Care Home: Springbank Road 152

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What the care home does well All the written and verbal feedback we received from the people who use the service and a professional representative was extremely positive, especially regarding the attitude of staff who work there. Typical comments included - `staff are dedicated to looking after the service users`, `staff have a wonderful relationship with the people who use the service`, `the staff are nice here - i like my keyworker.` The service has plentiful staff available at all times to support the needs, activities and aspirations of all the people who use the service. This staff team also has a good balance of all the skills, knowledge and experience to meet peoples needs. Staff met were able to demonstrate a thorough understanding of the particular needs of individuals, and were observed delivering it in a highly effective person centred care way. It was also evident that staff were are able to various communication techniques to interact freely and easily with all the people who use the service in the way they preferred. It was positively noted that the entire staff teams has recently received training in the use of non-verbal Makaton signing techniques. The care plan is developed with,the people who use the service and is based on a full assessment of their needs and wishes. Plans are person centred and focuses on what is important to the individual, how they keep safe, their goals and aspirations, their skills and abilities, and how they make choices in their life. Care plans viewed were also particularly good at identifying the services users unique spiritual beliefs, race and cultural heritage, their preferred methods of communication, food preferences, and social interests/hobbies. These plans are constantly reviewed and up dated accordingly to reflect any changes in needs and/or circumstances. The service also has excellent arrangements in place to enable the people who live there to influence key decisions in the home, whatever their communication style is. People who use the service are actively encouraged and supported by staff to be fully involved in decisions which affect their lives, such as staff selection, choosing the meals they eat, what activities they participate in, what colour their bedrooms are decorated, and the general future of their home. What has improved since the last inspection? All the outstanding requirements identified in the services previous inspection report have been met in full within the prescribed timescales for action, including: ensuring care plans were made available in easy to read versions for the people who use the service; better mobility risk assessments enable staff to help service users to be transfered safely in the way they prefer; more detailed health care action plans which set out the outcomes of peoples appointments with health care professionals; removal of debris from the garden and a time specific plan to landscape it; better arrangements to ensure all bedrooms smell fresh and clean at all times, and the reintroduction of monthly inspections by representatives of the provider as part of their much improved quality assurance systems. The service is also no longer so reliant on temporary agency staff because a number of new permanent support workers and bank staff have been recruited recently to fill the majority of its outstanding staff vacancies.Finally, building and decorating work on the kitchen and relatively new conservatory is now complete. Progress made to landscape the rear garden within the agreed timescale (i.e. By October 2009) will be assessed at the services next inspection. What the care home could do better: All the positive comments made above notwithstanding there remains scope for further improvement, especially with regards developing more service user `friendly` versions of documents and positive risk taking/assessing: The service should develop easy read versions of its Guide and complaints procedures to ensure all the people who use the service have access to all the information about their home, including how to exercise their right to express dissatisfaction with the service they receive. We also recommend all the people who use the service should be offered keys to their bedroom and the front door. This should be done with an appropriate risk framework to promote their independent living skills, and outcomes included in care plans. The way in which staff records the actual food and drink consumed by the people who use the service should be reviewed as current arrangement can be variable. This will ensure anyone authorised to inspect these records can determine whether or not the people who use the service are being offered a choice of nutritionally well balanced food at mealtimes. People using the service should be able to manage their own medication if they wish in order to promote their choice and independence providing all the risks associated with the activity are thoroughly assessed and managed. The damaged call bell alarm system in one bedroom must either be repaired, or based on an assessment of risk, be removed. This will enable the service user who occupies this bedroom to contact staff on duty at night. Finally, the service should consider fitting a suitable device to fire resistant bedroom doors if the service users choose to have their bedroom doors propped open during the day. The release mechanism would allow fire resistant bedroom doors to close automatically in the event of the fire alarm being activated in line with local fire authority guidance. