Care Home: Searsons Way

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What the care home does well Feedback received from the people living at the home was positive. One person said, "I am very happy where I live". A relative said, " I think the carers understand him very well and try their best to fulfil his needs." "The carers are kind to him and treat him extremely well." A healthcare professionals said, "my specific client gets good care". Staff said, "we listen to the service users giving them choice in their day-to-day lives. We respect the service users and I feel they are happy in their home." What has improved since the last inspection? All the requirements of the last inspection have been met. The electrical cabling to the garden shed has been made safe. Staff are receiving the training that they need to meet people`s needs. A senior activity coordinator has been appointed and people are involved in activities in the community. The statement of purpose has been updated and is now in Widget form to make it easier for people to understand. Individual plans have been updated, and any changes have been documented and discussed with the person and the people involved in their care. Some improvements have been made to the house in that new furniture has been purchased for the lounge and dining room and a bath was put into one of the ensuite facilities as the person using this did not wish to have a shower. What the care home could do better: There were staff changes earlier this year and this included a new manager. Some of the people who live at this home find changes very difficult to cope with especially as they need to be supported in a consistent manner. In some cases this has led to some problems with behaviour. New staff are in post and the situation has started to settle. However it was evident that the staff are not working together as effectively as they could be and team building work is needed to address this and to support the development of the service. The organisations monitoring of the service has not been as robust as it should be and this needs to be addressed to ensure that the service continues to develop in line with best practice and to meet the needs of people living there. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Searsons Way 40 Fairkytes Avenue Hornchurch Essex RM11 1XS     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: Jackie Date     Date: 0 4 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Searsons Way 40 Fairkytes Avenue Hornchurch Essex RM11 1XS 01708709149 01708709427 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Clearwater Care (Hackney) Ltd Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 4 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 Date of last inspection Brief description of the care home 40 Fairkytes Avenue, which has a registered name of Searsons is a home for four people with learning disabilities. At the time of this inspection four men were living there. They have been living there together since the home opened just over two years ago. The house is very close to Hornchurch town centre where there are shops, leisure facilities and access to transport links. The home is owned and managed by Clearwater Care who own and manage the house next door which is also a small care home. The fees for this service range from between 211 and 230 pounds per week. This 4 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home information was provided by the manager. Information about the service is available in a statement of purpose and service user guide. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection of this service was on the 15th December 2006. This inspection was unannounced and started at 10 a.m. It took place over seven hours. This was a key inspection and all of the key inspection standards were tested. Staff were asked about the care that people using the service receive and were also observed carrying out their duties. People using the service were asked to give their views of the service and their experience of living in the home. All areas of the home was seen. Staff, care and other records were checked. Feedback questionnaires were sent to staff, social workers, health care professionals and people live at the home. Feedback was received from six staff, three people who Care Homes for Adults (18-65 years) Page 6 of 32 use the service and two healthcare professionals. Services are now required to complete an AQAA (Annual Quality Assurance Assessment) and the completed form was received in August 2008. Information provided in this document also formed part of the overall inspection. The fees for this service range from between 211 to 230 pounds per day. This information was provided by the manager shortly after the inspection. We would like to thank the people living at the home and the staff for their input during the inspection. What the care home does well: What has improved since the last inspection? 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 set out on page 4. Care Homes for Adults (18-65 years) Page 8 of 32 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessments completed by the home and the information and reports received from other professionals means that staff have detailed information to enable them to determine whether or not the home can meet a persons needs. Evidence: Standards 2, 4 and 5 were tested. All of four people living in the home moved in when it first opened just over 2 years ago and have lived together ever since. Therefore there have not been any new admissions since the last inspection. The previous inspection stated that the quality of the initial assessment material was excellent and that people had been well supported through the transition period. The files seen contained assessment information that was gathered when people first moved in. This was detailed and comprehensive. Feedback from one of the people living at home was that moving into the home was discussed with him and that he came on visits. Therefore the service obtained the necessary information about an individuals needs before they offered the service to Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: them. The organisation, Clearwater Care, has now appointed an assessment and referral manager who will in future take the lead in carrying out the assessments of any people wishing to move into the service. They will also take a lead in planning any transition. Each person has a contract/terms and conditions of residence and copies of these were seen in individual files. