Care Home: St Chads House

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What the care home does well Residents we spoke with, and those who wrote to us, said they are happy living in the home, are well supported by staff and are involved in a range of activities using community facilities. They were seen to be supported in a respectful and confident way by each member of staff. The relatives we spoke with or who wrote to us said they satisfied with the quality of the care and support provided and think that staff have the right skills and experience to look after people properly. Staff who work in the home said they are happy working here, feel well supported and remain committed to providing a good service to the people who live here. Health professionals who wrote to us said each person`s needs are well met and they are supported to live the life they choose. The ethos of the service is clearly defined and remains focused on positive outcomes for each resident. Professional expertise is sought when necessary in order to ensure a specialist approach of support is promoted for each resident. There remains an extremely low turnover of staff. This helps to ensure consistency in supporting each resident and maintaining a cohesive staff team. St Chads offers very attractive accommodation. This provides residents with a homely environment, which is maintained to a very high standard. What has improved since the last inspection? The process for reviewing care plans has been improved to involve each resident`s Funding Authority. This ensures that each professional involved in each resident`s care participates in the care planning and review process. The home has reviewed its record keeping and terminology to promote a person centred approach. Separate lounge areas have now been created in the home, which give each resident more of their own private space. All staff are now provided with both mandatory and specialist training to enable them to support each resident. A clear record of all staff training is maintained. The organisation have now reviewed the content of reports of auditing visits. This promotes transparency and accountability to each person with an interest in the home. What the care home could do better: Staff members must be supervised on a regular basis and a clear record of each meeting maintained. This will ensure staff are supported to provide support to each resident. Monthly auditing visits must be carried out to ensure an accountable service is provided to each person with an interest in the home. The home must be managed with sufficient care, competence and skill to ensure the welfare and safety of residents and staff. This relates to fire safety checks. The home should consider developing supervision contracts with staff to agree the level of support they need to enable them to do their jobs well. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: St Chads House Withies Lane Midsomer Norton Bath Bath & N E Somerset BA3 2JE     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: David Smith     Date: 0 4 0 2 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 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: St Chads House Withies Lane Midsomer Norton Bath Bath & N E Somerset BA3 2JE 01761413173 01761419204 stchads@orchardvaletrust.org.uk 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) : The Orchard Vale Trust care home 4 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 4 May accommodate up to 4 persons aged 18 - 64 years of age requiring personal care only Date of last inspection Brief description of the care home St.Chads is owned and operated by Orchard Vale Trust, a Registered Charity. The home was opened in 1995 to provide care and support to four adults who have a Learning Disability and Challenging Behaviour. The home is a large detached property set in its own grounds, just a short walk from the town centre of Midsomer Norton. There are car parking spaces at the front of the house. There is level access to both the front and rear of the home, however access to the first floor is by stairs only. Bath is approximately nine miles away. There are four single bedrooms, each with en-suite facilities, three separate lounges, a kitchen and dining area. There are two rooms used as office space and one room used by staff members who sleep-in. The home is furnished and maintained to a very high standard. The home has maintained an extremely low turnover of staff and provides high ratios Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home of staff support. This continues to enable residents to develop and access facilities, both locally and in the wider community. 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 Key Inspection of this service was completed on 15/03/07. This was an unannounced visit to the home to enable us to complete a Key Inspection of this service. We spent 7 hours in the home on the day of our visit. The pre-inspection planning involved reviewing the report of the last Key Inspection completed in March 2007 and the Annual Service Review carried out in June 2008. We also looked at the service history, which details all other contact with the home. We (the CSCI) provided the home with their Annual Quality Assurance Assessment (known as an AQAA). This is a self-assessment, which focuses on how well outcomes Care Homes for Adults (18-65 years) Page 6 of 32 are being met for the people who live at St Chads. The home sent us their AQAA when we asked for it. It was clear and gave us all the information we asked for. We provided a number of surveys for relatives, health professionals and staff members to enable us to carry out the last Annual Service Review. We surveyed residents, staff and health professionals again before this Key Inspection and spoke with one relative. In total, twenty-nine surveys were completed and returned and the views of the people we spoke with or those who wrote to us have also been included in this Key Inspection report. We spoke with three residents in private and time was spent informally observing interaction and communication between staff members and people who live in the home. We also spoke with the Manager, Deputy Manager and other staff members. We gathered additional information for this report by looking at a number of records within the home such as care plans and associated records, risk assessments, accident and