Care Home: St Marys Continuing Care

Similar services:

• Sunny Bank (P.R.S.) Ltd
• Ruskin Lodge
• Ashwood Court Unit 1
• Dystlegh Grange
• Thornton Lodge
• The Good Companions
• Cuerden Grange Rest Home
• Springfield Cottage

What the care home does well The manager is experienced in managing nursing care services and this was reflected in how policies, procedures and training had been developed since the the last visit. Before people that use services decide if they want to live in the home their needs are discussed with them, their families and people involved in their care by a representative of the home so important information is gathered about their needs. A relative questionnaire returned during the visit commented that the manager and staff were good at communicating with them about the health needs of their relative. The home demonstrated a positive commitment to staff training with a varied staff training programme taking place so staff were provided with training and support to do their jobs. The home provides information to people that may choose to live there and people that use services so they are aware of the facilities, services and costs of their care. The home tends to treat people with dignity and respect and people that lived at St Mary`s said they enjoyed living there. A person that used services said, "There is lots to do, when I move out I will miss the social life here`. Another person said, "I like to join in the baking sessions, making a jam sponge is my favourite. I like to sit in my room and write poetry and things in my diary. I love the staff they are my friends". People that use services are offered a variety of recreational activities so they have a variety of lifestyle options to choose from. People that use services are confident they can raise concerns so they will be acted upon. The home provides a clean and comfortable place to live so people that use services live in a homelike environment with access to local amenities. Appropriate staffing levels are provided so people that use services are supported. What has improved since the last inspection? Additional facilities had been provided for people that use services so they could maintain their independence and do their own cooking and laundry. The recruitment of staff had improved so staff were recruited through good policies and procedures being followed so people that use services were protected. What the care home could do better: An application to register as the registered manager must be received so we and people that use services will have confidence the service is managed in their best interests. The home needs to improve in how it gathers information about people that use services so staff have important information about how to meet their different needs.The home needs to provide information in the statement of purpose, service user guide and complaints procedures in different ways that people with memory problems, brain injuries and visual impairments can understand them so that can receive useful information on the facilities and services and have confidence they can make a complaint so their concerns are listened to and acted upon. The home needs to improve how the personalisation of the care of people that use services are reflected in their care plans so staff and others involved in their care understand how important peoples` routines and decisions are to them and how these are transferred into how they receive care. Further training on the health and safety of people that use services, their different needs and conditions and how staff deal with difficult and angry situations between people that use services needs to be provided so staff are aware of their roles and responsibilities. Quality assurance needs to improve so senior managers and the owners are aware where staff performance, practise and training needs to improve so people that use services are treated with dignity and receive skilled care at all times. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: St Marys Continuing Care St Marys Continuing Care Ltd Penny Lane Collins Green, Burtonwood Warrington Cheshire WA5 4DS     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: Anthony Cliffe     Date: 2 0 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 31 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 31 Information about the care home Name of care home: Address: St Marys Continuing Care Penny Lane St Marys Continuing Care Ltd Collins Green, Burtonwood Warrington Cheshire WA5 4DS 01925294850 01925294855 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): St Marys Continuing Care Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 63 Number of places (if applicable): Under 65 Over 65 20 11 0 dementia mental disorder, excluding learning disability or dementia physical disability Additional conditions: 21 11 11 This home is registered for a maximum of 63 service users to include:- * Up to 20 service users in the category of DE(E) (Dementia over the age of 65) * Up to 21 service users in the category of DE (Dementia under the age of 65) * Up to 11 service users in the category of PD (Physical disability under the age of 65) * Up to 11 service users in the category of MD (Mental disorder excluding learning disability or dementia under the age of 65) or up to 11 service users in the category MD(E) (Mental disorder excluding learning disability or dementia over the age of 65) Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home St. Mary?s care home with nursing is a purpose built two-story building comprising of 63 single bedrooms with en-suite toilets/shower facilities. The four units are separate from each other and have their own manager. Each unit has its own dining and lounge facilities. There is a separate activities room and therapy room. The external grounds are landscaped and secure. It is located in the Collins Green area of Burtonwood in Warrington. It is on a local bus route and close to the railway stations at Earlstown and St.Helens Junction. Fees for those funded through the local authority or Primary Care Trust are at a locally agreed rate and the standard weekly fee is 405 pounds to 1320 pounds per week and no additional fees are asked for. Information about St Marys can be obtained directly from the home including a copy of the last visit report. Care Homes for Adults (18-65 years) Page 5 of 31 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: This unannounced visit took place on the 18th and 20th February 2009 and lasted over eleven hours. One inspector carried out the visit This visit was just one part of the inspection. Other