Care Home: Stepping Stones

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What the care home does well The service provides a safe secure and spacious location that has a large number of onsite activities and facilities. The service employs a clinical team of professionals to support and advise the care staff in meeting the needs of the people living in the service. The service supports the development of detailed care plans and behavioural management plans The service employs an independent professional to undertake their regulation 26 inspection reports. What has improved since the last inspection? The service has improved the staffing levels which has produced greater supervision, support and scrutiny of care staff, increased community access for people living in the service and increased activities for people. Improvements have been made in the provision of staff training The service has provided improved transport for the use of staff to support community activities and outings. What the care home could do better: The service could provide improved and more frequent formal supervision of the senior care staff. There could be better coordination of the care planning process between the senior staff, the care staff and the clinical team Some clearer risk assessments relating to personal care and support should be put into place. A greater variety of evening activities could be provided. The service could implement a formal quality assurance process. Parts of the environment could be made more homely and comfortable. The Statement of Purpose and Service User Guide could be provided in different formats to promote understanding for some people living in the service. The service needs to ensure that all senior staff are aware of the criteria for notifying the Commission of incidents under regulation 37. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Stepping Stones Broadoak Stepping Stones Newnham-on-Severn Gloucestershire GL14 1JF     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: Simon Massey     Date: 3 0 0 6 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: Stepping Stones Stepping Stones Broadoak Newnham-on-Severn Gloucestershire GL14 1JF 01452760304 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Stepping Stones Resettlement Unit Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 33 Number of places (if applicable): Under 65 Over 65 0 0 learning disability sensory impairment Additional conditions: 33 1 Sensory Impairment category applies to one (1) named service user only. Category to be removed when service user leaves the home. Date of last inspection Brief description of the care home Stepping Stones is a registered care home for 33 adults with a learning disability who may also exhibit challenging behaviour. Accommodation is provided in 7 small units. Each unit accommodates between 3 and 7 service users. There are further developments planned in the long term to provide self-contained accommodation for up to 6 people. The home is set in extensive grounds, which includes a horticultural area, an aviary and a swimming pool. There is also a day centre on site which is staffed separately. It is attended by service users from Stepping Stones and also from other homes in the Stepping Stones group. Stepping Stones Resettlement Unit Ltd has Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home recently retained its ISO 9002 award. Copies of the last inspection report are available in the home. The current fees of the home are from #1400-to #2450 per week. 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 inspection took place over two days and was started on 26/07/09. The inspector met with the senior care staff, support staff, various members of the management team and also a number of people who live at the service. Records relating to care planning, staff recruitment and training, health and safety and medication were examined. An inspection of the environment was also carried out. This was a positive inspection that identified a number of improvements and changes that have been implemented over the previous 12 months. There was no registered manager in place at the time of the inspection but the Commission was subsequently informed that a new manager had been appointed and was due to commence employment the following month. The current fee range is from 1400 pounds to 2450 pounds per week. Care Homes for Adults (18-65 years) Page 6 of 31 Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. 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 8 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 9 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. The admission procedure ensures that peoples needs and aspirations are assessed prior to moving into the home. The Statement of Purpose provides accurate and detailed information to prospective admissions but the presenting of some information in different formats may promote better understanding of the services being offered. Evidence: The service has a detailed brochure that provides extensive information about the facilities that are provided and the philosophy of care. This contains a lot of written information and also incorporates pictures of activities being undertaken. Some information could be presented in formats that are more easily understood by people living in the service. The Service Users Guide was not seen as part of this inspection. Examples of detailed assessments were seen of people who had moved into the service. These contained information about needs and behaviors and this information was used to develop the care plans. Several staff spoken with appeared well informed about this information but also some staff were unsure about certain aspects of needs Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: and also how they would contribute to the ongoing development of the person centered plans. Where possible and if appropriate all people moving into the service are provided with the opportunity to visit and have a preliminary stay if they choose. There has been some movement of people between different services run by the same Provider. Whilst it was evidenced that people had been in agreement to these moves, full assessments and documentations of these moves had not alway been completed. These should be treated as admissions and discharges between registered services. One person had moved back into the home and whilst a limited transition plan was shown to the Inspector, staff