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Springbank Road 152 Springbank Road 152 Lewisham London SE13 5BD     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: Lee Willis     Date: 1 3 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 33 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Springbank Road 152 Springbank Road 152 Lewisham London SE13 5BD 02086973816 02087786145 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : PLUS (Providence & Linc United Services) care home 4 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 4 This home is registered for 4 persons with learning disabilities of whom 1 may also have a physical disability and be over 65 years Date of last inspection Brief description of the care home 152 Springbank Road is a small registered care home which offers long term accommodation and personal support for up to four adults with learning disabilities, some of whom also have non verbal communication and physical needs. LINC, the company that previously owned and managed the home has recently merged with another company and since August 2005 the management and ownership of the home has been taken over by PLUS Providence LINC United Services. Sally Ann Ferguson remains the registered manager of the home where he has been in operational day to day control for some years. Situated in Lewisham the service is close to a wide variety of local shops, hairdressers, cafes, restaurants, pubs, banks, and parks. Good public transport links, which includes a mainline train station and numerous bus stops are also conveniently located close to the home. Built over two storeys all the people who use the service have their own single occupancy bedrooms. Communal Care Homes for Adults (18-65 years) Page 4 of 33 Brief description of the care home areas comprise of a main lounge, an open plan kitchen and dinning area, laundry room, and office. There is also a garden at the rear, which although not accessible to the service users, the providers have assured us they have agreed to plans to landscape it by October 2009. The home aims to provide a homely atmosphere where staff can support individuals to develop and maintain their skills and independence as much as possible and lead a fulfilling life. Twenty four hour staff support is provided with at least two staff on duty throughout the day. At night one staff sleeps in and managers take it in turn to be designated on call to cover emergencies. The service has developed clear information to help people who use the service and their representatives to understand what facilities and services it offers. Updated information on fees was not available. Care Homes for Adults (18-65 years) Page 5 of 33 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 people who live at 152, Springbank Road continue to experience good quality outcomes. We therefore continue to rate it as a 2 star good performing residential care service. From all the available evidence we gathered during this key inspection it was clear the service has significantly more strengths than areas of weakness, and that there are no significant areas for improvement relating to the health and safety of people using the service or issues of poor management. We spent 5 hours at the service. During the site visit we met all three of the people who currently live at 152, Springbank Road, a regional manager, and three support workers. We also spoke with the services manager by telephone and held a group meeting with all the support workers who were on duty that afternoon. We looked at various records and documents including, the care and health action plans for all three of the people who Care Homes for Adults (18-65 years) Page 6 of 33 use the service. The remainder of the visit was spent during the premises. Ten of our surveys about the home were returned to us. Three were completed by the people who use the service (some with support from staff), six came from support workers, and one from a health care professional. Finally, the manager completed and returned our Annual Quality Assurance Assessment (AQAA) when we asked for it. This self-assessment document tells what the providers think they do well, what has improved since the homes last inspection, and what the manager thinks they could do better. What the care home does well: What has improved since the last inspection? All the outstanding requirements identified in the services previous inspection report have been met in full within the prescribed timescales for action, including: ensuring care plans were made available in easy to read versions for the people who use the service; better mobility risk assessments enable staff to help service users to be transfered safely in the way they prefer; more detailed health care action plans which set out the outcomes of peoples appointments with health care professionals; removal of debris from the garden and a time specific plan to landscape it; better arrangements to ensure all bedrooms smell fresh and clean at all times, and the reintroduction of monthly inspections by representatives of the provider as part of their much improved quality assurance systems. The service is also no longer so reliant on temporary agency staff because a number of new permanent support workers and bank staff have been recruited recently to fill the majority of its outstanding staff vacancies. Care Homes for Adults (18-65 years) Page 8 of 33 Finally, building and decorating work on the kitchen and relatively new conservatory is now complete. Progress made to landscape the rear garden within the agreed timescale (i.e. By October 2009) will be assessed at the services next 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. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 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 33 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. The services Statement of Purpose and Guide could not be made available for inspection because they are currently being up dated into easy read versions to enable the people who use the service to have access to all the information they need to know about their home. Prospective users of the service and their representatives can be confident they will be offered opportunities to find out about the home through planned visits and a thorough assessment of their needs and wishes. This enables prospective new service users and their representatives to make more informed decisions about whether or not the placement would be right for them and/or their loved one. Evidence: The services Statement of Purpose and Guide could not be made available for inspection because the manager told us over the telephone she had taken the documents in order to up date them and make it easier for the people who use the service to read the Guide. The manager has agreed to supply us with a copy of the Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: services Statement of Purpose and Guide when she has completed reviewing them. 100 of our surveys which were completed by people who use the service with support from care staff ticked Yes to both the questions - Were you asked f you wanted to move into this home, and Did you get enough information about this home before you moved in?A member of staff told us that a new service user would be moving in the next day. In line with best practise this member of staff confirmed this prospective new service user and their next of kin had visited the service on numerous occasions in the past few months to meet the other services users and staff, and view their bedroom. Staff met also told us that these visits had consisted of an over night stay and having several meals with the other service users. Full needs assessments carried out by Care managers representing the relevant placing authorities were produced on request for two people who had lived at the service for many years. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes approach to care planning is person centred and focuses on individuals unique strengths and personal preferences. The plans also set out in detail how peoples current requirements and aspirations will be met through positive individualised support. The service has a can do attitude to responsible risk taking, which are being managed more positively in order to help the people who use the service lead the life they want. People who use the service are actively encouraged and supported to maintain and development their independent living skills and participate in the day to day running of their home. Evidence: 100 of the services care staff who returned our surveys wrote they are always given up to date information about the needs of the people they supported in their care plans. Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: We looked at two care plans in depth. Both plans were person centred and set out in great detail how these individuals current personal, social, and health care needs were being met through positive interventions, and what their unique strengths and preferences were. Staff met told us the people who use the service are fully involved in developing their own care plans with staff support and as required in the services last inspection report and now available in formats that the people who use the service can easily read. Documentary evidence was made available on request that collaborated the statement made by the services manager in the AQAA - Care plans are reviewed annually with a further review of goals carried out six months after the review. A person who uses the service told us they had a keyworker who they liked. Staff met confirmed everyone who currently resides at the service has a designated keyworker who are responsible for arranging regular one to one meetings with the people they keyworked. Documentary evidence was made available on request to show that one person who uses the service had attended two meetings with their keyworker in the past six months. Both the care plans viewed contained very detailed information about service users preferred methods of communication. A member of staff told us all the services support workers had recently attended a Makaton training course to enable them to communicate more effectively with those service users who are non-verbal. This particular member of staff demonstrated a good grasp of basic Makaton signing and was able to show us a number of signs they had recently learnt. We also noted a computer in one service users bedroom, which staff spoken with told us contained a specialist programme that enabled this individual to communicate more effectively with staff. We also noted a number of objects kept in a box in the lounge which staff told us they used as references to enable another service use with communication needs to express themselves more effectively. A member of staff demonstrated a good understanding of one service users preferred method of communication when we observed them correctly interpret this individuals non verbal ques to have a cold drink. All the staff met were keen to actively encourage and support the people who use the service to take responsible risks and do as much for themselves as they were willing and capable of doing. As mentioned above one member of staff was observed supporting a service user to choose and make their own cold drink in the kitchen. Both the care plans viewed referred to the household chores and personal safety training the people who use the service had agreed to participate in each week, which included tidying bedrooms, cooking and crossing roads safely. Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: Risks assessments selected at random covered various aspects of the services users lifes including; bathing, travelling on public transport, financial management, use of knifes, and epileptic seizures. A member of staff spoken with at length demonstrated an extremely good understanding of the needs and wishes of a person they were supporting that morning. This member of staff was observed keeping a closer eye on this individual and also told us they would have to postpone their plans to go for a walk that morning because of changes in this individuals health, which was the guidance specified in their care plan. All the risk assessments and associated management strategies viewed during this inspection had been reviewed within the past six month and up dated accordingly to reflect any changes in need or circumstances. Care Homes for Adults (18-65 years) Page 15 of 33 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 who use the service are involved in meaningful daytime activities of their own choice and according to their individual interests and capabilities. Meals are varied, well balanced, and highly nutritional ensuring the diverse cultural and dietary needs of the people who use the service are well catered for, although the way the service records the meals actually consumed could be improved. Evidence: On arrival we noted that most of the people who use the service were out engaging in various pre-planned community based activities. 100 of our surveys which were returned to us by the people who use the service told us they are able to make decisions about what they do each day and can do what they want during the day, Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: evenings and weekends. Furthermore, a lot of the staff who also completed our surveys made reference to the fact that they felt the home was good at providing social activities for the people who lived their to participate in. Weekly activity schedules included in care plans viewed were very detailed and demonstrated to us that people who use the service can choose to engage in a wide variety of social activities. Information entered in daily diary notes also showed us the people who use the service are engaging in the activities they are offered, which includes music, art, and cooking classes at local day centres, walks in the park, and various day trips to the coast and sporting events. During a tour of the premises we noted a lot of