Care Home: Swanton House Care Centre

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What the care home does well The Home provides a good standard of accommodation set in large grounds which enables residents to have space to walk if they wish to. Residents have a choice about where they spend their time and are not restricted to the part of the site in which they live. The Home has been well managed over the last few months by the two assistant managers with the support of the Operations Manager. Staff and residents told us that the assistant managers are supportive and approachable. They have provided good leadership. The organisation works well with the Commission and keeps us notified of issues as required to do. The staff team are enthusiastic and are positive about supporting the residents. Residents told us that: "the staff work hard" "staff are kind" "our rooms are lovely" Staff receive training and support to enable them to carry out their roles effectively. What has improved since the last inspection? There have been many improvements in the quality of the service provided since the last Inspection. The new buildings have been completed and residents are now living in the individual bed sits which provide a bed/sitting room with kitchen area and a separate en suite shower/toilet. Many areas of the older parts of the Home have been redecorated and recarpeted. There is a programme of ongoing improvements to ensure that all areas provide homely, attractive accommodation for the residents. The recruitment practices have improved and the files show that the records are kept as required. Staff confirmed that all checks are carried out prior to them starting work. The staffing levels have increased greatly. There are now three qualified nurses on duty during the day which enables each nurse to be responsible for a separate section of the Home. There are additional care staff on duty which means that those residents who need 1:1 support now receive this. The range and provision of activities has improved. Residents now have greater opportunities to take part in activities on site and within the local community. Residents and staff gave lots of examples of activities that have taken place recently. The care plans have been improved so that they now contain detailed guidance about how to meet residents needs. Risks are identified and plans are in place to manage risks. When needed referrals are made to the Independent Mental Capacity Advocates to ensure that the rights of the residents are protected. Residents are encouraged to put forward their views about the quality of the service provided and there are examples of changes that have taken place following consultation with residents. What the care home could do better: The appointment of the new manager and assistant manager will strengthen the management team and ensure that each area of the Home has its own dedicated manager. This will enable the managers to take on more of a direct monitoring role for the staff teams. The programme of redecoration and refurbishment needs to continue. The changes to the way training is provided need to be managed effectively to ensure that staff continue to receive mandatory and specialised training in a timely way. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Swanton House Care Centre Dereham Road Swanton Novers Norfolk NR24 2QT     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: Lella Hudson     Date: 2 7 0 8 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: Swanton House Care Centre Dereham Road Swanton Novers Norfolk NR24 2QT 01263860226 01263863012 john.hayes@swantoncare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Swanton Care and Community Ltd care home 55 Number of places (if applicable): Under 65 Over 65 0 0 learning disability mental disorder, excluding learning disability or dementia Additional conditions: 55 55 The maximum number of people who can be accommodated is 55. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Mental disorder, excluding learning disabilities or dementia - Code MD Date of last inspection Brief description of the care home Swanton House is a large country house situated in extensive and attractive grounds close to the small town of Melton Constable in North Norfolk. There are a number of cottages in the grounds that have their own kitchen and bathroom facilities and offer the opportunity for more independent living by service users. In 2008 the registration increased to 55 with the provision of newly built accommodation which provides additional flats for single person use. Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home The complex also has a purpose built activity centre. The fees currently range between £450.00 and £2, 800.00 per week and are agreed on an individual basis dependent on residents needs. Please contact the Manager for further information about fees. 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 contains information gathered about the Home since the last Key Inspection (July 2008). It includes information provided within the Annual Quality Assurance Assessment which was completed and returned to us. Within the report are some of the responses within the surveys that were returned to us from residents and staff. The report also contains information gathered during our unannounced visit to the Home which was carried out on 27th August 2009 between 8.30am and 5.15pm. During our visit we spoke to the two assistant managers, the Operations Manager, residents and staff. We observed staff supporting residents. We were shown around the Home and we also looked at a selection of records. Care Homes for Adults (18-65 years) Page 6 of 31 The Manager of the Home left in March 2009 and one of the assistant managers has also left this year. The Home has been managed by the two remaining assistant managers with the additional support of the