incident reports, medication administration, staffing records and health and safety procedures. We also viewed all communal areas of the house and the bedrooms used by the people who live here. The home uses the term resident to describe the people who live in the home. This term has therefore been used throughout this report. What the care home does well: What has improved since the last inspection? The process for reviewing care plans has been improved to involve each residents Funding Authority. This ensures that each professional involved in each residents care participates in the care planning and review process. The home has reviewed its record keeping and terminology to promote a person centred approach. Separate lounge areas have now been created in the home, which give each resident more of their own private space. All staff are now provided with both mandatory and specialist training to enable them to support each resident. A clear record of all staff training is maintained. The organisation have now reviewed the content of reports of auditing visits. This promotes transparency and accountability to each person with an interest in the home. Care Homes for Adults (18-65 years) Page 8 of 32 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.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. Prospective residents are provided with the information they require to enable them to choose where to live and would have their needs thoroughly assessed. Evidence: The home has a brochure, which is used as both the statement of purpose and service users guide. This provides details of the service and support the home is able to provide. This would be supplemented by a comprehensive assessment process, which is operated by the home, should a vacancy arise. There have been no new admissions to the home for a number of years. Care Homes for Adults (18-65 years) Page 11 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. Residents know their needs and personal goals are reflected in their individual plan. They are supported to make decisions and take risks. Individuals are consulted on, and participate in, all aspects of life in the home. Residents can be confident that information about them is handled appropriately. Evidence: We looked at the care records of two people who live in the home. These contain comprehensive information on the areas of support each person requires and the goals they are working towards. The home has improved care plans since our last visit. They have developed life plans, which are a much more person centred approach to planning residents care and support. The information in these plans is clear and the home has worked hard to Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: reduce the amount of technical terms they use. The life plans also clearly describe the goals residents choose to work towards. The daily records complement this process by ensuring there is a constant process of evaluation and review of the support being provided and the outcomes for the resident focused upon. There is now an effective review process. Regular reviews are held, which include residents, their relatives and staff from the home. Comprehensive review documents are produced which are discussed at these meetings. Each review is clearly recorded and the outcomes used to update care plans. The residents we spoke with said they made decisions about their lives. Staff support them, and help by explaining options or possible consequences, but let them choose. Residents who wrote to us said they make decisions about what they wish to do each day and staff listen to them and act on what they say. They are actively involved in all aspects of home life such as cooking, cleaning, decorating, gardening and deciding what activities inside or outside of the home they would like to take part in. Residents are encouraged to discuss all aspects of home life and regular house meetings are arranged. Recent meetings have focused on arranging social events, such as the bring and buy sale, and decorating the house. It is hoped that once each person becomes familiar with these meetings, a wider range of topics may be discussed. Interaction between staff and people who live in the home was observed at various times during our visit. These demonstrated staff have a good knowledge of the support needs of residents and how to communicate with them effectively. Both residents and staff are relaxed in each others company and at no time did staff appear rushed or unable to give people their attention. Care and support is provided within a risk assessment framework. Healthy risk taking continues to be encouraged and supported, as evidenced within the wide range of opportunities and activities all four residents are able to enjoy. Each of the person centred risk assessments examined are detailed and have been regularly reviewed. Each persons care records are stored appropriately and confidentiality is respected. Care Homes for Adults (18-65 years) Page 13 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have opportunities for personal development and are valued members of the community. Each persons rights are respected and their responsibilities are made clear. Individuals are supported to develop and maintain personal relationships. Residents have healthy, well presented meals and snacks at a time and place to suit them. Evidence: Residents remain well supported to reach their full potential in relation to their personal development. A great deal of importance is placed on residents being able to Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: participate in all aspects of home life and they are supported to enjoy a range of leisure activities, outings to places of interest, and to choose and attend holidays. The residents we spoke with described the wide range of their interests and the activities they chose either inside the home or in the wider community. These include golf, swimming, horse riding, cooking, ten pin bowling, attending church groups, social clubs, going to concerts and having lunches and other meals out of the home. During the last year residents have enjoyed holidays in Spain, Cyprus and Weymouth. One person prefers days out to longer trips, and these are often arranged for them. Residents who wrote to us said they can generally do what they want during the day, in the evening and at weekends. Comments from