spoken with had limited knowledge of the assessment that was planned to be undertaken and what the short term goal of the changed placement was. The person themselves was positive about the move and stated that they had wanted to move back to the main site. With one person there had been a delay in providing some medical and health care information, as the service were waiting for documentation from the GP. It would have been useful for some interim information to have been put into place, particularly in relation to the management of epilepsy. The senior care staff or team leaders had limited input in the assessment of new admissions and increased involvement in this may be of benefit to the transition process for some people moving into the service. Care Homes for Adults (18-65 years) Page 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Detailed care plans ensure that the service users needs are documented and guidance is available to staff. The home takes action to encourage service users to make choices and supports them to take appropriate risks. Evidence: All people living in the service have care plans in place and a sample of these were examined. There was comprehensive documentation in place and all records seen had been reviewed at appropriate intervals. People had Pathways to Independence documents completed, Personal Skills Development Plans and Risk Assessment Support Plans. There was evidence that, were possible, people were involved in the reviewing of their plans. The plans are written by the clinical team with input and involvement from senior staff and key workers. Some staff spoken with demonstrated a good understanding of the process and the plans relating to the people they were supporting but some staff were less sure of how they contributed to the reviewing of Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: plans and the identifying of goals and aspirations. Some staff, who were working in houses they did not work regularly, had limited knowledge of the care plans relating to the people living in that particular home. At the time of this inspection the service had appointed a new manager but they were yet to take up their post. Whilst the care planning system has detailed information, assessments and behavioral management guidance there appeared to be a slight lack of clarity of the overarching responsibilities in relation to the role of the clinical team and the registered manager. All incidents which occur are referred to the clinical team, who can provide expertise and advice in the managing and understanding of needs, but direction on staff practice, the organizing of the houses and the allocating of staffing comes through the registered manager and the senior staff. There have also been infrequent management meetings between the team leaders and the acting managers and there are also practical problems in organizing regular staff meetings for the care staff. This is due to the number of people living in the service and the degree of supervision required for many of these people. It was the view of the Inspector that there could be improved connectivity between documentation and practice which would promote better and more consistent understanding the care plans and the process involved in developing strategies to meet needs. This would result in improved outcomes for people living in the home. Any limitations in place on choice due to individual needs were recorded in the individual plans. There was evidence that efforts are made to promote choice and decision making and that this is done through a risk assessing framework. Care Homes for Adults (18-65 years) Page 13 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 using the service have been given increased opportunities to take part in a variety of activities in the community. There are some limitations on the opportunities for the development of independence skills and people may benefit from a more structured approach towards the development of these skills. Evidence: The service continues to operate a number of vocational activities for people, both on the main site and also on the farm which is also run by the Provider. People were observed working in the computer room, using the gym, working in the garden, using sensory equipment and doing arts and crafts work. Over the past several months the service has increased the number of community based activities that are supported. This includes day time vocational activities and also evening and weekend leisure activities. This has been facilitated by the increase in staffing, including the provision Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: of a designated driver during the daytime. Some people are supported and risk assessed to go out unsupervised and some people are also shadowed by staff during the initial period. Staff spoken with said this had been a positive development and it was evident that staff were being encouraged to develop other ideas for community based outings and activities. During this inspection people living in the service were observed leaving and returning on a regular basis from various trips activities. For people who were interested there was at least one daily option that could be offered. Every evening there were at least two trips out which were supported by staff and also two activities organized on the site. Staff commented that, given the number of people living in the home, there was still scope to increase some of the options and choices, particularly as consideration always had to be given to the combination of people going out, with some people have clear preferences who they went with. It is commented elsewhere in the report about a decrease in some aspects of challenging behaviors that are presented, and several staff commented that the improvement in community based opportunities was an important factor in this. Two people who live in the home described how they visit the local pub on their own, and another explained how they visited the local garage. Plans have also been implemented for some people to use public transport. Evidence was seen of risk assessments supporting the development of independent travel. There were examples in the care plans of goals to develop independence skills, such as cooking and cleaning. Whilst there is some work being undertaken around the developing of independence skills in terms of menu planning , cooking and general household chores, there are presently limitations