information received was also looked at. Some weeks before the visit the manager was asked to complete a questionnaire called an Annual Quality Assurance Assessment (AQAA) telling us what they thought they did well, what they needed to do better and what they had improved upon since the last visit, to provide us with up to date information about the services provided. This helps us to determine if the management of the home see the service they provide in the same way we do and if our judgements are consistent with homeowners or managers. We provided questionnaires for people that use services, Care Homes for Adults (18-65 years) Page 6 of 31 relatives, staff employed at the home and social and health care professionals involved in their care so they can tell us about their views about the service the home provides During the visit various records and the premises were looked at. People that uses services were spoken with and gave their views about the service. We also received questionnaires from people that use services and a relative. People that use services said they could choose what they did during the day, evening and at weekends and staff always listened to them and acted on what they said. A relative survey said what was good about the home was, The overall care of dad, in making him comfortable in his environment and paying him the attention he requires In March 2008 we did an annual service review of the home, which told us the home was still providing a good service. An annual service review is a summary of our knowledge about how a service that has not had a visit in the last year is still performing. It is also how we decide if a service is still as good as we thought it was since out last visit or annual service review. What the care home does well: What has improved since the last inspection? What they could do better: An application to register as the registered manager must be received so we and people that use services will have confidence the service is managed in their best interests. The home needs to improve in how it gathers information about people that use services so staff have important information about how to meet their different needs. Care Homes for Adults (18-65 years) Page 8 of 31 The home needs to provide information in the statement of purpose, service user guide and complaints procedures in different ways that people with memory problems, brain injuries and visual impairments can understand them so that can receive useful information on the facilities and services and have confidence they can make a complaint so their concerns are listened to and acted upon. The home needs to improve how the personalisation of the care of people that use services are reflected in their care plans so staff and others involved in their care understand how important peoples routines and decisions are to them and how these are transferred into how they receive care. Further training on the health and safety of people that use services, their different needs and conditions and how staff deal with difficult and angry situations between people that use services needs to be provided so staff are aware of their roles and responsibilities. Quality assurance needs to improve so senior managers and the owners are aware where staff performance, practise and training needs to improve so people that use services are treated with dignity and receive skilled care at all times. 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 31 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 31 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. People have their needs assessed before they move into St. Marys so they know their needs can be met but more information could be available to assist staff in understanding all their needs. Evidence: Since the last visit the home had employed a new manager and the details of the new manager were in the information given to people that use services so they were aware of who was responsible for the management of the home. People that may wish to choose to live at the home can visit to see if the like the home. The information available to people that may want to live at St Marys is called the service user guide and statement of purpose. These were available to people that use services and their relatives in the reception area of the home. The home is also developing information about the home and how to use the complaints procedure in an easy to understand versions so people with memory problems, brain injuries or learning difficulties could understand. This information could also be made available in large print or different languages if requested. The home plans to improve the brochure it provides to people Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: that use services so they can see what facilities and services are available to help them to decide if they want to live there. The owner is also developing a web site for the home so information can be obtained about the home from this. Before the visit people that use services returned surveys to us and said they were given information about the home that helped them to decide they wanted to live there. We examined the care plans of two people that use services who had moved into St Marys since we last visited. The home had gathered information about their needs and we saw this covered information about their social interests and hobbies, medical information on their physical and mental health, how they communicated with people, maintaining their safety, managing finances, help with personal care, and the life histories of people as some examples so staff had information about the people they cared and supported. There was no information gathered about how or if people that use services were able to make decisions about their lives and their dreams and aspirations so staff were not provided with important information on how people decided their routines or how they wanted their help and support to be arranged. Some information was not completed in one of the records we saw. This was important information on how a family would be involved in the care of their relative so staff would not know the arrangements for involving the family in the care of the person using the service. We could see that in other records gathering information usually involved families and health and social care professionals and important information was obtained about people that use services from families and health and care professionals so staff had information about them before they moved into the home. Care Homes for Adults (18-65 years) Page 