residents include: I always have a choice of what I want to do, I have a wide choice of activities that I can choose from daily and I always get the chance to do the activities I want. Since our last visit, there has been a strong focus upon the Mental Capacity Act, to ensure that the home complies with it and that this is incorporated into care planning and the day-to-day support each resident receives. The residents who live in the home have all demonstrated significant progress in their personal development. It is evident that the positive outcomes for each resident remain the focus of the care planning processes and support of the staff team. Families remain fully involved in the homes care planning process. Orchard Vale Trust was originally a family led organisation and the involvement and support of each persons family remains central to the philosophy of the home. All four residents have contact with members of their families and there are no restrictions on visiting times; relatives are free to visit whenever they wish. Residents visit their families and some stay overnight or for longer periods if they wish. The relatives we spoke with or those who wrote to us said continue to be very satisfied with the quality of the care and support provided by the home. One comment was there is always a happy, homely feel at St.Chads. It is very well run. Another relative said their son has greatly improved in all ways. He has become more confident in himself, he enjoys living there. The health professionals who wrote to us said the home supports people to live the life they choose, responds well to their different needs and respects each persons privacy and dignity. One professional said this is an excellent care home, I am always impressed by the care the residents receive. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: Each resident is aware of their rights and also their responsibilities in residing at St.Chads. The home develops agreements with residents so that they understand what is expected of them and what help and support they can expect from the staff. These agreements appear to work well: examples we saw include having a set of keys, turning lights off at a reasonable time, helping with the shopping and helping with the gardening. Menus are developed with the residents: these ensure a wide variety of food is offered to residents and a healthy and balanced diet is promoted. The home has a kitchen diner, where residents eat their meals. One person chooses to eat their meals in their own lounge, with staff support. Care Homes for Adults (18-65 years) Page 16 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. Residents are supported in their preferred manner and their personal and healthcare support needs are well met. Residents are supported to retain and administer their own medication where possible. The homes policy relating to administration of medication ensures each persons welfare and safety. Evidence: The care plans in place for residents provide clear guidance for staff on how they should support those living at the home with their personal and healthcare. Individuals are registered with a local GP, dentist and optician. Other specialist services are accessed when an identified need arises. In addition to external resources, there remains a high level of clinical expertise within the organisation to ensure that the care planning meets the needs of each resident. The continuity the home has managed to maintain within the core staff team also assists in providing consistency and quality of support in this area. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: The home keeps clear records of each health care appointment, together with the outcome of the visit. Since our last visit the home have also completed the ok health check, which looks at all aspects of each persons health. Record keeping for residents is excellent and can be easily tracked. This process ensures that health care is monitored and the support provided is subject to review. The health professionals who wrote to us said residents health care needs are well met and the home seeks their advice and acts upon this to manage and improve individuals health care. One professional said I have always been very impressed by the level of care given to the residents. I think it is a very good service. The home uses the Lloyds Pharmacy monitored dosage system of medication administration. The way medicines are dispensed have been improved since our last visit. Each resident now keeps a weeks supply of their medicines securely in their own room. Staff give residents access to these and observe them taking their medicines. Staff sign to say they have been taken and some residents also sign their records. One resident spoken with prefers this system and is happy that this has changed. They said they dispense their medicines from the blister pack and the staff make sure they take them. The other stock of medicines is kept securely in one office. Clear records of all medication taken or stored in the home are maintained. Staff are provided with medication administration training using Red Crier training materials. The homes GP said that they felt each residents medication is appropriately managed by the home. Care Homes for Adults (18-65 years) Page 18 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. Each resident feels their views are listened to and acted upon. They are protected from abuse, neglect and self harm. Evidence: The home has a formal Complaints Policy, an Adult Protection Policy and a Whistle Blowing Policy, which staff can use in confidence to raise any issue or concern they have regarding the service. There have been no complaints to the home since we last visited. We have not had any concerns or complaints direct regarding the service at St Chads. The residents spoken with and those who wrote to us said that they know who to speak to if they are unhappy and know how to make a complaint. They are clear on who they would approach and feel they are always listened to and their views are taken seriously. One resident said All the staff listen to me and ask what is wrong if I am looking unhappy and another said I can talk to any staff if I am unhappy. The health care professionals who responded said they have never had cause to complain and had received no concerns or complaints themselves regarding the home. The staff members