information about social events and leisure facilities in the local community and an assortment of games, and film and music DVDs in the main lounge. Staff met told us two people who use the service would be going on holiday with staff next week and that another had made plans to do a series of all day Green walks around London this summer. Care plans viewed contained very detailed information about each service users spiritual needs and wishes. Staff told us that as stated in a care plan they support one service user to attend religious services at places of worship which reflected their faith. On arrival the member of staff who let us checked my identity card and asked us to sign the visitors book, in line with the providers visitors policy and best security practises. All the staff met told us the service had a fantastic relationship with their next door neighbours. Staff met told us one person who uses the service has been provided with a key to the front door, but not their bedroom. We suggest a thorough risk assessment of all the services users wishes and capabilities, including the most recent admission, regarding the use of bedroom and front door keys is carried out and included in care plans. During a tour of the kitchen we noted it was well stocked with a wide variety of nutritional well balanced food stuffs. Staff told us people who use the service are encouraged to food shopping with staff on a regular basis and the one service user who is willing and able to prepare some of their meals is supported to do so at least once a week. Staff also told us they do not encourage the service user to plan menus because all are capable of clearly stating what they want to eat at mealtimes. A member of staff showed us how they use pictorial aids and non verbal prompts to ascertain the meal choices of the one service user with communication difficulties. It was evident from daily dairy notes inspected that the people who use the service are offered a choice at mealtimes, although the recording of the food actually consumed does vary. We recommended they way the service records what the service users eat is reviewed. Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: Nonetheless, it was positively noted from these daily records that one service user is frequently offered rice and has at least one oriental style dish at week at a local community centre. This individual preferences for oriental style cuisine and their cultural heritage was also reflected in their care plan. Care Homes for Adults (18-65 years) Page 18 of 33 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. Suitably robust arrangements are in place to ensure the people who use the service receive personal support in the way they prefer and require, and that their unique physical and emotional health care needs are continually recognised and met. Policies and procedures for handling medication are in the main sufficiently robust to keep the people who use the service safe, although far more could be done to actively encourage and support people who wish to take greater responsibility for administering their own medication to do so within an appropriate framework of risk. Evidence: 100 of our surveys that were returned to us by the people who use the service and the one completed by a health care professional all told us staff support the service users to live the life they choose. Recently up dated risk assessments were in place to ensure staff had all the information they needed to know about supporting the people who use the service move and transfer in the way they required and preferred. Staff met demonstrated a good understanding of these guidelines and provided us with documentary evidence Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: that showed us one person who uses the service regularly received advice and support from a suitably qualified physio therapist. As required in the services last inspection report a member of staff was able to show us health care action plans which set in detail the outcome of all the appointments the people who use the service regularly attend with various health care professionals. It was clear from the comments made by staff and records kept that the people who use the service have their health routinely checked by various health care professionals including; GPs, community based nurses, physios, and dentists. The health care professional who returned our survey told us service users health care needs are always met and staff are good at respecting their privacy and dignity. No recording errors were noted on any of the medication administration records (MAR) sheets inspected. These records accurately reflected current stocks of medication held in the home on behalf of the people who use the service. Staff told us an audit of all the services medication handling and recording practises is always carried out at the end of each shift. All the staff met demonstrated a good understanding of best practise regarding the safe handling of medication in a residential care setting. As none of the people who currently use the service self medicate we recommend staff assess whether or not anyone would be willing and capable of taking at least a degree of responsibility for administering their own medication. Care Homes for Adults (18-65 years) Page 20 of 33 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. The services arrangements for dealing with concerns and complaints are sufficiently robust and understood by staff to ensure people who use the service feel listened too and safe. The people who use the service are protected from harm and abuse by the homes safeguarding arrangements. Evidence: All the written feedback we received from stakeholders was very positive about how the service deals with concerns and complaints. 100 of the people who use the service told us they knew who to talk to if they were unhappy and how to make a complaint if they needed too. A health care professional wrote the service always responds well to complaints and 100 of staff who returned our surveys said they would always take a complaints seriously and pass it onto the right people to look into it. Staff met told us they were not aware of any formal complaints being made about the service in the past year. The services complaints policy is not available in a format that can be easily accessed by the people who use the service. We recommend the service develops a pictorial version to enable all the people who use the service to read the complaints procedure. Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: We received documentary evidence from this service without delay regarding the occurrence of two significant incidents involving the people who live there. Both incidents were handled in a very prompt and professional manner by staff on duty at the time. Staff told us none of the people who use the service had sustained any major injuries or needed to be admitted to Accident and Emergency. All the staff met demonstrated a good understanding of what constituted abuse and who they should notify without delay if they witnessed or suspected it. Staff also provided us with a copy of the Local Authorities safeguarding protocols and told us there had been no disclosures of abuse made within the service since it was last inspected. All the care plans looked at contained specific guidance to enable staff to deal effectively with incidents of challenging behaviour in a non-physical intervention way and in the best interests of the service users. Money kept in the home on behalf of the people who live there is securely locked away in individual tins. Money contained in these tins matched the recorded balances and receipts obtained by staff for goods and services purchased on behalf of the service users. Staff told us the people who use the service are actively encouraged be more independent and to look after their own personal allowance which individuals can spend how they like. Care Homes for Adults (18-65 years) Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The interior decoration of the home, including its fixtures, and fittings, are well maintained ensuring the people who use the service live in a very homely and comfortable environment. The homes arrangements for controlling infection are sufficiently robust to ensure the people who use the service also live in a very clean and safe environment. Evidence: All three of the requirements made at the services last inspection that related to the environment have been met. During a tour of the premises we noted no offensive odours in any of the bedrooms, no debris in the rear garden, and no damaged cupboards in the kitchen. Since the last inspection the kitchen and conservatory areas have been refitted. Staff on duty showed us plans that had been drawn up to re-landscape the rear garden. The services manager told us over the telephone that she hoped the work would be completed by 1st October 2009. Progress made to achieve this aim will be assessed at the services next inspection. Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: The en-suite facilities in one bedroom had been suitably adapted to meet the mobility needs of the person who occupied the room, which included a raised toilet seat, various grab and hand rails, and a wheelchair accessible shower unit. The temperature of hot water emanating from the shower unit in this en-suite was found to be a safe 43 degrees Celsius. The call alarm system in this bedroom no longer works. We agree with the comments made by a member of staff that it would be easier for this individual to contact staff at night in an emergency if it was repaired. All the communal areas look extremely homely and comfortable. We positively noted that a lot of the service users art work was conspicuously displayed on walls throughout the home. The home also looked and smelt extremely fresh and clean. 100 of the surveys that were returned to us by service users told us this was always the case. Care Homes for Adults (18-65 years) Page 24 of 33 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. People who use the service can be sure that they are safe because there are more than enough competent and in the main suitably trained staff on duty at all times. They also have confidence in the staff because checks have been done to make sure that they are suitable to care for them and they receive regular supervision and support from their line manager. Evidence: All three of the support workers we met during this site visit were observed interacting with all three of the people who currently use the service in a very caring and respectful manner. 100 of our surveys that were returned to us by the people who use the service told us staff always treated them well and listened to what they had to say. It was evidence from the records maintained by staff and practises observed during their afternoon handover that the service has developed very effective communication systems. Staff met also told us the homes communication book was a very useful tool for keeping up to date with all the service users changing needs and daily Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: appointments. We our aware that this service had become extremely reliant on temporary agency staff in 2008 because it only had 50 of its full compliment of staff employed at that time. However, staff we met told us this was no longer such an issue because a number of new permanent and bank workers had recently been recruited. It was positively noted from the services last four duty rosters that only one agency member of staff had worked at the home in this time. These rosters also showed us that at least two members of staff work during the day, and at night one staff sleeps-in. At night the home operates an emergency on call system. Staff met demonstrated a good understanding of who they should contact in an emergency should they need too. All staff met told us they believed current staffing levels were sufficient to meet the needs and wishes of all the service users. The services most recently recruited member of staff told us they were not allowed to commence working at the home until they had supplied their new employer with - A completed job application, an up to date Criminal Records Bureau (CRAB) check; two written references, of which one was from their last employer; and a Home Office approved work Permit/Visa. This member of staff also told us they were aware that their new employer had followed up their reference provided by their previous employer to verify its authenticity, and were satisfied with the induction they had received, which they told us had covered everything they needed to know about the service users and new role. All the staff met told us the people who use the service are actively encouraged and supported to participate in recruiting new staff. A relatively new member of staff told us a person who uses the service had asked them several questions during their recent job interview. 