12 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to live their preferred lifestyles, however information held about them does not support that they are directly included in the decision making process. Evidence: We examined the care plans of four people that use services. We could see that the home were using new docuemnts in which to records information about people that use services, what their needs were and how staff would provide care and support to people that use services so staf had guidance to help them meet their needs. The home does not use person centred planing. Person centred planning is a really good way for people that use services to take control of their lives. Person centred thinking helps staff that care and support people that use services to listen to them and then to get what they want. A person centred plan contains information on what is positive about people that use services for example what people like and admire about them and their gifts and talents. Information should be included about what and who is important to people that use services from their viewpoint, as well as what people Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: want for their future. A person centred plan should have information about how people that use services want to be supported, so stay healthy, safe and well. This is called a support plan but may be called a care plan. This should be detailed enough to provide a living description of how people that use services want to be supported, how they make decisions and says who will do what by when. We could see from the care plans and conversations we had with people that use services and staff that the needs of people living at the home were met and their privacy and dignity mainly respected. We could see that a lot of information had been gathered about people that use services. The information included copies of information gathered from social workers and health professionals from the NHS and local Primary care Trust so important information was shared and gathered about their needs. The information the home had about people that use services was about their needs, routines and lifestyle but this information was not reflected in the care plans the home had written to support and provide care for them so staff did not have information to provide individual care. Care plans did not reflect a person centred approach and only contained little information on how people could care for themself or be involved in their personal care so did not support a person centred approach. We could see many examples of how people that lived at the home chose their daily routines and followed their own lifestyles but this was not reflected in the care plans written about them and we could not see how they had been involved in the writing of their care plan so would not know what was written in them. Care Homes for Adults (18-65 years) Page 14 of 31 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 that use services are supported to maintain relationships and make choices about lifestyle and leisure activities but could be supported further to have control over their lives a lifestyle based on their personal choices. Evidence: People that use services had access to a variety of activities in the home and leisure pursuits outside in the community. The home also has its own transport. The home supports people that use services to access leisure activities so they do things they enjoy. The home employed two full time activities coordinators, physiotherapist and occupational therapist and provides a varies activities programme to suit people that use services. Activities were provided on a group and individual basis which included shopping trips to the local towns of St. Helens and Warrington, angling trips weekly, coffee mornings, relaxation to music, craft sessions, magazines and discussions, Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: singing sessions, cooking and baking, visits from the pet therapy dog and use of the fitness centre in the home. The home has its own fitness centre and activities room. There is fitness equipment available for people that use services so they can remain fit and active. As a result of asking people that use services what they wanted to change, changes to the activities programme and menus were made so they were involved in making choices about the activities they are involved in. The home had made arrangements to celebrate Valentines day and held a buffet and disco. On the units staff were seen to be involved in asking people that use services what they wanted to do with their day. During the site visit a relative completed a survey and said the home always supported people that use services to keep in touch with them. On one unit the staff had introduced anxiety management classes so people that use services understood the symptoms of worry and anxiety and could help themselves to manage this. The home was also holding residents meetings on some of the units in the home. The minutes of meetings were available so people that use services were given an opportunity to comment on the standards in the home but the frequency of these meetings could be increased and made available to all people that live at St. Marys so they all have an opportunity to contribute to the management of the home. On one unit in the home staff said the activities organiser were not visiting the unit as regularly as possible and they were not including people that use services in baking, relaxation, discussion and music groups. The clinical services manager agreed to look into this matter and discuss it with the manager who was on holiday at the time of the visit. The home had changed some of the facilities so that people that use services had access to a kitchen so they could cook their own meals and laundry facilities so they could do their own washing. The home supports young disabled adults to keep the skills they had by using the facilities so they can move back to independent living. Before the visit people that use services returned surveys to use and said they always chose what to do during the day, evening and at weekends. One person said they went out with their friends every Sunday and enjoyed going to church. The home also has links with Headways a national charity for people with acquired brain injuries. This provides people that live at the home with access to social, educational and possible employment opportunities so they can lead a full life. The home had a varied menu which offered a variety of choices including a cooked breakfast. People that use services