we spoke with or who wrote to us said they know what to do if a Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: resident, family member or a friend is concerned about any aspect of the care and support provided at St Chads. Comments from staff include: I would pass on any concerns to the manager or the trust and I could contact CSCI. The home has clear guidelines in place for supporting residents who are distressed or presenting behaviours which may be perceived as challenging the service provided. These behavioural approaches contain a clear rationale, long-term goals, direct treatment, reactive strategies and restrictions. If any form of physical intervention is included in care plans, they are recorded and shared with all appropriate parties such as family members, representatives, and Consultant Psychiatrists and Psychologists involved with the individual resident. The home also has up to date Risk Assessments in relation to physical interventions which may be used. Again the quality of record keeping in this area is excellent. This enables each residents approaches to be continually assessed and changes made when necessary. The home maintains clear records of each accident or incident which occurs in the home. Staff are provided with training in relation to the Protection of Vulnerable Adults and are subject to Criminal Record Bureau enhanced disclosures, before they start work in the home. Care Homes for Adults (18-65 years) Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. St Chads provides a homely, comfortable and safe environment for people to live in and is maintained to a very high standard. Evidence: St Chads is a large detached property set in its own grounds just a short walk from the town centre of Midsomer Norton. There are car parking spaces at the front of the house. There is level access to both the front and rear of the home, however access to the first floor is by stairs only. There have been some changes to the layout of the ground floor of the home since we last visited. A partition wall has been built and this has created two separate lounge areas, where there used to be one. There are now two rooms used as office space and one room used by staff who sleep-in. These changes have created more private space for residents to use. Two now have their own private lounge areas and two people share another lounge. Two residents we spoke with said they prefer this and are very happy that they have more of their own space in the home. Comments from residents include: I like my new lounge and I have just decorated my lounge. I chose my paint and wallpaper. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: Decoration and furnishing of these areas is ongoing. Each person has chosen the colour schemes and furnishings they would like. There is leather furniture, wall mounted TVs and residents choose the pictures or photographs they would like to put up. This needs to be completed, and we are sure this work will be completed to the high standards previously reported upon and evident throughout the rest of the home. Upstairs there are four single rooms all with en-suite facilities. Each residents bedroom has been personalised with photographs, pictures and been decorated to reflect their own personal tastes and wishes. All bedrooms are fitted with a lock so residents can lock their bedroom doors should they wish to do so. The home has one support worker, who is also responsible for maintenance. One member of staff is employed as a domestic and helps to keep the home clean and tidy. The residents remain actively involved in the maintenance of their home. The home has a large secluded garden, which residents also help maintain. The home was clean and tidy on the day of our visit. Residents said their home is always kept fresh and clean. Two of them said one member of staff helps us keep our house clean. Care Homes for Adults (18-65 years) Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by an effective, competent and well trained staff team. They are supported and protected by the homes recruitment policy and practice. Evidence: There is a core of well-established staff with varying skills and abilities who meet the needs of each individual who uses the service. Many of these staff have been employed by the Trust for a number of years and therefore know each of the residents very well. The home continues to be successful in retaining staff. This ensures the core team remains consistent when has led to a committed and skilled team being developed. The positive outcomes for each resident continue to reflect the commitment and cohesion of the staff team. Residents spoken with said they like the staff and feel well supported by them. Those who wrote to us said staff always treat them well, listen to them and act on what they say. One person said they always treat me alright. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: Discussions with staff members and observation of their work practice show that they are comfortable with individuals living at St Chads who were seen to be at ease with them. It is evident staff have a clear understanding of the needs of each individual and have built a good rapport with them. Staff who wrote to us said they are always given up to date information about the needs of the people they support. Newer staff said their induction covered the things they needed to know when they started working in the home. They confirmed they are well supported in their role and receive appropriate training. Comments for staff include I enjoy my job, it very rewarding, there is a very good staffing level and there is a good atmosphere in the workplace. Both the relatives and health professionals who wrote to us said staff have the right skills and experience to support people. The staff team continues to meet regularly. A record is kept of each meeting and these show that attendance is good and a variety of topics are discussed which relate to the people who live in the home as well as more general issues. The home operates a robust recruitment process. The personnel records of staff who have joined the team contain copies of their application form, documents proving their identity and eligibility to work in the UK, two satisfactory references and Enhanced Criminal Record Bureau Disclosure. Staff are provided with a variety of training opportunities. The home uses Red Crier training