on the extent of this work. The mixture of abilities and behaviors places some obstacles to fuller inclusion for some people. The majority of cleaning is done by the domestic staff and the majority of cooking is done by the care staff. In several of the houses there are frequent visits from other staff and in one house in particular it was observed by the inspector that nine different people had come through the lounge area into the office or the kitchen in a fifteen minute period. The service has a generic risk assessment for kitchens which say they should be kept locked at all times. Kitchens are clearly a potentially hazardous place for some service users and some behaviors, however the Inspector was concerned that a culture around the hazards of access to kitchen was placing limitations on some people to be more fully involved in the domestic running of the home and to have more ownership and responsibility for their accommodation. Some staff spoken to about the access to the kitchens appeared to have limited understanding of how these areas can be made safer and also the potential benefits to the culture and environment within a home. The Inspector accepted the complexity of the issue, particularly in relation to some of the behaviors presented, but it is possible that a more individual approach to risk assessing kitchen activities, and an improved understanding of the promotion of a Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: normal domestic environment, might result in better outcomes for some people. Several care plans identified the development of greater independence skills as being important. A sample of fridges and cupboards were examined and all food was correctly stored and labeled. There was evidence that individual diets are catered for and that healthy diets are promoted. Staff spoken commented that the food was of good quality and that People were encouraged to make choices and contribute ideas for the menus. The majority of food is purchased centrally and delivered to the individual houses. Care Homes for Adults (18-65 years) Page 16 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. Health needs are closely monitored and appropriate professional input provided to meet the needs of the service users, and provide advice and guidance for the staff team. Inconsistencies in the provision of risk assessments and updated guidance around personal care could potentially compromise peoples welfare. Satisfactory arrangements are in place for the handling and reviewing of medication, promoting service users wellbeing. Evidence: All people case tracked had health action plans in place and there was evidence of good recording around the meeting of health needs. Appointments and outcomes were clearly recorded. There was evidence of outside professionals being regularly involved with the service and contributing to assessments. The clinical team meet regularly with the local Community Learning Disabilities Team. A sample of medication storage was examined and all records were seen as up to date with all medication correctly stored and accounted for. Correct procedures were being followed for the administration of PRN medication and all medications had been Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: reviewed within the previous twelve months. All staff must complete medication training before they are deemed competent to administer. Regular audits are undertaken of the medication storage in all of the accommodation. The service has also had a pharmacy inspection undertaken by the Commission in 2007 and has also had pharmacy visits from the chemist supplying the medication to the service. Where appropriate, moving and handling assessments have been completed and guidance provided for the staff. A concern was identified around the personal care of one person recently admitted to the home. The inspector was told by the staff on duty that a duvet under the bed was to break the persons fall when they fell out of bed. This issue was not identified in any risk assessment, and in the view of the inspector the duvet was unlikely to provide any protection, and in fact made it more likely that the person could trip if they got out of bed. There appeared to be some confusion as to how often this incident had happened. On the daily recording sheet it stated in one entry that he had fallen out of bed several times that night, but in the nightly recording diary there was no entry at all. There had also apparently been discussion with the family, and the person themselves, about bed rails, but these had been declined. The night shift recording also suggested that the service user generally slept well, though this was contradicted by some staff. The personal file indicated the service user had epilepsy but there was no protocol in place for the administering of PRN medication, though this was provided later in the inspection. The inspector asked how this person would be be helped from the floor and was told that a hoist could be used, but neither staff on duty were able to use this equipment. There was one recorded injury to the person as a result of falling. There was also some contradictory opinions as to whether the service user fell whilst in bed, or as result of trying to get out of bed. There is a need for clearer risk assessments and also guidance for staff to follow as a result of any accident. This persons plan also stated that they needed to be in an armchair whenever possible and not stay in their wheelchair. Some staff stated the person refused to get into the armchair whilst others said he would. Two staff stated that another service user in the same house also occasionally fell out of bed but this was not evidenced in any of the care plans. This needs to be risk assessed and guidance put into place. All three people living in this home have fairly complex physical needs and improved guidance, to ensure consistency of support and that people are protected from potential harm, needs to be provided. Care Homes for Adults (18-65 years) Page 18 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. The home has satisfactory arrangements and procedures in place for the protection of service users and these will be further improved with the clarity provided over the requirements regarding notifiable incidents. Appropriate arrangements are in place to enable people using the service and staff to raise concerns and complaints. Evidence: The service provides care and support to people