Operations Manager. We were advised that a new manager and a third assistant manager have been appointed and will start work in the next few weeks. What the care home does well: What has improved since the last inspection? There have been many improvements in the quality of the service provided since the last Inspection. The new buildings have been completed and residents are now living in the individual bed sits which provide a bed/sitting room with kitchen area and a separate en suite shower/toilet. Many areas of the older parts of the Home have been redecorated and recarpeted. There is a programme of ongoing improvements to ensure that all areas provide homely, attractive accommodation for the residents. The recruitment practices have improved and the files show that the records are kept as required. Staff confirmed that all checks are carried out prior to them starting work. The staffing levels have increased greatly. There are now three qualified nurses on duty during the day which enables each nurse to be responsible for a separate section of the Home. There are additional care staff on duty which means that those residents who need 1:1 support now receive this. The range and provision of activities has improved. Residents now have greater opportunities to take part in activities on site and within the local community. Residents and staff gave lots of examples of activities that have taken place recently. The care plans have been improved so that they now contain detailed guidance about how to meet residents needs. Risks are identified and plans are in place to manage risks. When needed referrals are made to the Independent Mental Capacity Advocates to ensure that the rights of the residents are protected. Residents are encouraged to put forward their views about the quality of the service provided and there are examples of changes that have taken place following consultation with residents. Care Homes for Adults (18-65 years) Page 8 of 31 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 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. Effective pre admission assessments are carried out to ensure that the clients needs can be met at the Home. Clients are fully involved in this process and are encouraged to visit the Home prior to making a decision to move there. Evidence: We spoke to the Assistant Managers about the admissions procedure. They gave good examples of the comprehensive work that is carried out prior to offering someone a place at the Home. This includes obtaining information from the prospective resident, their family and from all health/social care professionals involved in their life. With regard to to a recent referral they have invited the current carer to come to speak to the staff as well as arranging a training session for staff about the residents individual needs. One of the residents told us about their move to the Home. He said that he had visited and was shown around as a way of helping him to make the decision to move there. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: We looked at examples of pre admission assessments and could see that these were detailed and contained information gathered from a range of sources. We also saw that a short term care plan had been put together to provide information for staff about how to meet a residents needs when they first moved into the Home. This is to ensure that the Home will be able to meet someones needs. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans contain detailed guidance for staff about how to meet residents individual needs. The residents are encouraged to make their own decisions and are given guidance about possible consequences of these. Risks are identified and assessed. Guidance about the management of risks considers the rights of the residents to make their own decisions. Evidence: We spoke to residents about whether they are involved in decision making within the Home. They said that they are and said that the staff always ask them for their opinion. One resident said that the staff explain the reasons if they are not able to meet the residents request. One of the residents told us that they attend the residents meetings that take place and that the staff also talk to them about their care plan and its contents. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: We observed staff routinely asking residents for their choices about a range of day to day issues. We looked at a sample of care records and could see that the residents views have been incorporated into the care plans. There are also records of discussions with residents and health professionals about issues where there are concerns about decisions being made by the resident. The Assistant Managers have attended training about the Mental Capacity Act and Deprivation of Liberty Act. They gave examples of situations in which they have requested an Independent Mental Capacity Advocate to become involved when there are concerns about the residents mental capacity. Discussions with staff show that they are very clear about the importance of encouraging residents to make their own decisions. However, they are also clear about the possible conflict that this sometimes causes with their duty of care. One of the staff said that these issues are regularly discussed within the staff team. We looked at a sample of care plans and these contain detailed guidance about how to meet individual needs. The quality of the care plans has improved since the last Inspection. The care plans show evidence of regular reviews and updates of the information. There is also evidence that other social and healthcare professionals are involved as required and that their advice is incorporated into the care plans. Risks are clearly identified and assessed with clear guidance for staff about how to manage risks. Staff work hard to balance the need to protect residents with their rights to make their own choices. 