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at this home are involved, as far as they are able, in developing and reviewing their care plans and these provide staff with the information they need to meet individual needs. Risk assessments are appropriate and people are supported to take risks according to their needs and to have the opportunity to try things as safely as possible. People are encouraged and supported to be involved in decisions about what they do and what happens in the home. Their opinions are valued and listen to. Evidence: Standards 6, 7, 9 and 10 were tested. Each person has a care plan and these contain information about them and the support that they need. The plans seen had been updated regularly and contained Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: appropriate information. This included, what I can do, how I like to be supported and behavioural support plans. Individuals are asked to take part in their reviews and families and friends are also invited. Other professionals such as the community nurse and challenging behaviour nurse specialist have been involved in developing plans. This is because people living at the home have complex needs in terms of their behaviour and consistency in routine and approach is very important. Feedback from staff was that they were given up-to-date information about the needs of the people they support. One person said that up-to-date information is always passed on at the start of every shift and that other additional information is usually in the communication book as well as in peoples individual daily logs. Daily logs are kept and these contain information about what people have done and how they have been. Updated risk assessments are in place. These identify risks to people and indicate ways in which the risk can be reduced to enable people to be supported as safely as possible. The risk assessments seen were relevant to each individual and the activities that they do. For example going swimming or going out in the car. Feedback from staff was that the guys have choices about what they want to do, what they want to eat and that their opinions are sought and valued. A member of staff said, we listen to the service users and give them choice in their day-to-day lives. We respect the service users and I feel they are happy in their home. People living at the home were observed to be given and to make choices on the day of the visit. Personal records and other information are stored securely in the office and staff are aware of issues of confidentiality. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to be as independent as possible, to take part in activities and to be part of the community. People are supported to keep in contact with their relatives. People have meals that they have chosen, like, and that meet their needs and preferences. Evidence: Standards 11, 12, 13, 14, 15, 16 and 17 were tested. The service now has a member of staff designated as a senior activities coordinator. It is her responsibility to organise activities for people living at the home. All of the Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: people using this service need support from staff to access and participate in activities. The home is situated near a local theatre and people use the facilities there. One person spoke about going to see an Elvis show and everyone was looking forward to going to see the pantomime. People had been to see Mama Mia, Irish dancing and also went to the circus. They were due to go to the churchs Christmas party and again were looking forward to this. One persons daily log confirmed that hed been bowling, been to the YMCA gym and also been out for walks. Some people had been to Clacton on holiday. One of the people living at the home had not been used to going out before he moved there. Its been a very slow process to introduce him into community activities but now he does walk to the local theatre and has a cup of tea there and it is acknowledged that this is a big step for him. A member of staff said that people do go out quite a lot. A relative said that her brother likes to stick to a strict daily routine but he is encouraged to participate in outdoor activities such as walking in the park, going shopping, going to the cafe and on day trips. The organisation has another home next door to this one and both homes share a car which can be used to take people out. Staff said that the guys get day-to-day choices and that their opinions are sought and valued. On the day of the inspection it was noted that one person chose what he wanted for breakfast and others what they were going to do that day. The support plans contain information about what people can do and how they are encouraged and supported to do things. For example, making the bed, putting dirty clothes in the washing basket or putting dirty clothes in the washing machine. For others it was making tea, sandwiches or preparing cereal. One person said he had helped to make pizza and crumbles. Most people have regular contact with their families and this contact is encouraged and supported by the staff team. A relative said, I think the carers understand him very well and try their best to fulfil his needs. The menu is varied and includes fresh fruit and vegetables. Doing the course of the visit one person chose his cereal and another helped himself to a banana. Although they have a menu people can and do choose what they want on a daily basis. For example, one person wanted toad in the hole on the evening before the inspection and he went with staff to the local shop and bought this. The other people had what was on the menu. None of the people living in the home have any specific dietary needs in terms of health, culture or religious beliefs. Although people usually eat together the staff do not sit to eat with them. Earlier this year the food budget was cut by 20 pounds per week and staff were told that food was not provided for them. Feedback received previously was that this cut in the food budget had limited the choices of food for people living there but there was no evidence of this at the time of the visit. Care Homes for Adults (18-65 years) Page 16 of 32 Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service receive personal care that meets their needs and preferences and staff support them to get the health care that they need. People are given their prescribed medication safely. Evidence: Standard 18, 19 and 20 were tested. All of the people living at home were clean and appropriately dressed on the day of the visit. Care plans contained information on what people can do, how to support them with personal care and focused on how to make the more independent. For example one persons care plan said that he can shave himself. They also contained information on what people like. For example one person does have an ensuite shower but likes to use the bath in the communal bathroom. Each person is registered with the local GP and receive specialist input as and when required. This includes input from a psychiatrist, occupational therapist and community nurses. The files also contained confirmation of checks from the optician, dentist and Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: chiropodist when needed. Each person has a health action plan and these were all upto-date. Records are kept of medical appointments and their outcomes. One healthcare professional said, my client gets good care. The community nurse and occupational therapist both confirmed that they work closely with staff at the home and have met with them to develop guidelines to work with people and to manage their behaviour. Also that they have provided training on behaviour management. The staff team have had training to administer rectal Valium and also buccal midazolam to enable them to support people who