Care Home: Tamarisk House

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What the care home does well People are able to keep their rooms how they would like them and to help make decisions about how their home is decorated. It is well maintained and homely and people have their own possessions around them. Staff work hard to find opportunities for people to pursue their interests and to have busy and fulfilling lives both inside and out of the home. This includes staff trying to find opportunities for people to have new experiences and learn new skills. Staff also support people to maintain contact with their families. Staff continue to support people well to make sure they get the health advice and input that they need and also help meet people`s personal care needs. They make sure people have regular check ups as well as specialist appointments when these are needed. Staff say that they have access to training that helps them to understand and meet people`s needs. People living at the home or their representatives know that their concerns would be taken seriously and there are measures in place to help make sure people are protected from abuse. The way that the service is checked and monitored helps to make sure that it is safe for the people living and working there. What has improved since the last inspection? The manager has done all the things that we said he needed to do by law and the things we suggested that could make things better. These were in our last report. The way people`s needs are set out has improved a lot. Information is clearer and staff and the manager are trying to make it easier for people to understand. This includes the risk of accidents or incidents when people are taking part in activities and what staff need to do to ensure the person is as safe as possible, without taking away their independence. Photographs are being used to help make things easier for people to understand and communicate. This includes pictures of planned activities, staff on duty, and how to choose a healthy diet. The manager has changed around the duty rosters and filled vacancies. This means that there are more times when there are two staff on duty so that people can do more and different activities. People also now have bus passes and the home has its own car which it did not have the last time we went. This means it is easier for staff to respond to people`s suggestions and be more flexible in the opportunities people have to go out. There are better notes for residents` meetings and these record people`s ideas and suggestions about what they would like to see happening. In many cases we could see that suggestions (for example for activities, outings or menus) were taken up and responded to by staff very quickly. There is clearer guidance about medicines that are only needed occasionally, and how much or how often they can be used and why. This helps to make sure people have the treatment they need to avoid difficulties and distress, but also so that treatment is not used in a way that could harm or badly affect someone`s lifestyle. There is better evidence that new staff are checked properly before they start work, to make sure there is no reason why they should not work with vulnerable people. This helps to contribute to the safety of people living at the home. Since we last visited, the wiring has been tested to make sure that it is safe and properly maintained. This helps reduce the risk of accident or fire. Staff are having more regular meetings with the team leader or manager. Staff need this so they and senior staff can talk about their role in supporting people and the aims of the service. What the care home could do better: There is nothing that needs to happen by law and that the manager has overlooked. Mr. Rendle has already identified some of the things that he could improve even more. This includes more improvements in care plans to show people`s long-term goals and how staff can help them achieve what they want to do. It also includes making assessments of risk that take more account of people`s abilities, skills and awareness of danger to see if they can be more independent in some things. There are some other things that he could think about. These include looking at the cupboard that medicines are kept in to make sure it is good enough to keep medication that might be prescribed by doctors in the future. There could also be more evidence that people`s rights to raise concerns or complaints are explained to them regularly and they are invited to express any worries they might have more often. The manager would find it easier to keep things up to date, and to reflect all the improvements he does make in the way the service is run, if he had access to his own work based computer. CARE HOME ADULTS 18-65 Tamarisk House 26 Holt Road Horsford Norwich Norfolk NR10 3DD Lead Inspector Mrs Judith Last Unannounced Inspection 18th August 2008 03:05 Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tamarisk House Address 26 Holt Road Horsford Norwich Norfolk NR10 3DD 01603 890737 01603 898792 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.caremanagementgroup.com Care Management Group Ltd (trading as CMG Homes Ltd) Mr Martin Edward Rendle Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd August 2007 Brief Description of the Service: Tamarisk is a care home providing personal care and accommodation for up to 3 younger adults with a learning disability. Care Management Group Limited, whose registered office is located in London, owns Tamarisk and other homes in the Norwich area. This home is located in the village of Horsford on the outskirts of Norwich. Local amenities, shops and pubs are close by. The home consists of an adapted bungalow. All the bedrooms are single ones. One has en-suite facilities. There is ample communal space and there is a large rear garden with patio, lawns and furniture. This is easily accessible to all service users. Limited off-road parking is available at the front of the home. Fees are from £744.05 to £1279.97 each week according to dependency. People living at the home would need help from staff to understand what is in the inspection report or the “easy read summary” which we produce separately. Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. Before making our visit we reviewed all the information we have about the home and looked at detailed information that the manager was asked to send to us. We also wrote to people before we visited to ask what they think about the service. We had letters from three people working at the home and two people living there. When we visited we used a method of inspection we call “case tracking”. This is used to see what records say about people’s needs and to find out from observation and discussion what happens in the daily lives of those people and the outcomes they experience. As part of this we also looked at and listened to what was going on while we were in the home. We spoke to the staff member on duty, all of the people living at the home, the manager and the regional director. We used all this information and the rules we have, to see how well people were being supported in their daily lives. What the service does well: People are able to keep their rooms how they would like them and to help make decisions about how their home is decorated. It is well maintained and homely and people have their own possessions around them. Staff work hard to find opportunities for people to pursue their interests and to have busy and fulfilling lives both inside and out of the home. This includes staff trying to find opportunities for people to have new experiences and learn new skills. Staff also support people to maintain contact with their families. Staff continue to support people well to make sure they get the health advice and input that they need and also help meet people’s personal care needs. They make sure people have regular check ups as well as specialist appointments when these are needed. Staff say that they have access to training that helps them to understand and meet people’s needs. People living at the home or their representatives know that their concerns would be taken seriously and there are measures in place to help make sure people are protected from abuse. Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 6 The way that the service is checked and monitored helps to make sure that it is safe for the people living and working there. What has improved since the last inspection? The manager has done all the things that we said he needed to do by law and the things we suggested that could make things better. These were in our last report. The way people’s needs are set out has improved a lot. Information is clearer and staff and the manager are trying to make it easier for people to understand. This includes the risk of accidents or incidents when people are taking part in activities and what staff need to do to ensure the person is as safe as possible, without taking away their independence. Photographs are being used to help make things easier for people to understand and communicate. This includes pictures of planned activities, staff on duty, and how to choose a healthy diet. The manager has changed around the duty rosters and filled vacancies. This means that there are more times when there are two staff on duty so that people can do more and different activities. People also now have bus passes and the home has its own car which it did not have the last time we went. This means it is easier for staff to respond to people’s suggestions and be more flexible in the opportunities people have to go out. There are better notes for residents’ meetings and these record people’s ideas and suggestions about what they would like to see happening. In many cases we could see that suggestions (for example for activities, outings or menus) were taken up and responded to by staff very quickly. There is clearer guidance about medicines that are only needed occasionally, and how much or how often they can be used and why. This helps to make sure people have the treatment they need to avoid difficulties and distress, but also so that treatment is not used in a way that could harm or badly affect someone’s lifestyle. There is better evidence that new staff are checked properly before they start work, to make sure there is no reason why they should not work with vulnerable people. This helps to contribute to the safety of people living at the home. Since we last visited, the wiring has been tested to make sure that it is safe and properly maintained. This helps reduce the risk of accident or fire. Staff are having more regular meetings with the team leader or manager. Staff need this so they and senior staff can talk about their role in supporting people and the aims of the service. Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who were thinking of moving into the home would have their needs and goals looked at, so that staff would understand how to support them. EVIDENCE: There are assessments of people’s needs on file for current service users, showing that these would be taken into account and information obtained to make sure that the home is suitable to meet needs. The manager says in information he sent us that the needs of existing service users would also be taken into account when deciding whether someone should be admitted to the home. This is to make sure people are compatible and see whether the home could offer a service that will continue to meet everyone’s needs. The regional director told us that the company’s managers will now do more of the assessing of prospective service users for themselves rather than this being done from head office. This means that they can determine existing demands on staff, relationships between existing service users, and how the needs of prospective service users can then be met. Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the 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 are being better supported to play a more active role in planning their care and the goals they want to achieve with further developments planned. EVIDENCE: Photographs and simple language are used to set out “my support plan” and “all about me” from the point of view of each individual. Although people do not currently hold their own plans, they do sign when things are discussed with them. “Individual action plans” set out what staff need to do to support people but have not yet taken into account how people can be supported with their “personal action plans”. For example, one person says in their plan, “I would like to learn more about money”. The individual action plan does not yet show what staff need to do to help with this. The manager recognises in information he sent to us that more work could be done towards people’s long-term goals. Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 11 The manager says the team leader is receiving training to help develop this system further and make care plans even more focussed on individual needs so we anticipate further changes and improvements. Each plan has been updated and reviewed recently. Two out of three staff who wrote to us say they are always given up to date information about people’s needs, for example via the care plan. One says they are usually. This means that they should know how to support people properly. Two people who wrote to us say they always decide what to do each day, that staff always treat them well and listen and act on what they say. This also shows up in notes of residents’ meetings. Daily records and care plans reflect choice as being important, and – as at our last visit - there are underpinning risk assessments for when these may not be safe, for example, accessing bank accounts and managing medication. Risk assessments have been revised. Staff say that files are more concise and so it is easier to find the information they need. This means they are more aware of how to support people in a way that does not expose them to unnecessary and avoidable risk. The manager is aware that further work could be done on these. This is because they are not yet wholly tailored to people’s individual skills, experience and awareness and are more “generic”. The manager raised one about making tea, which identifies risks and refers to supervision being given. In his experience, the person concerned has been able to do this task safely and without error for many years. He discussed with us that the risk assessment needs to take more account of the level of awareness of the individual, their existing skills and the impact of the person’s abilities on reducing risk. However, the existing assessment does reflect that supervision should not reduce someone’s potential for independence. Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 People who use the 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 are supported to live a fulfilling lifestyle and the service is responsive to people’s suggestions and wishes. EVIDENCE: The staff member we spoke to says that people now have many more opportunities to go out and make use of community facilities either close by or elsewhere. This has included using local buses as people now have concessionary passes, as well as the car that the home has now obtained. This is an improvement on our last visit when the home was sharing a car with another home nearby and so staff could not be so flexible in responding to people’s wishes. There are also additional staff hours available on some evenings and weekends to support this. Staff feel this is an improvement upon the situation when we last visited. Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 13 People’s cognitive abilities make it difficult for them to get paid employment or to benefit from educational courses that are too academic. However, this has not discouraged staff who have worked hard to try and identify suitable courses to help people learn new skills and follow their interests and were able to tell us about these efforts. People have been going to flower arranging sessions and showed us what they had made. One person is going for an interview for a part time cookery skills course to see if this is suitable. This shows that people are encouraged to practice and develop new skills. Records show that people have recently been to a show at Cromer pier that included drinks in the bar and fish and chips afterwards. One person we spoke so told us “I went to a show, a sing song. It was good.” People went to the cinema a few days before we visited. Records also show activities like meals out, shopping trips by car or bus, visits to garden centres. One person told us they like to walk. One person told us about holiday, that they were going on a plane to Spain and wanted to go “dancing” and to the “pub”. One person told us they had “been to a caravan” and had a nice time. Minutes from residents meetings show there had been discussions at one about going to the seaside more and going to a show. Records show that staff had made arrangements for this to happen. This means that people are able to influence the lifestyle they have and that staff try to listen and respond to their ideas and suggestions. People’s interests and the things that are important to them, are set out in their support plans. One person likes word search puzzles and we know from the provider’s monthly visit that they had recently been in the company’s newsletter for winning a prize. The person told us “I did it by myself” and was clearly proud of their achievement. A communication board with days of the week, photos of staff on duty and pictures of various options for activities or household tasks has been introduced. This means that staff are trying to explore additional ways of encouraging people to make decisions and choices and to understand the options available to them. People’s care plans show their family links and connections and what relationships are important. They also show that they make visits to relatives for short stays from time to time. Records show that they are supported to do things like buy birthday cards and presents for friends or family. One person had said at a meeting they would like to visit a parent’s grave. We could see that staff responded to this suggestion and that the person had been to the parent’s church to join in mass and light a candle for them. Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 14 Sexuality is reflected in people’s care plans, including that one person likes to spend time on their own in their room, showing their privacy is respected. People are prompted or assisted to join in with domestic routines. Records show people help with preparing snacks, drinks, loading the washing machine, emptying the dishwasher, putting away clean laundry and photographs support some of this. One person has recently said at review that they would like a pet. As a result, an aquarium and some fish have been purchased and the person is clearly interested in these. They showed us what they had got and went out with others while we were there, to buy some more fish food. There are menus showing what each person has eaten during the day, which show some choice where the three people have eaten different things. The minutes from residents meetings show that people are able to make suggestions about what they would like. Staff make use of photos displayed in the kitchen to show what is healthy food and what is not, to encourage people to make healthy choices. Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the 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 personal and health care needs met in the way they require. EVIDENCE: Each person’s care plan sets out the support they need to maintain personal care – for example, assistance with hair washing or cleaning teeth. One person’s plan reflects encouraging the person to choose their own clothes. The daily notes that staff make show that they offer people the support that care plans say they need. Care plans also set out people’s preferred routines, likes and dislikes. Daily records show that people have a range of times for getting up and going to bed. During the week these may be dependent on structured daytime activity programmes, but records show people who like to have a lay in at weekends, do this. One person resolves anxieties and stress by requesting to go to bed and records show that staff support this. There are currently no adaptations in the bathroom but this is not needed for existing service users. There are plans to create a shower room that would Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 16 increase people’s options and choices for personal care but these are on “hold” at present. Each person has their own folder for health care, provided by the local learning disabilities team, using symbols and plain language. We looked at these and found that they were up to date with changes that had been noted in reviews of support plans. A staff member told us that they found these useful as they could be taken to health care appointments without the need to pull information out of the main care plans. We saw evidence in records that people were supported with medical appointments and that, where specific interventions were identified as necessary, these were incorporated in care plans. This includes that one person needs additional support with managing oral health and applying gel to gums. Medicines are stored in a locked cabinet in the kitchen area. This cabinet does not comply with regulations for the storage of controlled drugs so none could be received into the home should they be prescribed for existing service users. There are audits of medicines to make sure these are managed appropriately. We saw that the medicine cupboard was organised in a manner that made it easy to see what was in stock. The amount of medication received is recorded on medication administration record charts. We checked two medicines that were not in blister packs and found that balances corresponded with the chart for one that had not been needed. For another that is prescribed for routine administration, the balance remaining corresponded with the amount received less the dosages signed for. This means there are systems in place to help monitor that medication is given as prescribed and to help prevent its misuse. Staff confirm that they have training in managing medicines and we saw certificates. They also say the manager checks from time to time that they are following procedures. The manager says he checks people’s competence and there is evidence of additional supervision or guidance when this has been needed. There is now clear guidance about the use of medicines needed occasionally to assist managing behaviour (although this has not been used). The protocol for managing behaviour in the care plan is clear about when this medication should be considered. The guidance in the medicines file shows the dosage that may be given and the minimum interval between doses if they are not effective, together with a maximum daily amount. This means that there are measures in place to help ensure the medicine is used effectively and safely, in the person’s best interests. Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the 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 (or their representatives) could be sure their concerns would be taken seriously. There are measures in place to help safeguard people living at the home. EVIDENCE: The people who wrote to us say that they know how to raise concerns about their care if they should need to. Three staff who wrote also said that they know what to do if someone, or their representative, wants to raise concerns. The complaints record shows that no complaints have been received in recent years. Compliments are recorded and these show where relatives feel that the service has performed well. People living at the home told us that they are “happy” and one says, “I like it”. Records show that staff have training in recognising and responding to abuse. In addition, a “flowchart” is displayed in the sleep in room for staff to refer to. This shows the reporting procedure and who should be contacted if there are any concerns. We spoke to a staff member on duty who told us about the kinds of things they would report and who they would tell. This shows that they are aware of their responsibilities to help safeguard the vulnerable people they support. There are systems in place to help protect people from financial abuse. The staff member on duty told us about the handover process as it relates to people’s personal monies, and what would happen if there was an anomaly. Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 18 The manager says there are now also financial audit systems. Balances are checked at random by the person who carries out monthly visits on behalf of the provider to look at the quality of the service. This helps ensure that there are checks to prevent people from being exploited or abused financially. Residents’ meetings are held but these do not always show that people are asked if they have any concerns or complaints or anything they are not happy about in relation to their care. The manager recognises that keyworker sessions could be better used to provide an opportunity to talk to people about concerns or complaints. However, people who wrote so us say that staff treat them well and they feel well cared for. Observations on the day were of people chatting with the staff member on duty and, later during the inspection, of one person sitting at the table with them for drinks. This showed that people living at the home felt comfortable with the staff. There are guidelines for staff to follow about managing behaviour that challenges. This includes ethical issues in relation to any physical intervention and what this might be. In practice, records show that situations are handled without the need to resort to interventions, including the use of medication prescribed to help with this, which has not been used for over a year. The organisation’s regional managers have a history of working constructively to manage concerns about staff and to safeguard people who use the service. Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the 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 live in a homely, comfortable, clean and safe environment that is suited to their needs. EVIDENCE: We looked round communal areas, and then saw each person’s room briefly. Décor is in very good condition and rooms have been recently repainted. The notes from residents meetings show that new furniture and the colours for the living room were discussed and agreed with them. Activity records show that people had been out to help choose new curtains for communal areas (and where one person didn’t want to join in), and had been to buy new “knick knacks” for rooms. People’s rooms show their own interests and preferences – having personal belongings, pictures and ornaments. The living room has family photographs for the people who live there and is homely and comfortable. The sofa and chairs are coming to the end of their useful life but new furniture is on order Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 20 and written confirmation from the suppliers shows this should be delivered in September. There are new chairs for the dining area in the kitchen. People are also able to make sure of a larger table at one end of the lounge and we saw someone using this for doing puzzles and colouring. There are plans to extend the home at some point and so the provision of a shower has been shelved at present because this room would be lost and relocated as part of any extension. The proposed extension would help provide increased choice about bathing facilities and help to accommodate any changes in mobility associated with increasing age. Alterations would also increase the size of one existing bedroom that is below current standards. This does not adversely affect the person whose room it is at present - and records show that the person spends time in there as and when they wish. However, the manager has no information from the owners about timescales for this work. Present occupants do not need special adaptations to use facilities. One person has en-suite facilities to their bedroom. All of the people who live at the home are independently mobile and so can make full use of the home and garden. One person enjoys playing on the swing. There is a fire risk assessment and equipment is maintained to help promote people’s safety in the event of a fire. Radiators are guarded so that people are protected from accidental burning. We were able to confirm what the manager told us, that all of the staff have had training in food hygiene and we saw expiry dates for this were monitored. Certificates were on staff files. We have not had any concerns raised with us by environmental health, GP’s regarding infection, or relatives by way of complaints. There is guidance on infection control and protective clothing is provided for when staff are supporting people with personal care. There is guidance about what colour aprons to wear for this and what to wear when preparing food. The manager says, in information sent to us before we went, that all staff have had training in infection control. These things mean that there are measures in place to help prevent the spread of any infection and to promote good hygiene in the home. Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36 People who use the 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 are supported by a consistent, skilled and competent staff team who understand their needs and how to meet them. EVIDENCE: Each staff member’s file has a clear, written job description. A staff member told us that they can look at their files “whenever we want” so can refer to this. The regional director and manager recognise that staff have got to know people well and work hard for their “key” clients. Each staff member has a copy of the General Social Care Council code of conduct on his or her file to refer to. The staff team has a core of people who have worked at the home for some time and there has been little turnover since we last visited. The manager says in the information he sent to us, that two out of five staff have national vocational qualifications and two more are working towards it. This means that progress is being made towards a good proportion of the staff Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 22 having the underpinning qualifications and knowledge to be able to support people even more effectively. A staff member on duty told us that they had much more training than in their previous job. All of the three staff who wrote to us felt that they were given training that is relevant, helped them to understand and meet people’s needs and kept them up to date with new ways of working. Certificates on file show that staff have relevant training. These showed training in a range of basic courses such as food safety and first aid, and also that training was available to help staff deal with challenging behaviour. There is a training matrix on the wall to help the manager monitor when updates might be needed. Some of this training is in need of updating and the manager says arrangements have been made to do this. We saw evidence of induction being completed and there was work present on the file to show how competence and understanding was assessed. The person whose induction records we saw had also written to us to say that they felt it covered very well what they needed to know to do the job. This means that new staff are supported to gain the basic skills they need to do their work properly. There has been no use of agency staff and the manager has systems in place to address sickness when this occurs, with return to work interviews. We saw from minutes that staff meetings take place regularly so that staff have opportunities to discuss issues and their work as a team. However, one person did write to us that the service could do better in employing better staff and paying them according to their abilities. We discussed this with the regional director who informed us that, since a change in ownership, pay structures are being looked at together with enhancements for people who have completed qualifications and stay with the company. The manager told us that he had restructured the duty rosters to increase the number of shifts when two staff on duty (confirmed by duty rosters). The staff member present says that about five evenings a week there are two staff and that this has meant people are able to go out more often, also that keyworkers get more time to spend with the person they are supporting. We looked at the recruitment file for one person