who can present challenging behaviors and all staff receive accredited training in this area. Evidence from notifications sent to the Commission, interviews with staff and examining records shows that there has been a reduction in the use of physical intervention and fewer incidents of challenging behaviors. There has been a reduction in the number of aggressive incidents towards staff and between people living in the home. This appears to be as a result of improved staffing levels, improved practice and the increase in activities in the community. Incident reports that were examined were generally well recorded with details of antecedent behaviors and action taken by staff. The reports often refer to walking restraints and some greater detail should be provided around this. The inspector discussed the criteria for notifications with senior staff and clarification was provided over this. The Commission should be informed of incidents when people living in the home are assaulted or harmed and also when physical intervention is required. A full description of the intervention techniques Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: deployed should be provided. The Provider should also inform families and placing authorities of any injuries sustained by people as a result of an incident in the care home. All staff are required to undertake training in Adult Protection. This training involves discussion of practice, types of abuse, a video presentation and information around the law. Staff are also required to complete a questionnaire at the end of the training that is followed up in their subsequent supervisions. Staff spoken to were positive about the training and were able to demonstrate an awareness of the issues around practice and protection. The service keeps a record of complaints and concerns that have been made and information and evidence was seen of the Provider acting upon these and taking appropriate action. Some staff spoken with commented that they felt more confident raising concerns than in the past and that concerns raised over poor practice were taken seriously and responded to. Care Homes for Adults (18-65 years) Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some parts of the accommodation are more spacious and homely than others but the overall site provides a good variety of facilities and a safe environment for people living in the service. Evidence: The service has a number of different houses on the same site and all were visited as part of this inspection. Efforts are made to provide a homely and comfortable environment for people but the challenging behaviors can place some restrictions upon this. Some people also have a need for limited fixtures and furniture in their environment. The AQAA supplied by the service states that they are looking at ways to improve the personalizing of parts of the environment. Some houses are more homely and spacious than others and it was explained during the inspection that this aspect of provision is being reviewed with an aim of improving some parts of the accommodation. The service has some excellent facilities on site for the use of people living there, including a swimming pool, sensory room, gym and an IT room. There is also a market garden area that continues to be developed. The grounds provide a spacious and safe area for activities and social interaction. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: The service has a maintenance team that have an ongoing programme of decoration and this is coordinated in conjunction with ongoing maintenance and repairs. Care Homes for Adults (18-65 years) Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in staffing levels and staff training have led to improved outcomes for people living in the service. Peoples needs are met by a staff team who are being provided with increased training opportunities and improved supervision. Opportunities for increased staff meetings could also improve outcomes for service users. Evidence: The service has increased the staffing levels, both during the day and at night. This has enabled more activities to be supported, more individual work with some people, improved supervision and scrutiny of staff practice and was seen as a very positive development by all staff spoken with. Staff commented that the increased staffing meant better support when dealing with difficult or challenging situations and improved options for the organizing of the staffing cover. There is now a supernumerary team leader on every shift who is able to oversee the care and support across all the houses. There are three teams of staff, each with its own team leader, with each senior staff member having overall responsibility for two of the houses. One house, Populars Cottage, has its own senior staff member who just works in the one setting. The service has increased its number of bank or relief staff which has resulted in less Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: agency staff having to be used during staff holidays or sickness. Senior staff said that this had helped with consistency of support and care. Staff were observed interacting in a positive and appropriate manner with people and staff spoken with demonstrated a good understanding of the principles of a low arousal approach. The Inspector did observe the use of some inappropriate terms of address, such as lovey or deary, but in general people living in the home were observed as being treated in a respectful manner. There has been increased use of picture boards and symbols to improve communication and promote choice and some staff commented that this had been very beneficial and could be developed further. Several people living in the home have excellent support plans to encourage understanding the dangers of smoking and support them to manage this. There are designated smoking areas to be used. At various times during the inspection staff were observed using these smoking areas with service users, which is not good practice and also provides a mixed message to people. Staff have been receiving regular supervision and people spoken to were positive about this. Some staff spoken to commented that teamwork had improved as a result of better supervision and communication and also the perception that action would be taken to address poor or uninformed practice. Several staff said they received good support and advice from the team leaders. Whilst many staff were reasonably well informed about