need this medication due to their epilepsy. During the course of the visit one person had a seizure. Staff were very aware of him and his needs and he was supported quickly and quietly until he recovered. There are policies and procedures for the handling and recording of medication. Medication is stored in an appropriate locked metal cabinet in the office. None of the people living at the home are able to self medicate and medication is administered by staff that have been trained to do this. Medication is administered via a monitored dosage system. Medication records are kept and these had been appropriately completed and were up-to-date. Medication records included a photograph of each person and also there was a list of the names and the signed initials of people authorised to administer medication. Both of these are good practice. The practice at the home is that two staff assist with medication. One person administers the medication and the other witnesses and checks this. The witness signs on a separate sheet. There was a handwritten entry on the medication record and for accountability any handwritten entries made by staff must be endorsed with the date and the signed initials or signature of that person. There was a copy of the BNF (British National Formulary) which gives information about various medications. However this was an old copy from 2005 and it is recommended that a more recent copy be purchased to ensure that staff have updated information to help them to support people to receive their prescribed dedication as safely as possible. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at this home are safeguarded by the working practices and support of the staff team. Evidence: There is a complaints procedure and it is planned to develop this in a more userfriendly format in the near future. There were not any recorded complaints. Feedback from a relative was that they knew who to speak to if there were any concerns. Feedback from a member of staff was that the manager would address concerns and that senior managers are quite open and approachable. Staff recently received updated protection of vulnerable adults training and were aware of safeguarding issues. The section on staffing later in this report gives information that confirms that there is an appropriate recruitment procedure and this also helps to safeguard people living at home. None of the people in this home are able to manage their own finances. The London Borough of Havering is a corporate appointee for two people, the organisation is the corporate appointee for a third. The fourth person has a bank account and he is supported by staff to go to the bank. The records and cash held for three people were checked and found to be correct. Peoples money is stored in the safe and only the manager and seniors can access the cash. There was evidence that the manager carries out checks on the cash held and also that a senior manager from the Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: organisation audited the cash held in October. Appropriate records are kept of cash held and receipts obtained as far as possible. Therefore safeguards are in place for peoples finances. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and comfortable home that is suitable for their needs. Evidence: Standards 24, 25, 26, 27, 28, 29 and 30 were tested. The house is situated within a short walking distance of Hornchurch town centre which has a selection of shops and leisure facilities and access to transport networks. On the ground floor there is an open plan kitchen/diner/lounge, a small laundry area and two bedrooms. Both of these bedrooms have ensuite facilities. Upstairs there are two further bedrooms and an office. The upstairs bedrooms have ensuite toilets and hand basins and share a bathroom. There is a good-sized garden that people can use and a large storage shed. Electric cabling to the shed has been changed to make it safer as required by the previous inspection. When people moved into the home they were able to choose which bedrooms they wanted. We toured all areas of the building and everywhere was clean and appropriately decorated and furnished. All of the bedrooms were different and personalised. Although one person uses a wheelchair when out in the community he is able to manage around the home with staff support. There are not any specific adaptations around the house for him although it has recently been assessed that he requires a shower chair. There was a query as to whether the Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: individual or the organisation should pay for this. This was clarified with the manager at the time of inspection. All areas of the home appeared to be clean and hygienic and staff meeting minutes showed that issues of infection control and hygiene had been discussed. This included information on disposable gloves, aprons and mops. Also colour-coded chopping boards and knives for the kitchen. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff receive the necessary training to meet peoples current needs and provide an appropriate for service for them. People using this service are supported and protected by the recruitment practices of the service. Staff have the opportunity collectively and now individually to discuss their own development and any problems and developments within the service. Most staff feel supported by the manager. Evidence: Standards 31, 32, 33, 34, 35 and 36 were tested. There have been some staff changes this year and this included a new manager. Feedback from staff was that there was a period of time when there were some staff shortages and a lot of agency staff were being used. However staff have been recruited and are settling in. The changes did present difficulties as some of the people living there are unable to cope with changes and this did affect their behaviour. The new staff team needed to learn how to work with these people and how to work Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: consistently. Feedback from health care professionals was that things are much more settled now and that they have worked with the staff team on new guidelines for managing individual behaviour and that they have provided training on behaviour management. Feedback from a healthcare professional was that the quality of care had not changed and that their specific client gets good care. Feedback from a relative was that her brothers carers were very fond of him and despite his behaviour difficulties they are extremely kind to him and treat him extremely well. We saw feedback from another relative who in May 2008 said that they were very pleased with their relatives progress and did not have any concerns about his care. There are two staff on duty during each day shift and whenever possible a third person is is on duty during the day to support activities. At night there is one waking staff on duty. The house next door is also a small care home run by the organisation and there is a sleeping in staff on duty there. This person can be summoned in case of need. The manager is supernumerary and usually works during the day from Monday to Friday. The manager also works occasional shifts. From