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. The residents are supported to take part in a range of meaningful activities. Residents are offered choices about how they spend their time. The residents enjoy their meals and their dietary needs are met. Evidence: At the last Inspection a requirement was made for activities to be more readily available. This requirement has been met as there have been many improvements with regard to the provision of meaningful activities for residents to be involved in. The organisation has employed a second full time member of activities staff. The range and number of activities available for residents to take part in has greatly increased. On a weekly basis there are swimming sessions, bowling sessions, shopping in local towns, sailing sessions and keep fit. There are also activities arranged in the Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: community on a more ad hoc basis. Some activities are for groups of residents whilst others are arranged on a one to one basis for those residents who find being in a group difficult. The noticeboards around the Home show photographs of recent activities and the residents told us about these. They include a Barchesters Got Talent competition, poetry competition, a Celebration of Scotland day and barbeques. Some of the residents have also taken part in a sponsored walk which raised a lot of money for a national charity. Activities also take part within the grounds of the Home. There is an activity room in the grounds and a new social club has also been developed in one of the cottages which is no longer used for residents to live in. Each of the residents has an individual programme of activities which they have been involved in choosing. These are varied and reflect individual preferences. Several of the residents have been on holiday this year to a variety of places. One of the improvements that has had a positive effect on the provision of activities is the increase in staff on duty. This means that now all of the residents who are assessed as needing 1:1 staffing are able to have this which was not happening at the time of the last Inspection. Staff and residents confirmed to us that this does take place. The staff surveys that we received included comments about there not being enough staff or transport to carry out activities but we received these three months ago and staff confirmed that the situation has greatly improved. There have also been improvements in the provision of meals. The meals are still prepared and cooked in the kitchen in the main house but now staff collect these in hot trolleys and serve them in the individual dining areas. The dining room in Bluebell is too small to adequately serve as both a lounge and a dining room. Residents told us that they enjoy their meals and that there are always at least three choices. Some residents choose to have their meals in their rooms but the majority go to one of the communal dining rooms. The new bed sits have their own kitchenette areas which some residents use to make drinks and snacks. Currently none of the residents are supported to cook in their own kitchens on a regular basis. We saw one of the care plans that shows evidence that dietary advice is sought from professionals as needed and is incorporated into the care plans. Currently the care Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: plans contain a nutritional assessment and two of the nurses are going to attend training about the MUST nutritional assessment system which is used by dieticians in the local area. 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. The personal and health care needs of the residents are met. Medication is managed safely. Evidence: A recent improvement has been that there are now three qualified nurses on duty during the day. This means that there is one nurse in the main house and then one nurse each for Bluebell and Holly House. Staff and residents said that this has been an improvement. The nurses are responsible for a smaller area which means that they have more time to spend with residents and to monitor care staff. Residents gave us examples of how staff meet their personal and health care needs. One of the residents said that it was not only the care staff who assist them but also the kitchen staff and the activity staff. They said that the staff are kind and that they respect the residents privacy. Discussions with the nurses and care staff show that the increased nursing staff on duty means that care staff find it easier to locate the nurse for advice if needed. It Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: reduces the number of care staff that the nurses provide support to on each shift. Staff said that communication has improved due to this increase in nursing staff. The local GP provides a weekly surgery at the Home although visits can take place outside of this planned visit if needed. One of the residents prefers to go to the GP practice and so is supported to do so. Residents are supported to attend appointments with other health care professionals such as dentists, opticians and chiropodists. Residents gave us examples of staff supporting them with appointments with a range of health professionals such as psychiatrists, mental health nurses, dietitians and occupational therapists. The care plans contain records relating to appointments and any advice that may have been given. Discussions with staff show that they have a good understanding of the residents needs and how these should be met. We observed relaxed communication between residents and staff. Staff were kind and respectful but there was also a lot of laughter. Staff receive training about a range of subjects relevant to meeting the residents needs, such as moving and handling, challenging behaviour but there is a need to ensure that all staff