materials, which can be delivered in-house once staff within the home have been trained to both deliver the programme and assess the competence of staff. The records we looked at show that staff have attended the following sessions: first aid, fire safety, food hygiene, how to move and handle safety, health and safety, legislation and protection of vulnerable adults. New units added to this training programme include risk assessment, nutrition, dementia, infection control, aggression and death, dying and bereavement. Staff will work through these units as quickly as possible. Staff are supported to attain a National Vocational Qualification, known as an NVQ. Six staff members have attained this qualification, with seven staff currently working towards their awards. Staff are provided with 1:1 formal supervision meetings, which should be held every 6 weeks. Whilst supervision has improved since our last visit, not all staff are being Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: provided with this level of supervision. The Deputy Manager said that some staff do not work regularly at St Chads and others may have additional supervision meetings at another trust home, although records are not routinely shared between homes. Some informal meetings or discussions with staff are now recorded, but not all of them due to time constraints. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run and residents benefit from the ethos, leadership and management approach of the home. Residents views are central to the review and development of the service. Each persons rights and best interests are promoted by the homes policies, procedures and record keeping and their health, safety and welfare is generally promoted and protected. Evidence: The home is being managed on a temporary basis by Mr. Melvyn Phillips: Mr Maggs, the registered manager, is temporarily managing another of the Trusts homes. Mr Phillips has a formal nurse qualification (RNMH), is also an Applied Psychology Graduate and has an NVQ Level 4. He has approximately 25 years experience in working with people with learning difficulties and ensures that he keeps himself well informed and aware of best practice by attending refresher courses and conferences. Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: The management team consists of the manager, one Deputy and three Senior Support Workers. Mr Phillips provides clinical support and guidance at St Chads and other homes within the Trust and St Chads is therefore effectively managed day-to-day by the Deputy Manager. There is an open atmosphere within the home and it is run in the residents best interests. Due to relatively small nature of Orchard Vale Trust, resources will always be limited and due to new pressures, some of which are required by changes to existing regulatory legislation, this will remain a difficult issue for the home to address as it does not to wish to reduce resources, and in particular time, spent directly supporting the people who live here. The staff who wrote to us said they are well supported by the management team. Comments from staff include: the management and staff work well together, management are always willing to discuss issues with us and I feel my manager is very supportive. The views of the residents are sought wherever possible and the home uses a number of ways to obtain them. House meetings, described earlier in this report, are now being held. Residents are involved in their reviews and three people are able to say what they like and what they do not. Detailed records are kept which describe residents responses to activities and other situations to ensure their well-being. The home has a quality assurance policy and procedure. This system provides an ongoing audit of each shift. This information is used to minimise errors and maintain and develop standards. The trust has a number of policies and procedures to ensure the safety of the people who live or work in the home. These are also used to ensure the home complies with the law and remains up to date with the good practice. Details were provided by the manager in the AQAA he completed for us. There are efficient management systems and structures in place to ensure the home runs effectively. The quality of record keeping in the home is good, with all records required during our visit easy to access and stored securely when not in use. The registered providers representative visits the home to conduct an audit. They complete a report following their visit, which describes which records they have looked at and who they have spoken with. We did note that there is no record of an audit being carried out over ten separate months since our last visit: these must be carried Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: out each month and the report available for us to look at. There are recording systems in place to support the maintenance of health and safety in the home. The safety of portable electrical appliances were tested in December 2008. We examined the fire log, which shows that residents and staff members take part in a regular fire drills. The homes Fire Risk Assessment was last updated in June 2008. The alarm system should be tested each week, but the records we looked at show that tests have not been recorded over at least 5 separate weeks. The home has developed a number of general Risk Assessments to promote the welfare and safety of people who live in or work at the home. These are clearly written and subject to regular review. 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 36 18 Staff members must be supervised on a regular basis and a clear record of each meeting maintained. This will ensure staff are supported to provide support to each resident. 04/05/2009 2 42 10 The home must be managed 04/04/2009 with sufficient care, competence and skill to ensure the welfare and safety of residents and staff. This relates to fire safety checks. Monthly auditing visits must be carried out. This would ensure an accountable service is provided to each person with an interest in the home. 04/04/2009 3 43 26 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 36 The home should consider developing supervision contracts with staff to agree the level of support they need to enable them to do their jobs well. 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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