taken on since we last visited. This showed that the manager makes proper checks to make sure prospective staff are suitable to work with vulnerable adults before they start work. The application form provides for gathering full employment histories with boxes for jobs held, dates and reasons for leaving. References were not on file but copies were obtained while we were there. Workers for whom English is not their first language, sit a simple written test so that the manager can be confident they will be able to complete the reports Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 23 needed as part of their work and to understand what has been written by others. We discussed that some staff who do have English as their first language might also have difficulties with written English and could be assessed to make sure they are also able to complete records to the expected standard. The last time we visited, supervision was not happening as it should. This has improved and there were notes and schedules showing that it takes place monthly whenever possible. A staff member confirmed this and said that they had only missed one and this was when they were on holiday. There is evidence that additional supervision and support is made available when problems warrant this. This shows that staff now receive more of the support and guidance they need to ensure they work as the owners expect, to agreed standards, and so that any concerns they have can be taken up promptly. Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the 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 manager runs the service effectively, taking into account the views, safety and welfare of people living and working in it. EVIDENCE: The manager showed a letter from the company confirming that he has achieved his Registered Manager’s Award. He is awaiting his certificate. Since our last visit he has worked hard to develop the service and to comply with the requirements we made (things that need to happen by law,) and our recommendations (suggestions for further improvement). The manager recognises that things could be improved if he were allocated individual budgets for each of the small homes he oversees so that he could prioritise expenditure for himself. Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 25 The owner’s quality monitoring team visit the service every three months. They check performance in a range of areas and also countersign some of the audits and documents already in place to show that they have checked them. Managers are expected to act upon their findings to improve the service. In addition, there are monthly visits by the regional director to look at the way the service is performing and what residents and staff think of it. Where appropriate, these reports show what action the manager needs to take to improve things further. The manager says that the questionnaires about service quality have been sent out recently. These are distributed and analysed by the regional administrator every year. We were able to see that there were some on file returned in October last year as part of the last annual survey. The information we asked for before we visited was completed better than last time and included a better range of evidence. However this can improve further as Mr Rendle agrees and training has now been provided to the local managers to help with this. His ability to use it as a working document (into which the providers quarterly quality monitoring audits, monthly visits by the regional director, and improvement plans from stakeholder surveys are incorporated) is compromised because of lack of access to a computer in the work place. This means he will need to start it from scratch each year and may miss over time, improvements that have actually been made as a result of the quality monitoring process and his own personal aims. We sampled maintenance and safety records which shows that equipment is maintained and tested regularly. Some tests due annually are coming to the point where they need repeating but are currently still within date. The manager also carries out monthly health and safety audits. The wiring that had not been tested last time we visited, has now been properly tested and certificated as safe. There is evidence that staff and people living at the home practiced a fire drill in August. The fire risk assessment was reviewed in January. The equipment needed to detect a fire and raise the alarm is tested and serviced regularly. Staff have fire training, training in food safety and health and safety. Working safely is also covered in induction (records seen). First aid training was seen as having gone past the expiry date slightly but has been arranged. Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 26 There is policy guidance and regular monitoring of health and safety, also of control of substances that could be hazardous to health (for example, cleaning products). Risk assessments have been simplified and staff say that these are now easier to follow. These things mean there are measure in place to help promote the safety and welfare of people living and working at the home. Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA20 Good Practice Recommendations Medication storage should meet standards that would allow for storage of “controlled” drugs. This is so that, if someone needed such medicine, it would be able to be received and stored properly in the care home rather than the treatment not being available because existing storage does not meet standards. Keyworker time could incorporate evidence of some discussion about people’s concerns and show how keyworkers advocate for them if they are not wholly satisfied with the service. This would help show that people are actively supported and encouraged to improve the service they receive. Where it is intended written tests should form part of the interview process, this could be introduced for all applicants to check their ability to complete records to the expected standard. DS0000027586.V370307.R01.S.doc Version 5.2 Page 29 2. YA22 3. YA34 Tamarisk House 4. YA39 The manager should have access to computer facilities so that he is more easily able to update things for himself and can manage information more easily. This would help to save time and run the service even more effectively. Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tamarisk House DS0000027586.V370307.R01.S.doc Version 5.2 Page 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. 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