have sufficient training about mental health issues. We saw a good example of detailed information within one of the care plans with regard to supporting a resident during periods of aggressive behaviours. There was a lot of information about possible triggers and how to avoid these situations as well as how to manage a situation safely. Some training has been provided to the assistant managers and nurses about the Mental Capacity Act and Deprivation of Liberties. The Assistant Managers gave examples of referrals that have been made to the Independent Mental Capacity Advocates and the outcome of this process. We looked at the medication system in the main house. Only qualified nurses administer medication. The medication was stored appropriately and records are kept of medication that arrives at the Home, medication administered to residents and any returned to the pharmacy. When asked about guidance for the use of PRN medication the nurse said that this is available. When we asked to see examples of this the nurse showed us the PRN guidance for three of the residents but was unable to find it for one of the residents whose records we asked to see. The nurse was clear about when the medication should be used and said that she would ensure that the guidance would be available by the end of the day. Care Homes for Adults (18-65 years) Page 19 of 31 Care Homes for Adults (18-65 years) Page 20 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. Procedures and staff training are in place to provide protection to the residents from abuse. Complaints are taken seriously and action taken to address any issues. Evidence: The Home has received one complaint which was not substantiated. The complaints procedure is on display around the Home and residents told us that they know who to talk to if they are not happy about something. Improved opportunities exist for residents to raise any concerns. There are now more staff on duty and so staff have more time to spend with individual residents. Regular residents meetings take place. Responses within the staff surveys indicate that staff know what to do if someone wishes to raise a concern. Staff told us that they have received Safeguarding training and that they would feel confident in speaking to one of the nurses/assistant managers if they were concerned about something. As previously mentioned, training has been provided about the Mental Capacity Act and the assistant managers have contacted IMCAs in situations where they are concerned about decisions being made on behalf of residents. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: Training about Safeguarding vulnerable adults is provided within the staffs induction and then further, more detailed training is provided during their first year of working at the Home. Care Homes for Adults (18-65 years) Page 22 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. The Home provides good accommodation for residents but there are some areas still in need of redecoration. Evidence: We were shown around all of the communal areas of the Home and some of the residents showed us their individual rooms. A lot of work has been completed at the Home since the last Inspection. The building of the new individual bed sits has been completed and these now provide a high standard of accommodation for residents with the provision of a bed/sitting room, kitchen area and large shower/toilet en suite. The Home is divided into three areas and mainly provide accommodation for residents with distinct needs. The main house provides accommodation for residents with mainly physical disabilities. A lot of redecoration and replacement of carpets has already been carried out and there are further plans to complete this process to ensure that all areas of the Home are nicely decorated and furnished. The dining room and lounge have been switched around which provides a larger, Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: brighter lounge area with patio doors to the large gardens around the building. There is a passenger lift in the main house. Bluebell is the area of the Home which provides accommodation to residents with mental health needs. Accommodation is provided within individual areas around a courtyard. There are also rooms provided within a newly converted building which also provides a small communal kitchen/lounge/dining area. This room is really too small for the amount of residents who live in this area. Currently this is not an issue as the nicer weather means that many of the residents prefer to sit outside. Holly House provides a similar mix of styles of accommodation although the lounge/dining room is much bigger and more homely. There is also a seperate kitchen which has a dining table and chairs providing additional choice for residents. Staff and residents told us that residents are able to choose where to have their meals and that this does not have to be the dining area attached to the area where their rooms are. Holly House mainly provides accommodation to residents who have a learning disability. Two of the houses that are on the site are no longer used for residents accommodation. One is not currently used at all and one has been converted into a social club which is regularly used by residents. The Home has large gardens surrounding the gardens. There is also an activity area and an area for pets and gardening. Residents are encouraged to be involved in looking after the animals and to be involved in gardening if they wish to be. Care Homes for Adults (18-65 years) Page 24 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. The residents are supported by a staff team who receive approrpiate training and support to carry out their roles effectively. Appropriate recruitment procedures are followed. Evidence: We spoke to several members of staff, both qualified nurses and care staff as well as to the two assistant managers and the Operations Manager. All are clear that the increase in staffing numbers has meant considerable benefits to the residents. Residents also confirmed this to us. Staff said that one of the improvements is that the residents who are supposed to have 1:1 support are now able to have this which was not always taking place at the time of the last Inspection. Staff said that they feel that they have time to support residents without having to rush through tasks. They said that they have time to chat to residents and to provide additional support when needed. The number and range of activities has greatly increased since the increase in staffing. In addition to this staff are more enthusiastic about being involved in the provision of activities. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: We observed staff supporting residents in a kind and appropriate manner. Residents told us that they like the staff and that there is always someone who they feel that they can talk to. They said that they are able to make a choice about who provides support to them. The increase in qualified nurses means that it is easier for the nurses to allocate tasks to the care staff and to provide additional support. However, the assistant managers are aware that this can be improved and once the new manager and additional assistant manager starts work this will be easier to carry out. We looked at a selection of staff files and could see that appropriate checks are carried out prior to staff starting work at the Home. This is an improvement since the last Inspection. The assistant managers have carried out a lot of recruitment in the last few months and so there is a lot less use of agency staff. Staff confirmed that they were provided with an induction programme which included them shadowing more experienced staff before supporting residents on their own. Staff all said that they receive regular supervision and that they feel that there is always someone senior on duty for them to speak to. Staff have receive mandatory training as well as additional training about issues relevant to individual residents. However, there is a need to ensure that all staff have received training about supporting residents with mental health issues. The training has been co-ordinated by a member of staff who has recently left. There are plans for the assistant managers to take on this role. Plans are in place for staff to attend Training the Trainers courses in different subjects so that they are suitably qualified to provide training to other staff. The Operations Manager is aware of the need to monitor this situation to ensure that the assistant managers have enough time to ensure that a suitable level of training is provided to all staff and that regular updates take place as necessary. Care Homes for Adults (18-65 years) Page 26 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 temporary management arrangements have provided good leadership in the period that the Home has been without a manager. The views of the residents are sought with regard to assessing the quality of the service provided. The health and safety of the residents and staff is protected wherever possible. Evidence: The Registered Manager left the Home in March 2009 and one of the assistant managers also left around that time. A new manager and a new assistant manager have been appointed and are due to start work within the next two months. In the interim the two assistant managers have managed the Home effectively with the support of the Operations Manager. The two assistant managers work well together and have provided good leadership and support to the staff team during a difficult period of time. We spoke to the two assistant managers and they are both enthusiastic about working with the residents and the staff team. They have clear ideas about the quality of the service that the Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: residents should be receiving. They both said that they have received good support from the Operations Manager. Discussions with the staff and residents show that they have felt well supported during the time without a manager. They said that they feel that they can raise issues with the assistant managers and that there is good communication between them and the staff team. The assistant managers are aware of the areas in which further work is needed, such as planning in more detail the plans for training now that the member of staff has left who used to carry out this role. They are positive about the forthcoming start of a third assistant manager and a new Manager. Once the whole management team is in place then each of the assistant managers will take on responsibility for a different area of the Home with the Manager having overall management responsibility for the whole site. The assistant managers gave examples of how the residents views are sought as part of the overall review of the quality of the service provided. There are plans to further develop this to ensure that the residents views are really at the centre of all improvements. The organisation has a well developed formal system in place for auditing aspects of the service. We looked at a selection of maintenance and servicing records which show that regular checks are carried out on equipment. Risk assessments are in place with regard to the environment and also for individual residents where risks are identified, either to themselves or to others. Care Homes for Adults (18-65 years) Page 28 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 29 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 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 35 It is recommended that the training plan includes the provision of training to all staff about mental health issues. 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. 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