the care plans and needs of the people they were supporting, there was some inconsistency in this, with some staff unsure about their role in care planning and also some lack of clarity over certain protocols and procedures. It is important to note thought that there are a large number of people living in the seven houses and all key workers spoken with were clear about the plans relating to the people they had specific responsibilities for. Some staff commented upon the improved understanding of the managing of behaviors across the team and the decrease in the amount of challenging incidents that had occurred over recent months. An inspection of the recruitment procedures and staff files was undertaken and found to be in order. All the required preemployment checks are being completed and recorded. Changes are being made to the induction process for new staff. All new staff have meetings with the health and safety manager and members of the clinical team. Staff work through the induction standards and it was explained that a more structured competency based approach is being implemented. Staff are initially supernumerary, but there is not set period for this at present. It was explained that a system of annual appraisals is being developed and will be introduced over the coming months. All new staff undertake a six month probation period during which they are assessed by the Team Leader who supervises them. Statutory training is monitored Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: and the records showed that staff are up to date or had the required updates booked. Staff have had some training on the Mental Capacity Act and further training was planned for this, as well as some training on the Deprivation of Liberty Act. The service has improved the system for putting staff through NVQ training and the majority of staff are now undertaking this training. The service has started using a new Provider for this training and staff spoken to were positive about the increased support and opportunities they were now getting. There are daily handovers meetings between the morning and evening shifts which are attended by representatives from both groups of staff, and further information is distributed through the teams working in the individual houses. Whilst there have been some team leader meetings due to the large number of care staff and the number of individual houses within the service it is difficult for full staff meetings to be organized. It is recommended that it is considered whether some form of regular meetings for staff teams working in the individual houses can be facilitated. 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. The senior staff are providing leadership and direction in terms of care practice and the promoting of choice and the appointment of a registered manager should further improve outcomes for people living in the service. People living in the service are protected by the promotion and maintenance of a safe environment. Outcomes for people could be improved by the implementation of formal quality assurance system. Evidence: At the time of this Inspection the position of manager was vacant and interviews were being planned to fill the post. During this period the Team Leaders running the homes had not received any formal supervision and there was also confusion over which member of the senior management team was line managing them. The Teams Leaders had been meeting regularly as a group every two weeks. Care staff and Team Leaders were positive about the change in the staffing structures that provided improved supervision and support to care staff. Senior staff were clear about the direction of the service and the aim of providing improved community activities, the promotion of choice and decision making, and improving the skills of the care staff meeting the Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: needs of the people living in the service. Care staff spoken with stated that senior staff were approachable and supportive and were also positive about the improved frequency of formal supervision. Senior staff were positive about the new management structure that has been implemented. The registered manager will provide this team with formal supervision and further coordinate a consistent approach to the meeting of needs. Regulation 26 inspections are completed by an external professional and copies of these reports were seen. The reports provide detailed feedback to the management and highlight any areas of concern requiring attention. The reports are generally done on an individual house within the main site. Another piece of quality assurance had been undertaken with the completion of a staff survey, which had also provided feedback to the staff team. There is however no formal quality assurance process in place that provides input into a management plan for improvement. It is recommended that this is considered. All fire safety checks had been completed and recorded and all fire maintenance was up to date. The service had a detailed fire risk assessment in place. Staff confirmed that any maintenance in respect of health and safety issues were dealt with promptly as a priority. A safe environment is promoted and maintained. A sample of environmental risk assessments were seen and all had been appropriately reviewed. Care Homes for Adults (18-65 years) Page 27 of 31 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 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 19 13 The service must ensure appropriate risk assessments and guidance are in place in regard to the management of personal care needs Guidance on personal care needs ensures that people are not at risk from inconsistent practice 14/10/2009 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. No. Refer to Standard Good Practice Recommendations 1 2 16 23 The service should review its risk assessment policy in relation to the locking of kitchens. The service should ensure that all senior staff are aware of the criteria for notifying incidents to the regulator and clarity should be provided over the decision making process for these notifications. The service should consider having staff meetings for the staff teams in the individual houses. The service should consider introducing a formal quality 3 4 33 39 Care Homes for Adults (18-65 years) Page 29 of 31 assurance process 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. 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