new furnishings have been provided in some bedrooms. Bathrooms have been redecorated and the floring has been replaced in the main downstairs bathroom. Double glazing has been provided to further areas of the home. The outdoor area has been tidied and made into a more welcoming place for the people using the service. As previously stated the statement of purpose should clearly state that this area would not be entirely suitable for wheelchair users as the grassed area is uneven. There are still however further improvements that need to be made to ensure that a safe and comfortable home environment is provided. Garden furniture should be purchased for use by the people using the service. Some bedrooms need attention as the decoration and furnishings are worn and a carpet in one persons bedroom was very stained and needs to be replaced. The flooring to the downstairs toilet and the Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: two bathrooms upstairs needs to be replaced. The manager reported that this flooring has been ordered. There was no maintenance, decoration or development plan to let people know when their room or bedroom would be refurbished with carpets and new furniture. It is recommended that this be put in place. The home is personalised with photographs of all the people who live there displayed in communal areas. Bedrooms are individualised according to the interests and tastes of the people using the service. Staff confirmed that people using the service had chosen the colour schemes for the communal areas and for their bedrooms. The kitchen at the home is a domestic type kitchen, which is accessible to most of the people who live there and provides a large open space which was clean, tidy and organised at the time of our visit. There is a separate laundry room with one washing machine. At the time of our visit, washing was being dried in the room and it was full of damp clothes and cramped. This room has a window that does not open. This area needs to be suitably ventilated to reduce any risks from air borne infections. Following this visit the manager reported that this has been attended to as the window has been fixed and now opens. Since our last visit to the home a radiator cover has been fitted to the radiator in the lounge. There is a risk assessment for the remaining uncovered radiators. The manager was advised to update this so that it covers the further checks that are being undertaken to prevent a risk. The person in charge at the time of our visit said that the water at the home is regulated to ensure it does not get too hot. The temperature of the water to the baths was safe however the downstairs bathroom sink had water that was 48 degrees centigrade. Following the inspection the manager confirmed that a plumber would be attending the home next week to ensure the temperature controls on the water are working. In the meantime, the manager advised that staff are ensuring that residents do not use this sink unsupervised. The manager reported that regular checks of the water temperature are undertaken but that this information is not recorded. A record should be maintained. We looked at a sample of maintenance and contractor checks which showed updated certificates for the facilities, installations and equipment in the home. This showed us that these were being maintained so they were safe. Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: Care Homes for Adults (18-65 years) Page 24 of 35 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. The people living at Seabank House are supported by staff who are knowledgeable about their needs to help make sure they get the support they need in the way they prefer. Evidence: A sample of weekly rotas were seen. They showed that in the morning during the week there is generally one member of staff available, generally the manager, until 2pm. Most of the people who live at Seabank House attend a day service most days with some people having days off during the week which can leave 1 to 2 people at the home in the day time. When the majority of residents are at the home, in the late afternoon and at the weekends, there are between 2 and 3 members of staff available. The 3 staff spoken with during this visit considered that the staffing levels are sufficient to enable appropriate care and attention to be given to the people using the service. The rotas show that the manager continues to work long hours including nights and day shifts at the home. The rota for the week of our visit showed the manager was working between 50 and 70 hours per week. The majority of these hours are made up Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: of waking night duties. The manager carries out care tasks and domestic tasks when she works alone at the service during the day. It has been recommended at previous inspections that the manager does not work such long hours as it could lead to the manager not completing her duties satisfactorily. Given that the manager also undertakes care and domestic tasks it is recommended that specific time be allocated for management tasks to make sure that the home is run in the best interests of the people who live there. The majority of staff have an NVQ 2 in supporting people with a learning disability and 3 staff have just completed the NVQ 3. Since our last visit to the service the majority of staff have attended various mandatory training and the manager has developed a training plan that is displayed on the office wall to help show what each person has attended and what training they are next due. Since our last visit staff have completed training in dementia awareness for people with a learning disability, 6 staff have just completed a basic nutrition course, all have undertaken fire awareness and moving and handling, some of the staff have undertaken a refresher course in first aid, the administering of rectal diazepam and safegaurding of vulnerable adults. At our last inspection it was identified that a number of staff needed training to update their knowledge around safeguarding and the administering of rectal diazepam. Dates for the remaining staff to attend this training were made available following this inspection. It is important that staff attend this training so that they are kept up to date with the right skills to support the people using the service. Certificates of training were available on staff training records seen during this visit, to show that all staff are supported in being up-to-date in training necessary for their work and development while at the home. The three staff spoken with during the visit and those who returned surveys said that they are happy with the support provided by the manager and with the training opportunities. The staff spoken with described the service as homely and said they feel that the people who live there make choices in their day to day lives. Some comments were I think Seabank House offers a brilliant service. Its a lovely place to work. The staff get on well with each other and there is good communication between them.Staff were very enthusiastic about their work and felt they had received all relevant and necessary training to help them do their job. People living at Seabank House told us they liked living at the home and they liked their bedrooms. Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: We looked at the recruitment records for three staff working at the home. These records had been developed and updated following our last visit and were much more organised with the right checks in place. The records for a member of staff who began work in November 2009 showed no evidence of an induction having taken place. New staff must be provided with an induction so that they have the knowledge and skills needed to appropriately support the people living at Seabank House. Care Homes for Adults (18-65 years) Page 27 of 35 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 of the home ensures that the home is run in the best interests of the people using the service. Evidence: The manager is a qualified nurse. The manager has completed the work for her NVQ Level 4 in management and is waiting for this to be assessed. Since the last visit to the service the manager has re-organised the staff team and has appointed two senior carers who both have responsibility for the running of the home in the managers absence. Both senior carers were spoken with during this visit. They reported that their new roles are working well and they were both knowledgeable about the needs of the people using the service and the operation of the home. During this visit we identified developments and improvements by the manager with the care plans, staff training, home environment, personnel files, consultation with the people who use the service and the management of finances. The management style within the home supports and guides the staff team to be Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: more focused on outcomes for the people receiving their care and support. The manager continues to improve the overall organisation, structure and storage of documentation required by the Care Homes Regulations 2001. This work needs to continue to ensure the safety of the people using the service and the continuing competency of the staff team. A discussion with staff and an examination of a selection of care plans, risk assessments and daily diary entries indicate the opinions of the people who use the service are sought and valued in all areas of the homes life. There are regular meetings with the people using the service where they decide on future activities, issues such as decoration and make their views known about any equipment they want for the home. The most recent record showed that the people using the service would like new outdoor chairs and a table. Since the last inspection a survey has been completed by the people who use the service which shows they have positive views about living at the home. The accident records were examined and indicated appropriate information had been recorded and appropriate actions had been taken to help keep people safe. Care Homes for Adults (18-65 years) Page 29 of 35 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 30 of 35 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 1 17 A record of the extra amounts payable for additional services not covered by the care homes charges, such as costs due to staff accompanying the people using the service on outings, must be made available. This is to ensure that people using the service and their representatives are clear about what additional costs they made need to pay and to protect the people using the service from financial abuse. 30/06/2010 2 20 13 The administration 30/04/2010 directions for the medication identified during this visit is to be clearly recorded by the pharmacist following advice from the dietician. Care Homes for Adults (18-65 years) Page 31 of 35 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 To ensure that at all times medication is administered appropriately. 3 24 13 All steps must be undertaken to eliminate any unnecessary risks. Water that is accessible to the people using the service must be maintained at a safe temperature. To prevent a risk to the people using the service. 4 24 13 The risk assessments for the 30/04/2010 radiators that are not covered are to be more detailed. To ensure that staff have access to clear guidance around the actions they are to take to prevent a risk to the people using the service. 5 24 23 The home must be kept in a 30/06/2010 good state of repair. The stained carpet in a service users bedroom and the worn flooring in the bathrooms are to be replaced. In order to ensure that the people live in a wellmaintained, dignified and comfortable home. 30/04/2010 Care Homes for Adults (18-65 years) Page 32 of 35 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 6 35 18 All new staff need to be provided with induction training. To ensure they have the knowledge and skills appropriate to support the people using the service. 30/06/2010 7 35 18 Staff must be provided with training appropriate to the work they perform. Up to date training in the safeguarding of vulnerable adults and in the administration of rectal diazepam must be provided to any staff who have not received this. To ensure that staff have the knowledge and skills available to appropriately support people using the service. 30/06/2010 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 1 The statement of purpose must be updated to that people have the most up to date information to help them make decisions about the home. The statement of purpose should be up to date with the staffing levels that people can expect to find at the home, the commissions address and contact details in case anybody wants to contact us, details on the fees charged, what the fees do not cover, activities offered and supported, staff training and qualifications and Care Homes for Adults (18-65 years) Page 33 of 35 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 menus and meals offered. This document should also indicate that the garden is not accessible for wheelchair users. 2 5 Contracts need to be further developed so that people have the right information to make choices about the service. The contract should provide information about any goods and additional services the owner expects people to pay for in addition to the weekly fees charged. The behaviour management plan for the person identified during this inspection is to be developed further so that staff have access to the information they need to appropriately support this person. Further information on the preferred methods of communication of people living at the home should be documented and developed to include symbols and preferred signs e.g. using makaton for some people who choose to use it. This will ensure the staff team are able to communicate effectively with the people living at the home. All staff should have training around the use of makaton. Where a person self administers medication staff should sign to say they have received the completed medication containers and record whether all have been taken as this will provide a means of ensuring that the person is continuing to be able to appropriately self administer. A record should be maintained of all checks undertaken of hot water temperatures and of checks to ensure that risks posed by hot surface temperatures are being minimised. Design solutions that control the risks from hot radiator services should be put in place. A development plan for Seabank House should be produced and shared with the people who live there and include staff and relatives to show what plans are taking place regarding developing their home including decoration, refurbishment and maintenance of the home. The manager should not work excessive hours at the home to make sure that the home is run in the best interests of the people who live there. The manager should obtain an NVQ Level 4 (or equivalent) in management. 3 6 4 6 5 20 6 24 7 8 24 24 9 33 10 37 Care Homes for Adults (18-65 years) Page 34 of 35 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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