observations on the day and discussions with other people it would appear that staffing levels are sufficient to meet peoples needs. Issues of lack of training had previously been raised in feedback received. However the manager has organised a lot of training and recently all staff had manual handling, infection control, protection of vulnerable adults, challenging behaviour, skills development and rectal diazepam administration training. The manager is in the process of organising further training for staff. One member of staff said that she had completed her NVQ level 3 since joining the company. Two staff have completed NVQ level 2 and 4 other staff have started NVQ level 2. Therefore staff are receiving the training they need to carry out their duties. A random sample of staff records were checked during the inspection and they contained the required information to demonstrate that staff had been appropriately recruited. This included application forms, references, proof of identification and CRB (Criminal Records Bureau) checks. There was evidence of staff meetings and that appropriate issues had been discussed. There had been gaps in supervision since the new manager started. However each member of staff has now had at least one supervision with the manager. The manager acknowledged the gap in supervision but said that it had started and it would now continue. From discussions with and feedback from staff and other professionals it is apparent that there have been issues with teamwork and changes of management Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: style and expectations. There was also some conflicting information that the manager was not hands-on and did not deal with difficult situations when they arose. A member of staff said that as the manager was there most of the time she could make necessary suggestions for the smooth running of the home. This person also said that they had the right support from the manager and that the manager as well as supporting staff ensures that the service users needs are met individually. Overall, we were satisfied that the manager does provide the support that staff need. Feedback from other professionals was that the staff are not working as well together as the team had previously but that things are settling down. It is recommended that some team building work is carried out to help the team to develop and to work together in a consistent manner. This will assist the service to improve and develop further. 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. People living at this home benefit from a service that is appropriately managed and where their opinions are sought and acted upon as far as possible. They live in a safe home. Evidence: Standards 37, 38, 39 and 42 were tested. The new manager has been in post for approximately 4 months. She is a registered general nurse and has been with working with people with learning disabilities for several years. She has also managed services for people learning disabilities. The manager will be enrolling for the relevant qualification in the near future. This will be either the Registered Managers Award or the new equivalent. The manager has not yet applied to be registered with the Commission and said that she was waiting until she received her first formal supervision before she did this. The manager was advised that she needed to make the application and has subsequently contacted the Commission for the necessary documentation and application forms. Although the manager said Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: that she had not had any formal supervision she also said that she had good support from senior managers and that both senior managers had visited and talked through issues with her. She said she was also able to discuss issues with the director of the company. It is important that all staff receive regular, recorded supervision in addition to contact on day-to-day practice. It is especially important for a new manager as they need to to be clear as to what the organisations expectations are and to receive structured feedback on their progress and the quality of the service provided. The manager acknowledged that she is more office based than the previous manager which is possibly what some staff find difficult to understand and accept. She is aware of the need for more teambuilding to be done. The quality of the service provided is monitored by the manager. The manager and staff confirmed that senior managers visit the home and the manager said that she recalled two monitoring visits. There were reports on file of monitoring visits carried out in July and August. Regulations require that a representative of the organisation visits the home regularly and carries out unannounced monitoring visits each month and then writes a report on the findings of the visit and this must be done. The organisation need to be more robust in this area particularly as there have been some difficulties in the last few months and it is their responsibility to ensure that the home is operating within its stated aims and objectives and that it is providing an appropriate service to the people living there. We had received feedback of concerns about money not being available for people who use the service, cheques being late and cheques bouncing. However the manager confirmed that since shes been there the cheques needed for the next months expenditure have all arrived on time and that there have not been any problems cashing these. We were able to confirm that each person living at the home has cash available for their own expenses. The necessary health and safety checks are carried out and records are kept of these checks. These records were up-to-date and accurate. A safe environment is provided for the people living there. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Any handwritten entries made by staff on the medication administration record must be endorsed with the date and signed initials or signature of that person. For accountability and also to provide an audit trail. 18/01/2009 2 39 26 A representative of the organisation must visit the home unannounced at least once a month to carry out a monitoring visit. A report must then be written on the conduct of the care home. This is to monitor the quality of service provided and to ensure that the home is operating in line with its stated aims and objectives and providing a suitable service to the people living there. 28/02/2009 Care Homes for Adults (18-65 years) Page 30 of 32 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 20 It is recommended that a new copy of the BNF (British National Formulary) be purchased so that staff have up-todate information about medication. It is recommended that team building work takes place to help the team work more effectively together. Is recommended that the manager receives regular formal supervision in addition to regular contact on day-to-day practice. This will provide an opportunity for the manager to individually discuss both the development of the service and her own personal development. 2 3 35 39 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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