could choose where they ate their meals. We saw meals being served during breakfast, lunch and tea time. On the older persons Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: dementia care unit we saw lunch being served. People that use services that could assist themselves to eat had the opportunity to sit in the dining room so they could choose their meals and assist themselves with their meals. Staff were seen to take the choices of main course plated up over to people that use services so they could choose what they wanted, otherwise people chose their meals when asked by staff what they preferred. People that use services that could not use words were shown the choices of main course to make a choice where possible but a number of meals were seen to be served onto the plate by staff and then taken over to the person to be helped to eat so were not always offered a choice. The manager on the unit said staff knew what people preferred to eat but this was not supported by decision making agreements in care plans which would detail how decisions for people that lacked capacity to make decisions about choices would have them made on their behalf. The clinical services manager said that people that use services also shopped for themselves and could prepare meals so they could remain independent and do their own cooking. There was also themed nights when people that use services could eat a fish and chip supper, Chinese or Indian meals. We saw that when staff assisted people to eat their meals they did so with dignity and respect other than staff placing blue plastic aprons on them without asking so they were not given a choice or having their dignity upheld at all times. Otherwise staff concentrated on helping people to eat. They were seen to explain what they were doing and asking people when they wanted another mouthful of their meal. They were seen not to rush people that use services so they could enjoy their meals. We saw breakfast and an evening meal being served on other units where people that use services chose their own breakfast and evening meal. They could choose what they wanted to eat and the menu allowed for a vegetarian choice. The atmosphere in the units at meal times was vibrant and people said they enjoyed meal times. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use services personal, physical and emotional needs are met so their health and welfare is maintained. Management and administration of medicines was safe so people that use services received their medicines correctly. Evidence: The information the manager sent to us before the visit said that people that use services receive individualised care plans constructed by trained and experienced staff. The care plans we saw gave details as to the personal care needed by people that use services but did not always reflect their preferences or routines about how they wanted their personal care to be arranged so care based on their personal preferences was not provided. For example routines around bathing. Care plans did provide staff with some guidance on supporting people to remain independent by encouraging them to choose their clothes and saying they liked to remain smart. Care plans included details of the health and social care professionals involved in their care. Care plans and daily records showed that staff acted on recommendations from professionals such as physiotherapists and psychiatrists. However care plans did not Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: always agree with other information written about people that use services. Examples of these were the use of physical means to prevent people from hurting themselves and exactly what staff could do so they understood if restraint was acceptable. Another example was the records of a person using the service had information about being at risk of falls and concerns about nutrition recorded in risk assessments but the information was not referred to in care plans so important information may not be available to staff. People that use services were all registered with one General Practitioner practise and were supported to see their own doctor and attend hospital visits. Records showed that Doctors, dentists, opticians, chiropodists and other professionals visited people that use services so they had access to health care support when needed. The owners pay for chiropody, hairdressing and private transport to hospital as part of the fees for services so people that use services do not have to pay these fees as additional charges. The home also provides the service of a consultant psychologist, consultant psychiatrist and physiotherapist. All people that use services have their own space so that care can be provided whilst protecting their privacy and dignity. Medication policies and procedures were comprehensive so staff understood their responsibilities and accountability for their actions when administering medicines to people that use services. All four units had the same medicine storage facilities and procedures in place. Medicine fridges and controlled drugs storage was available with the operational temperatures of the drugs fridges regularly recorded so staff knew they were operating safely. Each storage area contained the policies and procedures for medicine administration with specimen signatures of staff responsible for administering medicines. We looked at the arrangements for the ordering, receipt, administration and disposal of medicines and found no errors so people that use services were receiving their medicines safely. We talked to the clinical services manager and staff who were administering medicines about the arrangements for giving out medicines during meal times which seemed to add to this busy time of the day. They agreed to look at the arrangements for the administration of medicines to fall into line with good practise on one unit where medicines were given at times chosen around the routines of people that use services. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use services are usually protected by the safeguarding adults procedure in place but staff understanding could be improved so people that use services will be confident they are protected at all times. Evidence: The information sent to is before the visit by the manager said that the home had a complaints procedure which promoted the rights of people that use services. We received surveys from people that use services that said they knew who to speak to if they were unhappy and knew how to make a complaint so understood how to make a complaint. The information sent to us by the manager said complaints and protection was incorporated into the homes training programme. We did not see in the staff records we examined that staff had any training on dealing with complaints nor was there mention of complaints training in the training programme. The clinical services manager said the manager had an open door policy and was always available to people that use services, relatives or staff should they have a complaint. The complaints register had details of two complaints received by the service. One we asked the home to investigate and one the local council had asked the home to investigate. The complaint we asked the home to investigate was investigated by the manager to our satisfaction. The complaints procedure is not made available to people at the home in a variety of Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: different ways, for example a talking book, large print or pictorial editions so they may not all be able to understand the complaints procedure. Policies and procedures were in place to protect vulnerable adults called the safeguarding adults procedures. The safeguarding adults procedure is how we, the local council, police and other agencies respond to and manage allegations or suspicions of abuse against vulnerable adults. Staff at St.Marys had received safeguarding training with a total of sixty four staff receiving training which helped them to respond to suspicions or allegations of abuse or neglect to make sure vulnerable adults were protected. There was information that staff on night duty had training planned for March 2009. The home had a copy of the local councils safeguarding policy and procedure. Staff spoke with said they received safeguarding adults training during their induction. Staff spoken with during the visit were knowledgeable about safeguarding adults. On one of the units we saw that a person using the service had been involved in aggressive incidents toward other people that use services. The staff on the unit knew the policy and procedure on how to report incidents but could not account as to why some incidents had not been reported under the safeguarding adults procedure. We receive regular information about anything that effects the wellbeing of people that use services from the home and the unit called notifications. The clinical services manager immediately referred the incidents to the local council as well as a further incident which occurred during the visit so people that use services would be protected by the safeguarding procedure. The clinical services manager in the absence of the manager commenced an internal investigation as to why the matter had not been reported. Prior to the visit the home had told us about several safeguarding referrals they had made which included the manager and clinical services manager investigating the matters internally. When allegations where made against staff they were immediately suspended from duty. The provider had also taken disciplinary action and dismissed staff as a result of their investigations so people that use services were protected by the employment procedures in place. During the visit staff said they had received training in restraint two years ago but felt that they needed training in dealing with worrying incidents. They said they felt they dealt with worrying incidents very well but wanted further training so they were confident they knew how to handle different situations and when they use were able to use restraint as this was not clear to them. Care Homes for Adults (18-65 years) Page 21 of 31 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. People that use services live in a comfortable well maintained home which is equipped to meet their needs. Evidence: The home is purpose built with all single en suite bedrooms. It provides spacious lounges and separate dining areas. There is a programme of maintenence and decoration in place and at the time of the visit the home was being decorated so people that use service live in a comfortable home. A housekeeper was employed as well as maintenence and domestic staff to ensure the home is kept clean and in good repair. Surveys returned to us before the visit by people that use services and a relative said the home was always fresh and clean. We saw records of maintenence/cleaning schedules and checklists and the housekeeper was seen constantly checking the home so staff knew what work needed to be dome to keep the home fresh and clean. A relative described the home as clean and comfortable. Improvements have been made with new lounge chairs bought for two units and the building of the rehabilitation kitchen and laundry so people that use services have facilities they can use to help care for themselves. The clinical services manager confirmed that good practise in supporting people with Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: memory problems will be introduced into the dementia care units within the near future. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good employment policies, procedures and training is in place however training in safe systems of care and the different needs of people needs to be improved so that staff understand their needs and people that use services receive receive appropriate care. Evidence: Staffing levels seemed more than adequate with a good mix of staff skills so the needs of people that use services could be met. The clinical services manager showed us that there were ten new staff waiting to commence employment at the home. Thirty six care staff were employed and twenty of these had an NVQ level 2 qualification which is a nationally recognised qualification in social care. We examined the recruitment records of four staff employed at the home. Recruitment procedures were robust and included staff having to complete an application form, full employment history and two references sough about this suitability four employment. The recruitment of staff also included a Criminal Records Bureau (CRB) disclosure which is a check of staff to see they are suitable people to provide personal care and support to vulnerable adults. Staff were also issued with the General Social Care Council code of practise a guide for social care staff on the standards expected of them so they were aware of their responsibilities and practise when providing care to people Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: that use social care services. The information sent to us by the manager before the visit told us there had been some use of agency staff to cover staff absence. The clinical services manager said that agency