100 of the staff who returned our surveys told us the training they received was relevant to their job and continually up dated. The health care professional who also returned our survey wrote - permanent staff have the skills and experience to meet the service users needs. The services manager told us there are currently no gaps in her staffs teams training needs having recently carried out a thorough assessment. Staff met told us they had all received training in fire safety, first aid, moving and handling, physio, food hygiene, health and safety, safeguarding vulnerable adults, safe handling of medication, and Makaton. Furthermore, the manager told us in the service AQAA that the majority of the current staff team had achieved a National Vocational Qualification in care - Level 2 or above. 100 of the staff who returned our surveys told us their manager meets with them to Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: discuss their work on a regular basis. One staff wrote -i have a supervision session with my manager at least every six weeks. and three others met confirmed this was the case. Another member of staff told us - they found these sessions very useful and very much a two way process. Minutes taken of staff meetings revealed they continue to be held once every two months. The three held in the first half of 2009 had each been well attended by staff and had covered a wide variety of relevant topics including, service users changing needs and health and safety issues. Care Homes for Adults (18-65 years) Page 27 of 33 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 people who use the service benefit from living in a home that is now being well run by a very experienced and competent manager. Sufficiently robust quality assurance and monitoring systems are in place that allows the views of the people who use the service to influence homes operation and development. In the main the homes health and safety arrangements are sufficiently robust to safeguard the welfare of the people who use the service, although some of its fire containment systems should be reviewed. Evidence: All the verbal feedback we received from the staff met during this site visit was very positive about their line managers approach to running the service. Typical comments included, shes very hard working, is easy to talk too, and firm, but fair. AQAA states the manager is suitably qualified, experienced and competent to run a Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: residential care home for adults with learning disabilities, and has built up good working relationships with the people who use the service and her staff team. As required in the services last inspection Regulation 26 visits are now bing carried out at regular intervals by representatives of the provider. Documentary evidence of these internal quality assurance visits were produced on request, along with the outcomes of quarterly audits, carried out by the homes manager. Staff produced an up to date version of the services fire risk assessment for the building on request. Other fire records revealed staff continue to test the services fire alarm system on a weekly basis and conduct fire drills approximately once a quarter in line with best practise guidelines. During a tour of the premises we noted a fire resistant bedroom door being inappropriately propped open contrary to Local fire Authority. The wedge was immediately removed by staff on request, who also told us that the individual who occupied this bedroom liked to have their bedroom door ajar during the day. We suggest a a sound activated mechanism is fitted to this door which will allow it to be propped open while ensuring its automatic closure in the event of the fire alarm being activated. Up to date Certificate of worthiness were made available on request to show that suitably qualified engineers had checked the homes gas installations, fire extinguishers, and portable electrical appliances in the past twelve months. During a tour of the kitchen it was noted that all items of food kept there were correctly stored in line with basic food hygiene, and that multi-coloured chopping boards for the safe preparation of all foodstuffs and a well stocked first aid kit were all made available on request. Care Homes for Adults (18-65 years) Page 29 of 33 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 33 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 5 The provider must supply us 01/09/2009 with the most up to date easy to read version of the service users Guide. This will enable prospective new service users and their representatives to make more informed decisions about whether or not the placement is right for them and/or their loved one. 2 29 23 The damaged call bell alarm system in one bedroom must either be repaired, or based on an assessment of risk, be removed. This will enable the service user who occupies this bedroom to contact staff on duty at night. 03/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of Care Homes for Adults (18-65 years) Page 31 of 33 improving their service. No. Refer to Standard Good Practice Recommendations 1 16 All the people who use the service should be offered keys to their bedroom and the front door. This should be done with an appropriate risk framework to promote their independent living skills, and outcomes included in care plans. The way in which staff records the actual food and drink consumed by the people who use the service should be reviewed as current arrangement can be variable. This will ensure anyone authorised to inspect these records can determine whether or not the people who use the service are being offered a choice of nutritionally well balanced food at mealtimes. People using the service should be able to manage their own medication if they wish in order to promote their choice and independence providing all the risks associated with the activity are thoroughly assessed and managed. The service should develop an easy read version of its complaints procedures to enable the people who live their to access this information and ensure they know how to exercise their right to express dissatisfaction with the service they receive. The service should consider fitting a suitable device to fire resistant bedroom doors if the service users choose to have their bedroom doors propped open during the day. The release mechanism would allow fire resistant bedroom doors to close automatically in the event of the fire alarm being activated in line with local fire authority guidance. 2 17 3 20 4 22 5 42 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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