staff were used to cover staff vacancies. The nurse in charge on one of the units that was using agency staff said they usually used the same staff from the agency to provide consistency of care and staff were used to provide one to one staff to vulnerable adults using the service so they were less of a risk to themselves and others. The agency staff we saw were sat around watching the television and reading newspapers and not interacting with people that use services so were not providing care to them. On the older persons dementia care unit people that used services wore blue plastic aprons during meal times, which staff placed on them without anyone beings asked if they wished to wear one so their choices were not sought on this decision and their dignity not upheld. A staff member said they did not agree with this practise which they had seen in practise from day one of their employment and did not feel able to challenge the registered nurses abut this so staff did not feel confident about their ability to challenge poor practise. Staff had attended training in induction, moving and handling, safeguarding adults, fire, food hygiene, first aid, diabetes, infection control, and HIV awareness. Senior nurses had received training in Yesterday, Today and Tomorrow for the Alzheimers Society to increase their knowledge and awareness of dementia but staff had not received any training so were not aware of this best practise in dementia care. Senior staff had also received training in managing challenging behaviour but were unsure if care staff would also receive the training. Staff did not have training in non physical management of behaviour that challenge or on mental health and mental disorder. No training was recorded on the promotion and management of continence or end of life care. Care staff we talked to said they needed more training on the different needs of people using the service so they could understand them and help support and motivate them to care for themselves. The home has become a learning centre to take social work and nursing students on placement. The owner was also sponsoring a registered nurse to gain her registration as a registered nurse in mental health. Care Homes for Adults (18-65 years) Page 25 of 31 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. Quality assurance could be improved so areas for further development are identified so the welfare of people that use services is promoted. Evidence: The manager has been in post since the summer of 2008. We were told about her appointment as the acting then appointed manager when she was recruited. The manager had previous experience of managing care services. We have not yet received an application from the manager to register as the registered manager so cannot yet confirm her suitability. The manager completed quality assurance audits as part of the quality assurance system which covered audits of staffing, training, record keeping and documentation, catering, housekeeping, laundry, internal and external environment, medicine administration and storage and social needs. The manager had to produce a plan to improve any shortfalls identified as a part of the quality assurance process. However Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: the quality assurance process did not identify issues around the inadequate practise we saw on some of the units in the home for example use of plastic blue aprons and agency staff not interacting with people that use services so the quality assurance system does not cover important matters. Since coming into post the manager had improved quality in the home. New training packages for staff had been purchased and introduced using Mulberry House a nationally recognised training provider training materials. The induction programme based on the Skills for care Standards, nationally recognised standards for social care workers had been introduced but not all staff had completed these. The manager had also introduced a range of meetings in the home which included meetings with all grades and levels of staff so staff had an opportunity to listen to and discuss important matters about the management of the home . The AQAA confirmed that all the required maintenance and health and safety checks had been completed as required. We looked at the fire safety for the testing and maintenance of equipment and found these to be completed so people that use services live in a safe home. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 31 8(1) The registered person must 01/03/2008 ensure that an application for a suitably qualified and experienced manager is submitted to the Commission for Social Care Inspection. Care Homes for Adults (18-65 years) Page 28 of 31 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 35 18 Training on the health and safety of people that use services, their different needs and conditions and how staff deal with difficult and angry situations between people that use services must be provided. So staff are aware of their roles and responsibilities and provide care and support on the different needs of people that use services. 16/06/2009 2 37 8 An application to register as the registered manager must be received. So we and people that use services will have confidence the service is managed in their best interests. 16/06/2009 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 improving their service. Care Homes for Adults (18-65 years) Page 29 of 31 No. Refer to Standard Good Practice Recommendations 1 1 The statement of purpose, service user guide and complaints procedures in different ways so that people with memory problems, brain injuries and visual impairments can understand them so they can receive useful information on the facilities and services and have confidence they can make a complaint and their concerns are listened to and acted upon. Improvements in how information is gathered about people that use services should be made so staff have important information about how to meet their different needs. The home should improve how the personalisation of the care of people that use services are reflected in their care plans so staff and others involved in their care understand how important peoples routines and decisions are to them and how these are transferred into how they receive care. Quality assurance should improve so senior managers and the owners are aware where staff performance, practice and training needs to improve so people that use services are treated with dignity and receive skilled care at all times. 2 2 3 6 4 39 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!